CT scan meaning and what's next?

Portal Forums Cancer Basics Imaging Issues CT scan meaning and what's next?

This topic contains 5 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 2 years, 3 months ago.

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August 1, 2015 at 2:53 am  #1270670    

ttroop7

My CTA scan of my lungs results are below, done 7-29-15. I have not been diagnosed with lung cancer at this point. I worry because both my Aunt and Grandmother died from squamous cell lung cancer and my mother is a breast cancer survivor. I am most worried about the Hilar node they mentioned and ground glass appearance. The 7mm node has been there for a few years unchanged but everything else is new. I have been a heavy smoker since age 15, I am 41 now. I was previously diagnosed with COPD. Any thoughts about the situation? I see a Pulmonologist on August 7th and I am not sure what they will do either… should I be concerned? Expect talk of biopsies?
Imaging is obtained after 100 cc Isovue 370 resulting in good vascular
enhancement and excluding the diagnoses of aortic dissection,
aneurysm, and pulmonary embolism. There is a 15 mm right hilar node.
No pathologic effusion. There is a 7 mm noncalcified nodule in the
right middle lobe and a 5 mm nodule in the superior segment of the
right lower lobe. Mild ground glass opacity is seen in the lung
apices.

CONCLUSION: Negative for pulmonary embolism but positive for ground
glass opacity and right lung nodules.

Thanks,
T.

August 1, 2015 at 8:07 am  #1270671    
JimC Forum Moderator
JimC Forum Moderator

Hi T,

Welcome to GRACE. I’m sorry that you’re facing the uncertainty of these scan findings, but I hope that further workup will allay your fears.

As far as the two lung nodules, they are really too small to biopsy at this point; usually the lower limit is about 1 cm. There can be many causes other than cancer for both an enlarged node and a ground glass opacity, such as infection. Although you’ll have to see what your pulmonologist has to say (since he has access to all of your information and is in the best position to make judgments regarding your care), it is not uncommon to prescribe a round of antibiotics, then rescan in a couple of months. If the GGO has been resolved, it was likely an infection. If the nodules do not grown, there is a high probability they are not cancer. Finally, if the nodules grow to a sufficient size, a biopsy may be the next step.

Good luck, and please let us know how it goes.

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 1, 2015 at 2:32 pm  #1270672    

ttroop7

Thank you! I was treated for pneumonia two years ago (Jan 2013) in the right middle and lower lobes. They said it was better on the next CT scan but the scan reads, diminishing pulmonary infiltrates as compared to previous study then says mild lingular and right middle lobe atelectasis. The CT scan said I had sub centimeter reactive lymph nodes when they diagnosed the pneumonia none at the next scan. I am looking back at old CT scans and sometimes they mention a couple nodules, then three, then one… it doesn’t seem to be consistent. Is that normal? I will thank you in advance for your reply and put this to rest until I see the doctor Friday.
T.

August 2, 2015 at 7:38 am  #1270674    
JimC Forum Moderator
JimC Forum Moderator

Hi T,

If you had pneumonia back then, that seems consistent with decreasing infiltrates and nodes that were no longer enlarged on the follow-up CT. As far as the nodules, if they are small it’s certainly possible that depending on how the CT images “cut”, on one scan a nodule may be visible and on another perhaps not, at least not to the extent of being noted on a report.

Although as you noted in your first post you have a significant smoking history and that increases your risk of developing lung cancer, the lung cancer of your Aunt and Grandmother were most likely due to smoking or other environmental factors (such as exposure to radon gas) rather than genetics, so that probably doesn’t increase your risk.

I think putting your concerns to rest until you see the pulmonologist is a great idea. We look forward to an update with encouraging news.

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 8, 2015 at 3:21 am  #1270741    

ttroop7

Update on 1st appointment with Pulmonary Cancer Specialist-
He said I need a repeat scan in 3-6 months. If the hilar node has increased in size he will biopsy. If the nodules increase in size he will remove them, and test for cancer.
He also said the ground glass appearance could be left over from previous bouts of pneumonia I had. He was unsure though because it didn’t show in a previous scan.
He showed me the actual nodules ect on the ct scans.
The only thing that bothers me is that yesterday was a “good” breathing day for me and my pulse ox was taken after I just had a coughing fit. It read 98% in his office yet it is regularly 94% or below.
So now I wait yet again… he will talk to his colleagues at a team meeting and see if they have any other thoughts and let me know but I’m guessing nothing will change in the treatment plan.
Thanks for being here!
Any thoughts?
T.

August 8, 2015 at 5:09 am  #1270742    
JimC Forum Moderator
JimC Forum Moderator

Hi T,

The plan sounds perfectly reasonable and appropriate. Although the waiting game is difficult, it’s a big step to have surgery, and you wouldn’t want to do that if it’s unnecessary. I tend to be a worrier, so personally I would probably choose an interval closer to the 3 month mark rather than 6, but you also don’t want to make it so short that any growth seen might be so small as to be ambiguous.

Oxygen readings can vary quite a bit from moment to moment, so I don’t know that I’d be too concerned about a single reading, whether it’s high or low.

Good luck with your follow-up scan, and please let us know how it goes.

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

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