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 113 replies, has 6 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 4 months, 1 week ago.

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July 30, 2016 at 11:33 am  #1286735    

Cheryl3700

Thanks Jim, official ct scan of chest is in. Learning the actual wording.

New ground glass opacities in all lobes of lungs. There are new small pleural effusions. The heart is at upper limits of normal for size. First time the reports mention heart size, could this be enlarged heart?

Possibly pneumocystis pnemonia.

Waiting is always so hard, won’t get to speak with drs until next Wed. Day 12 of fevers.

July 30, 2016 at 3:21 pm  #1286736    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

This is what Dr. Sanborn has stated with regard to ground glass opacities:

“The most common cause of ground glass images is inflammation or infection, not cancer or BAC. When a person has had a pneumonia, we can see ground glass findings for quite some time. If these are found after cough or infection symptoms, the most common first step is to perform follow up imaging. This usually is performed between a month and several months later, depending upon the look on the CT and the level of concern of the doctor or patient. BAC does indeed move very slowly, and what we are looking for is for evidence that the ground glass images are improving. This would point very strongly to a benign source, and away from the need for invasive procedures such as a biopsy. Even in the case of “stable” images, there are times where ongoing monitoring may be more appropriate than moving directly to a biopsy. This is particularly the case if the areas are small or difficult to reach without a significant surgery.”http://cancergrace.org/forums/index.php?topic=4268.msg25398#msg25398

Certainly in combination with your husband’s symptoms, pneumonia seems to be a very likely cause of these GGOs.

As far as the comment about his heart size, when you look carefully at what was written, it is still within the normal range. As a result, radiologists reading prior scans may not have mentioned it because it was not outside that range. Radiologists tend to have little information about a patient other than diagnosis or presenting symptoms, so at times they report findings that simply aren’t relevant or worrisome. You could ask his doctor whether the heart size appears increased since previous scans, to see if there is a trend.

Otherwise, if pneumocystis pnemonia is suspected, I would expect that he will be treated an antibiotic such as Bactrim, and likely hold his chemo until he improves.

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 30, 2016 at 6:39 pm  #1286737    

Cheryl3700

Thanks so much Jim. Still running fevers, guess we won’t know anything until at least Wed which is our next chemo appt (expect chemo part to be cancelled).

Weird thing is about his heart, I always look at scans on CD and I noticed it seemed larger to me before I even read the written report. I was trying to measure previous scans to current scan, he has lost 55 lbs since start so I thought the heart should measure smaller, however in various places it’s measuring slightly bigger. Just seems odd the this report is the first to mention it after 9 CT scans.

Waiting is not fun.

July 31, 2016 at 8:22 am  #1286739    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

There are various reasons the heart may appear enlarged, including a pericardial effusion, which in itself can have various causes, including cancer and fungal infections. If your husband really does have pneumocystis pnemonia, that could be the culprit.

I hope you can get some good answers on Wednesday, and get your husband on the path to clearing up this condition.

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 31, 2016 at 8:44 am  #1286741    

Cheryl3700

Thanks again Jim. Just reading the abdomen written report, it all sounds not good to me. But will wait until Wed appt to get it all explained. :(

There is a new 1.2 cm lesion in hepatic segment 5/8 (series 301, image 21). Subtle hyperdensity along the surface of the right hepatic lobe is suspicious for metastasis.

Subtle hyperdensity along the inferior margin of the spleen is suspicious for metastatic spread.

A 2.3 x 2.3 cm soft tissue nodule adjacent to the gastroesophageal along the lesser curvature of the stomach may represent a nodal metastasis.

Subtle enhancement along the serosa of the sigmoid colon likely represent metastatic deposits. There is additional peritoneal thickening adjacent to the descending colon.

Findings suspicious for disease progression with peritoneal carcinomatosis, with thickening along the serosal surface of the sigmoid colon, right hepatic lobe and inferior margin of the spleen.

August 1, 2016 at 8:53 am  #1286882    
JimC Forum Moderator
JimC Forum Moderator

Hi Cheryl,

Yes, it is often problematic to try to interpret a CT report before talking to your doctor, who is in possession of all of the information to explain it best.

We’ll keep you in our thoughts for a good meeting on Wednesday.

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 9, 2016 at 2:55 pm  #1287992    

Cheryl3700

Hi folks,

Update today, after some whirlwind days, we are now home on hospice with hubby. It’s strange having no appts in the calendar. His fevers continued for over 2 weeks, nothing was found in all infectious workups including a bronchoscopy. Did 5 day course of broad spectrum antibiotic and no fevers since.

Today online I see this new info on lung test.
Gram StainNO POLYS , Very Rare MIXED GRAM POSITIVE AND NEGATIVE ORGANISMS WITH NO SPECIFIC TYPE PREDOMINATING  

Not sure what that means. So onto this new phase and try to enjoy the next weeks/months.

Thanks everyone.

August 10, 2016 at 7:53 am  #1287998    
JimC Forum Moderator
JimC Forum Moderator

Cheryl,

I am sorry to hear of these latest developments. It’s good that the fevers have ended, and I hope that hospice will be able to keep your husband comfortable and that you will enjoy many good days together.

I wish you comfort and strength in these difficult days ahead. He is fortunate to have had your love and support throughout his cancer journey.

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 19, 2016 at 9:22 am  #1288357    

Cheryl3700

Hi again,

Home with hospice since 8/8. Hubby doing a bit better since fevers stopped. However we see signs of food getting stuck again. If this progresses, we have to see what is available while on hospice to help alleviate eating problems. This road we might have to cross sooner rather than later. His last chemo was July 13, so we are a month out from that. Amazingly he still has no pain from any of his cancer, for that we are blessed.

Latest report from lung bronchoscopy regarding the new GGO in all lobes shows: “Acute and Chronic inflammation”. From what, we may never know. Also saw it noted “failure to thrive’ in his records. Assuming that’s part of diagnosis allowing him to go on hospice.

Day by day.

Thanks.
Cheryl

August 21, 2016 at 12:58 pm  #1288389    
catdander forum moderator
catdander forum moderator

Hi Cheryl,

Just checking in to see how things are going for Hubby and you. It’s great to know that he’s not been in any pain. How’s the food intake situation?

Keeping y’all in my thoughts,
Janine

August 21, 2016 at 3:05 pm  #1288393    

Cheryl3700

Hi Janine, thanks for asking, the eating is getting more difficult. He can swallow ok, but things getting stuck after. The EC is at the junction. So we will see how this goes over the next few weeks. Scarey. Cheryl

September 26, 2016 at 2:23 pm  #1288747    

Cheryl3700

Update Sept 26. Hubby got really bad after 3 treatments of taxol/cyramza, fevers and very weak. So weak they sent him home with hospice on Aug 8. Last chemo was July 13. After this much time off treatment, hes feeling better. Went back to onc, came off hospice and is starting Keytruda Wed. Might as well be up at bat instead of sitting on the bench. We know that it only works 20-30% of the time on EC, but worth a shot.

September 26, 2016 at 10:13 pm  #1288749    
catdander forum moderator
catdander forum moderator

Hi Cheryl,

I’m so glad you’ve updated us. I hope your Hubby is one who does really very well on Keytruda without side effects. My fingers and toes are crossed.

Janine

September 29, 2016 at 10:02 am  #1288793    

Cheryl3700

Question, I can’t find details on any website. I was curious if keytruda initially works for a patient and then fails after a year or so, what is the reason it starts to fail? I understand for chemo, the cancer mutates to grow around the chemo, but for immunotherapy what’s the reason? Thanks.

September 29, 2016 at 10:42 am  #1288794    

Dr. Weiss

Great question that many of us wish that we knew the answer to. This question is the subject of a LOT of research. There are no clear answers, but I’ll share some speculation.

When I was a resident, we were taught about the systems processes employed on airlines to prevent terrible things from happening (and, I write to you from an airplane!) We were taught about a “swiss cheese model” where many things had to go wrong for a plane to crash. Increasingly, I think of cancer the same way. While one mutation may be particularly important (such as EGFR) for a once-healthy cell to go bad and become cancer, fixing that one problem does not cure cancer once it’s established (erlotinib may be great, but it doesn’t cure). The same is probably true of the immune system. It likely takes multiple immune defects to allow a cancer to grow. Fixing one key defect may help control cancer, but cures remain uncommon. Current therapeutic strategies are focused on T cells, but it is very likely that other components of the immune system are also important. I predict that one day, we will target many aspects of immune failure all at once. And, I predict that we will discuss cure more often than we do now.

September 29, 2016 at 12:29 pm  #1288796    
catdander forum moderator
catdander forum moderator

Cheryl, Is it ok to start a new thread with this new questioning on the subject of immunotherapy. It will be excellent for so many others but is buried in the rest of your story. What’s worked for others in the past is keeping a thread of personal experiences like you’ve done so far in this thread but when you’ve got a new question that could be asked by many put it in a new thread so others can find it in a search. I know it’s more work on your part but it can be so helpful for so many. If it’s OK I’ll split the thread off into another.
BTW, I don’t think there is an answer to your question yet but I’ve ask an onc who does research on the subject to comment so we’ll see.

Janine

September 29, 2016 at 12:34 pm  #1288797    

Cheryl3700

Thanks Janine, hope someone can explain as it’s interesting to me. Cheryl

September 30, 2016 at 2:40 pm  #1288813    
Dr West
Dr West

These are new agents, and we really just don’t yet know the mechanism(s) for acquired resistance. It is likely to be different for different people and cancers, & researchers rarely have the opportunity to study tissue from repeat biopsies after a patient has developed acquired resistance after previously responding well to immunotherapy.

I’m sorry we don’t have an answer yet, but of course it’s a subject of intense research and clinical interest!

-Dr. West

October 3, 2016 at 3:31 pm  #1288848    

Dr. Ben Creelan

There are ‘acquired resistance’ mutations to Opdivo/ Keytruda described.

For example, tumor cells may mutate, causing defects in the way they present their proteins to our immune system. These mutations may render the cells resistant to cytokines, or unrecognizable to our T cells. The group at UCLA has described this. This is a big area of research.

http://www.nejm.org/doi/full/10.1056/NEJMoa1604958

October 4, 2016 at 4:17 am  #1288856    

Cheryl3700

Thanks so much for the link and info Dr. Ben. It’s very interesting to me, even though I’m a computer programmer this stuff fascinates me.

My husband got his first infusion of Keytruda last week, he did well only slight nausea and chills, plus fair amount of fatigue. I find it strange his dr. did not test for pd-l1 expression in his tumor. I noticed he’s Macro Satellite Stable (MSS) and I’ve been reading that most likely means no pd-l1 expression. Waiting is always the hardest part, scans again after 6 or 9 weeks she was not sure which yet.

I’ve read a couple of articles on here about to test or not to test and also about pseudo progression. All very informative.

Thanks!
Cheryl

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