6mm Growth in 3 Months

Portal Forums Q&A, Ask Us New Questions 6mm Growth in 3 Months

This topic contains 4 replies, has 3 voices, and was last updated by  onthemark 3 weeks, 3 days ago.

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July 21, 2018 at 1:59 am  #1294918    

peterc037

Hi,
A CT scan has just shown a 6mm fissural nodule in my lung. Three months previous to this there was no nodule on a scan. Over the last 2 years I have had 4 scans which did not show this nodule, I am confident it is a new finding.
From what I know, 6mm would be too small to biopsy. It would seem that the standard is to rescan after a period of time. My concern is that zero to 6mm represents rapid growth and a 6 month, or even three month follow up might be inappropriate.
Is there any protocol for this type of scenario?

I have been suffering from extreme tiredness and some muscle loss.

Regards

Peter

July 21, 2018 at 7:44 am  #1294919    
JimC Forum Moderator
JimC Forum Moderator

Hi Peter,

Welcome to GRACE. I am sorry to hear that your scan finding is causing you such understandable concern and worry. It is important to know that many people have such solitary nodules, and the majority are not cancerous. Dr. West discusses the imaging features which make such nodules more or less suspicious for cancer in this post. At the end of his post, there are links to other posts which may provide relevant information for you.

One thing to stress is that a 6mm nodule is extremely unlikely to cause the symptoms you describe.

For such a small, single nodule, it’s pretty typical to scan in 3 to 6 months to check for growth. I understand your desire to scan sooner, but with a shorter interval, it can be difficult to detect any change on the scan, and an unchanged nodule can look somewhat different on successive scans, due to slight differences in scan angle, and the way the images “cut” (since a CT is made up of multiple images).

I understand your concern, so it is difficult to suggest that you not worry about this finding. But try not to conclude the worst, as many of these nodules are harmless.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 21, 2018 at 8:08 am  #1294921    

onthemark

Hi Peter,

I’d just add to Jim thoughtful post by asking why you were scanned four times in the last two years and what else might be on the scans that could prompt a concern, if anything.

Is it just a solitary nodule?

For protocol, from the “Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017″

https://pubs.rsna.org/doi/full/10.1148/radiol.2017161659

“For solitary solid noncalcified nodules measuring 6–8 mm in patients at high risk, an initial follow-up examination is recommended at 6–12 months and again at 18–24 months (grade 1B: strong recommendation, moderate quality evidence). This recommendation is based on an estimated average risk of malignancy of approximately 0.5%–2.0% for nodules in this size range and is derived from screening studies, most notably the PanCan, BCCA, and NELSON trials (6,7) Again, the precise intervals can be modified according to individual risk factors and preferences. In some patients in whom nodule stability remains uncertain, further surveillance may be required; however, two follow-up examinations should be sufficient to exclude growth in most subjects.”


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

July 21, 2018 at 9:13 am  #1294922    

peterc037

Hi,
Thank you for the welcome. I was scanned 4 times as they were monitoring an aneurysm. So it was a shock to get this finding. At least I am confident that it is appropriate to wait, I have been sweating over this the last few days.
I feel more relaxed already.

Regards,
Peter

July 21, 2018 at 9:25 am  #1294923    

onthemark

Hi Peter,

One day, hopefully in the not too distant future, there will be blood or breath tests for lung cancer but at the moment the only alternative in your situation is to watch and wait for 3 to 6 months. It can take several months for local inflammations that can lead to nodules such as yours to resolve. I would lean toward 3 months since the lesion appeared on that time scale and try not to worry too much in the meantime. It is likely not cancer, but needs to be watched.


10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

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