Very slow growing solid module

[razp]

My dad (65 male non smoker) has a very rare form of vasculitis (churg Strauss) which has been managed well for circa 15-18yrs. He has that’s asthma as a result. He had a CT scan back in 2011 which showed a 1mm nodule in his lower right lung. By 2017 that had increased to 4mm and in 2024 this nodule is 7mm. It’s describe as “solid well circumscribed”. There are another nodules which have remained stable. He was referred to lung specialist who only recommended a ct in 12 months given no particular concerning features from CT and the fact that it’s increased so slowly. His vasculitis doctor wants a PET scan.

is a PET really necessary in this case or will a CT in 12 month suffice?

[tgif i guess]

as i understand it, a pet scan is an enhanced ct scan - a pet scan does a ct scan when you get a pet scan - if the order calls for it

if you have never had a pet scan, its nowhere as bad as an mri - very much like a ct scan but takes less than 20 minutes - they check your glucose level, shoot you up with a mild dose of radioactive agent in a glucose base - after waiting about 30 minutes, you get the scan

no eating or drinking after midnight on the day of the scan

i guess each test has its purpose - a pet scan is expensive - but from a patient's point of view, the pet scan is a cake walk

pet scans show active uptake of the radioactive agent -i guess it shows growing cancer but a ct is more like a photograph

i'm having another pet scan next friday - with the cea blood tests i feel better about the claim that i am in remission 

[LouT]

All that TGIF said about PET Scans is accurate.  They are one of the diagnostic tools used during any diagnosis where cancer may be involved.  But a PET is not a conclusive test.  The gold standard test to determine malignancy is a biopsy.  In the case of your father it appears that the nodule is very slow growing and, at the present time, not showing signs of malignancy.  Most lung nodules (about 60%) are benign and many have been shown to appear and even disappear over time.  They can be caused by a number of things including infection, allergic reaction, etc., and it is likely that the second doctor is recommending a 12-month follow up for the aforementioned reasons.  If they see changes and/or unexpected growth then it is likely that they will conduct additional tests (which may include a PET Scan and/or a biopsy) to determine the nature of the nodule.  Our website has a section called "Diagnosing Lung Cancer" and it can help in better understanding the process your dad is involved in, and it can be found here.

Lou

[Livin Life]

Wishing you and your father as you navigate how to proceed.  If it helps I had two nodules, one solid and one considered more fat-based in 2015 and then 4 months later no change.  Fast forward to Sept 2023 and the former grew a little bit and the latter changed to solid and nearly doubled though still very small.  Not too mention several ground glass nodules (6 mm) in both lungs.  All stable in Dec 2023 so I asked for rescan in July which is coming up.  If all stable I'll likely ask for another 6 month scan though also qualify for biopsy which I'll do IF they recommend.  They do think adenocarcinoma in my case.  So just so you see there are options.  If you all are uncomfortable with 12 months you could ask about 6 or even 8 months....?

[razp]

Hi Living life - why do they think it’s adenocarcinoma in your case? Is it the flat module which has become solid over time or the solid one?

[Livin Life]

I think it was initially b/c the one that was seen as fat in 2015 and 2016 turned solid AND grew (about 5 mm to 8 mm) by Sept 2023.  I think that is the main reason.  Tho from Sept to Dec it seems that one may be a mix of ground glass and solid - report wasn't clear tho it was a little different again.  The 1 cm solid from that same time frame is now 11 mm x 8 mm and its close buddy (new in Sept 2023) is 9 mm.  They zero in on that in the report too though that one hasn't really changed? 

Then there were ground glass nodules in every lobe now which persisted from Sept 2023 to Dec 2023 so the persistence of these likely doesn't help.  If inflammatory those, or some of those, would likely be gone.  It was a local hematologist/onc I'm seeing for something else who told me (when I asked) she thought it a slow growing cancer.  One of the differentials on the CTs (done at a different facility 4 hours away from where I live) is adenocarcinoma.  My rheum at that facility said not ILD b/c the pattern is wrong and then asked if I was ever a smoker - that was in October 2023.  So I'm kinda preparing myself if you can ever really be prepared for this kind of thing.... I've lost 2 sibs and my father to lung cancer too so that likely adds to the mix....