9mm lung nodule and lytic rib lesion

Portal Forums Lung/Thoracic Cancer Work-Up/Staging of Lung Cancer 9mm lung nodule and lytic rib lesion

This topic contains 99 replies, has 6 voices, and was last updated by  Cheryl3700 1 month, 3 weeks ago.

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February 26, 2015 at 6:51 pm  #1268659    

Cheryl3700

Cheryl3700
Hi, I found this site highly helpful back in 2011 when my mom had lung cancer. Now finding myself back here, husband having issues. First symptom, swelling in RUQ. Little pain. Dr thought hernia, ultra sound negative. Onto CT scan found lytic lesion of 7th rib on right side, plus 9mm nodule in lower left lung. He also had 2 confirmed SCC skin cancer last year on scalp, grenz radiation 8 cycles.
I know SCC skin can metastasize, but rare. Indications of the SCC report were not concerning for spread.
Question is, can a 9mm lung nodule metasasize to bone? Just not sure if it’s too small to do that?
Thank you for this wonderful site!!

February 27, 2015 at 4:01 am  #1268664    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

Although I’m sorry you need to be here, welcome back to GRACE. I’m sorry to hear of these issues you and your husband are facing.

Although cancer can do pretty much anything, it would be unusual for such a small nodule to spread and produce a symptomatic bone lesion. For that reason, the usual treatment for a Stage I cancer such as a solitary 9 mm nodule would be surgery, without following up with chemotherapy.

I hope that as your husband’s workup continues you will discover that this does not represent cancer.

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

February 27, 2015 at 4:20 am  #1268669    

Cheryl3700

Thanks for the encouraging response. Now more tests to find out what both things are. Best case we are hoping for benign 9mm and the rib is something also benign. Just scary when there are 2 findings together. On CT quite a large length of the rib is involved.

March 14, 2015 at 5:16 am  #1268912    

Cheryl3700

Update as of 3/14/15: 2nd Ct scan of chest reported a 1.1cm nodule in other lung and hiatal hernia. Bone scan reported only the 1 expansile lytic rib lesion. Went to Boston for consultation, were thrown a curve ball when their dr/radiologists told us, they suspect possible esophageal cancer. That was not reported on any other tests and we were not prepared for that added news! However, hubby has been having problems in that area for at least 6 mos and I’ve been trying to get him to ENT for swallowing issues, so it’s not totally new news, but had no idea of possible EC. Onto PET scan soon and GI endoscopy.

It’s a little unsettling to uncover so many things at same time, still hoping they are all unrelated, but scared!

March 14, 2015 at 12:11 pm  #1268919    
catdander forum moderator
catdander forum moderator

I’m so sorry Cheryl, I know how scary this must be. Hoping for the best.

Keep us posted,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

March 17, 2015 at 4:51 pm  #1268956    

Cheryl3700

Now fighting ins who denied pet scan. Dr wants pet b4 endoscope biop because the info from pet will help guide where to take biop and if biop done first that will cause biop site to light up on pet. However ins is denying stating he’s not had a biop of cancer yet and so won’t approve pet. Ugh! So frustrating that nothing is getting done.

Ins denied once, denied on peer to peer and denied first appeal. Dr is doing 2nd appeal.

Sorry had to vent!

March 17, 2015 at 6:14 pm  #1268957    
catdander forum moderator
catdander forum moderator

I know how frustrating all this must be. I’m glad the doctor is so involved and likely to be of much help. I can’t say why the ins would deny this. A PET scan after a worrisome CT is pretty standard work up in the US for lung cancer. Perhaps it’s because the nodule is 9mm not 10mm (1cm). One cm is considered the benchmark for a nodule to be large enough to show uptake on the PET scan. Often when smaller it doesn’t express enough activity to show uptake. Hopefully the doctor will have better luck. If not perhaps a specialist with a bigger name could inspire the insurance co.

From Dr. Silvestri’s post on work up of lung cancer, “Another complementary scan to the CT scan that is being increasingly performed in patients with known or suspected lung cancer called a Positron Emission Tomography (PET) scan. This scan is more of a metabolic scan. It tells us whether what we see on the CT scan is metabolically active. In patients with cancer, the scan should “light up” or show “uptake” in areas where there is tumor.” http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-lung-cancer-what-do-you-need-to-know/

Keep us posted,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

March 25, 2015 at 8:00 am  #1269016    

Cheryl3700

Well insurance company won, we had to get upper GI EUS done first, and as suspected GI dr is saying 90% chance its esophageal cancer T4. They biopsied it along with one lymph node. Now ins will probably allow PET after biopsy results come back. So scared.

March 27, 2015 at 10:41 am  #1269038    
catdander forum moderator
catdander forum moderator

Hi Cheryl,

I’m so sorry about the possible diagnosis. I don’t think it’s necessary to remind you of keeping hope alive. I’ve decided through my husband’s journey that hope remains no matter what; there’s always something to be hopeful for. So I’ll remain hopeful.

Best to you and your husband,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

April 8, 2015 at 3:59 pm  #1269161    

Cheryl3700

Thanks for all the responses of hope.

Update 4/8/15, confirmed stage IV esophageal cancer, adeno, G3. Waiting on brain MRI. Confirmed met to rib. Getting chemo port put in next wed. Waiting her2 status.

Still feel like I’m in a nightmare and will wake up soon.

Also going to chemo class next week. Dr said he will get 5fu, will get more details next week.

Praying we can beat this beast for as long as possible.

April 15, 2015 at 11:33 am  #1269214    
catdander forum moderator
catdander forum moderator

Hi Cheryl,

I am so very sorry about your husband’s diagnosis. I meant to come back a respond earlier so sorry for the delay. What I have to say are my own thoughts from my own experience and not those of a medical expert.

I know how unreal it seems to you and I wish I could give you some helpful ideas to move through this. What comes to mind right now and maybe because of a movie I watched last night is a good scream is quite cathartic. I remember when D was diagnosed, he was very sick and needed a lot of care. I found myself screaming in the car when I thought no one else could hear. I mentioned it here on Grace (there was quite a bit more activity and conversation here at the time) and it seemed everyone had a positive reaction to this type of letting it out. Several had tried it and several planned to. Help you husband to be as comfortable as possible through all the treatment, side effects, and symptoms. To do that you’ll also need to recognize your own needs by planning for them because your body stops telling you what that is. I think it has something to do with the fight or flight hormones, Adrenaline, Cortisol, Norepinephrine. Your body most likely is stuck in the fight or flight mode and these hormones help you address the problem no matter what; but since we want to make this a long long process it’s important to recognize your body has most likely shut down any mechanisms of telling what the body needs/wants. I let a lot go by the way side and payed a price though I’m rectifying that now.
And very important and maybe doesn’t even have to be mentioned but only reminded…There’s always reason for hope. Hope can be a very powerful tool.

All best,
Janine


My husband, 8/09 53 @ dx stage III squam nsclc R. pancoast tumor
Destruction of 3 ribs, touching brachial plexus.
6/09-8/09 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable)
9/09 Chemo/rads curative intent
11/09 MRI by pancoast specialist surgeon spine met found undiagnosed Rad to spine, Chemo continued thru 6 cycles
Tarceva maintenance 2/10
11/10 3cm tumor L lung, undx core bx w/collapsed lung. Gemzar, 12/10 through 7/12
NED 3/12, stop tx 7/12. Remains NED as of 9/16
Unanswerable question. Was it ever metastatic?

April 16, 2015 at 6:17 am  #1269217    

Cheryl3700

Thanks so much Janine, I remember doing those screams when my Mom had cancer. Lately I listen to my favorite keep me going song “strong enough” by Matthew West.

Chemo starts next week Wed. Will be folfox with 5fu pump 2 days at home – every 2 weeks. Not sure what to expect, don’t know anyone whose had chemo. Guess we will be learning lots.

Thanks again for your response.

April 16, 2015 at 8:37 am  #1269222    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

Here is a page from the American Cancer Society which describes the possible side effects of such chemotherapy: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-chemotherapy

Of course, each patient is different and your husband is unlikely to experience all of the listed side effects.

I hope that he does well with his treatments.

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

April 26, 2015 at 6:31 pm  #1269345    

Cheryl3700

Hi, slight delay in chemo due to little skin infection near chemo port. Starting the 29th now.

Was reading endoscopy report . . . have a couple questions.

Mass found from 37cm to GEJ at 41cm, appeared to extend to castric cardiac. Bx taken of cardia component separately. What is castric cardia?

Several perigastric nodes were seen. These were round, well defined and hypoechoic. What does this mean?

Thanks.

June 16, 2015 at 9:14 am  #1270142    

Cheryl3700

Update 6/15/15:
Completed 3 rounds of folfox with 5fu pump at home for 2 days. Tolerating chemo pretty well, has the cold issues and slight numbness in hands and feet for 5 days or so following. After first round of chemo, hubby ended up in the hospital due to passing out, guess we learned real quick about hydration!! Funny thing is, he’s got practically no issues swallowing except a pill here or there. Also no pain from the rib lesion. So thats all good.

Getting scans on 7/1 after 4th chemo to see whats going on.

Last few days developed a hoarse voice, so hoping thats just a cold and not something spreading. Also got a bad flare up of his gout in wrist, can’t even move it at all. That usually passes in a few days.

Very curious what will happen after these 6 rounds, guess it all depends on those scans. If things are good, perhaps a little chemo break? If things are bad, we will see what is suggested.

Will update after 7/1.

  • This reply was modified 1 year, 10 months ago by  Cheryl3700.
  • This reply was modified 1 year, 10 months ago by  Cheryl3700.
July 2, 2015 at 5:18 am  #1270303    

Cheryl3700

Update 7/2/15:
Completed 4 rounds of folfox with 5fu pump, we believe the hoarse voice was from thrush infection got a prescript for that which is helping.

Got CT scans and were pleasantly surprised with a good reduction in tumor size (40%+). Plan from our oncologist at MGH is to continue with folfox. 4 more rounds and another scan.

Only issue with blood work is platelets continue to drop, presently below 150. Eventually those could cause a delay in one or more chemo treatments. But thats really not bad for overall experience with this folfox. The hands/feet numbness and problems with cold continue, but subside after 4-5 days post chemo.

Maybe with enough tumor reduction, there could be a chemo holiday of a month or two in the future. This esophageal cancer is well nick named as “the beast”.

For now we will relax with this good news that this chemo is working.

July 2, 2015 at 8:26 am  #1270305    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

Thanks for the update, and congratulations on the good scan report, and relatively good tolerance of the folfox regimen, which never tends to be an easy one.

Wishing your husband continued success!

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

August 24, 2015 at 6:27 pm  #1270940    

Cheryl3700

Waiting for results of next scans after 8 rounds of folfox. Looking at older ct RPT, can anyone tell me what neoplastic etiology means?

IMPRESSION:
Indeterminate 2 to 8 mm noncalcified bilateral scattered pulmonary nodules. The differential diagnosis would include neoplastic etiology, noncalcified granulomas, and intraparenchymal lymph nodes.

Thanks!

August 25, 2015 at 4:38 am  #1270943    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

In the “Impression” section of a scan report, the radiologist speculates as to what the findings might represent. “Neoplastic etiology” refers to these nodules possibly being tumors.

Good luck with your scan results!

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

September 15, 2015 at 12:05 pm  #1271167    

Cheryl3700

Update scans from Aug 20, 2015 show everything is stable, nothing new to report. Dr. says stable is good, however it’s scarey, makes you wonder does this mean next will be progression, it’s nerve wracking! Chemo #10 was completed. Some blood counts are moving too low like RBC and BUN. But was given ok for chemo, so guess they aren’t too far off yet. This past week has seen some symptoms return, first the rib pain is back, he’s got tumor in 5th and 7th ribs that were reported more sclerotic and less lytic, they had not been given any pain up to last week. Stabbing pain when he rolls out of bed, but it goes away quickly. A little more trouble swallowing pills and chocked on scrambled eggs yesterday am. Additionally the constant throat clearing which had gone away is back a lot of the time. Also a fair amount of coughing. All of these things make us nervous of progression. Will mention on 9/23 at chemo appt. :-(

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