Pulmonary Nodules - anything to worry about?
 

Hello all,

I have only been lurking the last few months, but once again I am asking for your collective wisdom :-)

I hit my one-year survivor mark on January 12, 2008 (Yahoo!!!), but the moment was somewhat marred by the accidental discovery of a 7mm solitary spiculated pulmonary nodule on my CT in November 2007 (my first CT in April 07 was clear). The follow-up PET scan in November showed mild uptake - I guess this is common for smaller nodules so it didn't really reassure me much. The nodule does not have any of the hallmarks of a benign origin, like calcifications or fat deposits.

I have been waiting for my follow up CT which was this week. Now it seems that have found another, somewhat smaller nodule in the same area. (Yikes!), but the original nodule has not changed. But, here is what seems weird to me...they don't want to do anything about it right now (?) Just follow it up with another CT in 3 months. Does that sound right to you all?

I have read that a spiculated nodule, even a small one, should be considered suspicious for cancer until proven otherwise. Now that I have two nodules, I assumed they would want to go in and see what they were, but the doc is content to sit tight for three more months.

I certainly don't want any more procedures than needed, but I also want to be careful. Can you all give me your opinions?

Thanks so much!

Dear Erin

Now you have a second nodule. Get another opinion from a different practice to be sure. Call for an appt and ask what tests you should bring along with you.

What if in 3 months you have 3 or 4 nodules?

Hi Erin,

I can completely relate to your worry. In October 2006, an adominal CT picked up two lung nodules, 4 and 5 mm. They were not there upon intitial scans following diagnosis. After getting second and third opinions, I waited three months for a rescan, which showed no change. Waiting those three months was awful! I've now had three scans (Jan 2007, July 2007, Jan 2008) and there has been no change. I'm told the nodules could be a number of things, prior infection, radiation, etc. I 'll have another scan in October, which will be 2 years since first spotting of nodules. Your doctor's suggestion to wait three months seems standard, but I understand your worry. A second opinion might ease your mind, just knowing you're doing all you can. I pray we both have nodules that turn out to be nothing. Take care,

Lynn W

Erin,
I understand what you are going through. A long story but I too have nodules in the left lung and have had two CT's three months apart with no change. After a department consultation the decision was they are from radiation. I go in for another CT in June.

Are the nodules on your radiated side? If you are uncomfortable with the wait, perhaps a second opinion would be in order.

Good luck,
Donna

I'm with Becky. Get a second opinion. Nodules happen. My brother has lung nodules that doc aren't excited about.
Spiculated makes me want to know more. When they looked at my BC tumor, they said spiculated, spiral in appearance almost certainly meant cancer. Lungs and breasts are different animals though. You'll feel better with all the more info you gather.Let us know how it turns out. Bev

I also had lung nodules found on a CT for some abdominal pain I was having. I was shocked to hear that I had multiple >5 mm nodules in both lower lung lobes. These were not present at the time of pre-cancer treatment scans to determine staging. I have since had 2 CT's that confirm the presence of the nodules but also confirm that they are stable. as I have been told, they could be anything from cancer to something as benign as scar tissue. This is the reason for following them, to determine if there is anything to worry about. I know that just them saying that it could just be scar tissue, does not elliviate the worry.
Alice

I understand how you're feeling. A little over a week ago I had a scan of my chest and it picked up something in the upper lobe of my right lung (side that was radiated). My primary doc called my onc and he said it could be scarring from pneumonia or radiation but we will keep an eye on it. My onc is not one for ordering scans or such so I rely heavily on my pc doc. Thank God for him, he ordered the scan when my onc refused. He also ordered a brain mri and a stress test and heart echo. I'm seeing my onc this afternoon and we'll see what he has to say, I swear, you'd think he was the one paying for these things the way he refuses to do tests. So, I am more than a little concerned about the lung thing, guess it's another story of "wait and see". I'm terrible at waiting!
Hugs

Hello, I was found to have one lung nodule 1 cm. on the left lower lung 3 years after diagnosis...also one on right which was 5mm....a pet scan showed barely any uptake on the left and none on the right. However, my onc ordered a lung biopsy and the left proved to be an extension of bc. Never sure about right but I assume it was, too. Since treatment I have been NED. Don't want to alarm, but I would check it out a bit more. Ceesun

Also have nodule they are watching in lung
 

Erin, I saw your post about the lung nodule they are watching. Last year (on my one year anniversary) my onc did a CT scan. It showed up a density or nodule of some sort that was not there the year before. He had me come back in 6 weeks to do another but there was no change. I then went back in 3 months and still no change. It was in my left lung, the same side I had radiation and he is pretty much satisfied it is from the radiation. He still does a scan every 3 months just to make sure no change. In fact I am due for a scan next month. Hopefully both of us can contibute this to radiation. Prayers for all to be benign. Nancy

Lung nodules are not uncommon from radiation, pneumonia, brochitis etc....many will just show up and never change...its multiplying or changing in size that worries the Dr's, and if the report said spiculated, I would not wait 3 months, I'd get another CT and another opinion just to make sure....and rest easy. Just that word raises a flag....of course it could be the person that read it...but who wants to worry for 3 months...most are benign, but why take a chance?

Spiculated means it has arms - kind of thin and coiling with an irregular shape. It is not round, smooth, symmetrical and pretty.

Just Found this and it might help
 

Ruth also has been told she has tiny nodules; they said there is no sign of cancer, and that they think it's prior or current infection that can sometimes happen from chemo. They have, however, postponed getting her port out until a followup scan in July, so I suppose there's that tiny possibility, ugh.

She also had rads tho the nurse didn't mention in her telephone call that that could also be the source. I have put in a call to find out which side these nodules are on.

I also posted about nodules see "CT of chest question"
and received some answers. It seems to me as there are a lot of nodules in the lungs. Mine was tiny and will be followed up in September. Some nodules were noted
on previous scans and others not but I was not scanned
so I don't know. Some of the nodules are on the cancer
and radiation side, some not, mine is on the other side.
We just have to follow up and maybe get other opinions if warranted. I did that and got the same answer.
Take care and good luck.
patb

Erin,

I would get another opinion.

Best,

Joan

Hi,
I have had a lot of problems with lung nodules coming and going. They found a nodule about 7 months ago. Had another cat scan 3 months later and it had disappeared, but then another one showed up. So, 3 months later I had another cat scan, and that one was gone but this time another larger one showed up which was 1.3 cm which is relatively big. It also looked very suspicious, and my doctors were worried. So, I went through a VATS procedure and it turned out to be only some sort of undefined infection. Other than a cold (with no fever) I had been health throughout this period. So to be honest, my feeling at this point is I don't want to get any more CAT scans.

More importantly, the one thing that I have learned is that a lot of nodules that look suspicious are often benign. In addition, from what I understand there is a stronger argument to take it out, if it is a solitary nodule. If there is more than one nodule, I think a wait and see is more common.

I know the waiting and not knowing is terrible. For me, I just wanted to know - whatever the answer was.

Best,
Monica

couldn't get anything when clicked on Becky's linke--here is an abstract which might
 

help put your mind at ease (or at least make you a bit less anxious):

2008 Abstracts Home
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Indeterminate pulmonary nodules in breast cancer: Clinical significance and management.

Sub-category:

Adjuvant Therapy

Category:

Breast Cancer--Local-Regional and Adjuvant Therapy

Meeting:

2008 ASCO Annual Meeting




Abstract No:

617

Citation:

J Clin Oncol 26: 2008 (May 20 suppl; abstr 617)

Author(s):

B. Lee, A. Lim, R. C. Leonard, J. Lewis, C. R. Coombes, J. Stebbing

Abstract:

Background: Increasing numbers of patients with early breast cancer undergo routine staging using computerized tomography (CT). Those in whom indeterminate pulmonary nodules are visualized without the presence of other potentially metastatic lesions represent a clinical dilemma of whether they should be managed as early breast cancer or metastatic disease. This study sought to investigate the incidence, clinical characteristics and outcomes of patients with indeterminate pulmonary nodules in breast cancer, which has important implications for their management and also entry into clinical trials. Methods: Medical records of individual breast cancer patients who underwent thoracic CT scans between the years 2002 to 2007 were analyzed and those with obvious metastatic disease were excluded. Patients were identified via the radiology database by searching for the following terms: suspicious lung metastases, and/ or indeterminate nodules. Results: Out of 2,578 patients scans, we identified 34 cases (1.3%) with indeterminate pulmonary nodules without evidence of disease elsewhere on CT scanning. We categorized these cases to the size of the nodules. At a median follow-up of 13.5 months, there were no changes in lesion size in 86% of the patients with a solitary nodule smaller than 1cm, and 89% with multiple sub-centimeter nodules. In contrast, 100% of cases with pulmonary nodules larger than 1cm had progressed at follow up (ψ2, p=0.004). Conclusions: Breast cancer cases with sub-centimeter indeterminate pulmonary lesions and no evidence of metastases elsewhere are unlikely to represent metastatic disease. Treatment with curative intent or entry into clinical trials should not be excluded.