Micro nodules 5 months after lung lobectomy scar tissue or cancer

Portal Forums Lung/Thoracic Cancer NSCLC Early Stage/Surgery Micro nodules 5 months after lung lobectomy scar tissue or cancer

This topic contains 10 replies, has 4 voices, and was last updated by  onthemark 3 months, 2 weeks ago.

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April 24, 2018 at 8:16 am  #1294296    

metafran

I had a follow up Ct scan in March after a right middle lobe lobectomy in late October. PT2aN0 1b adenocarcinoma grade 2 . No adjuvant tx. Got the results of Ct scan says: a few millimetric nodules in the horizontal scissure. Wouldn’t there be a difference in nodules to differenciate after 5 months? Next step possibilities? How likely is this cancer or just scar tissue? Ther rest of the scan seems normal after surgery.
Thanks for all you do!

  • This topic was modified 3 months, 3 weeks ago by  metafran.
  • This topic was modified 3 months, 3 weeks ago by  metafran.
April 24, 2018 at 5:30 pm  #1294300    
catdander forum moderator
catdander forum moderator

Hi metafran,

I hope you’re cancer free. A few mm nodule post surgery is at least as likely inflammation, scar tissue or infection as cancer. Has it been there? If so it’s most likely benign and won’t change. If it’s near the surgical site then scar and inflammation is likely. Your radiologist will compare this scan with your next and keep an eye on changes.
Lung cancer does tend to grow with certain characteristics but a few mm won’t tell much about that.

I wish I could tell you not to worry but I know better. Regular follow up scans will tell the tell. I a couple of months or years from now I look forward to hearing you’re living life with less worry.

All best,
Janine

April 26, 2018 at 10:00 am  #1294302    

metafran

Thanks for the reply …

am I in error thinking that if there are micro nodules along the horizontal fissure that they are on the periphery of the right upper lobe because the middle lobe is gone. It was at a 5 months ct scan LDCT 1st Ct surveilance post-op. they are new micro nodules not see before lobectomy of right middle lobe. They appeared within a 5 month window.
Thanks

  • This reply was modified 3 months, 2 weeks ago by  metafran.
  • This reply was modified 3 months, 2 weeks ago by  metafran.
April 26, 2018 at 4:08 pm  #1294305    

onthemark

Hi Metafran,

The horizontal fissure (also called the minor fissure) is a structure in the right lung that separates the right middle lobe from the right upper lobe. So, yes, they would be on the periphery of the right upper lobe.

Since you had your right middle lobe removed, that region would have been disturbed, so as Janine said, it could be scar tissue or inflammation. What does your report say as to the overall impression or recommendation for follow up scans?


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.

April 26, 2018 at 4:46 pm  #1294306    

metafran

It says
Some modifications postoperative with a few areas resembling fibroatelectastic right pericardia.

With coronal reconstructions I find a few millimetric nodules along the grande scissure. This irregularity must be followed closely.

Post middle lobectomy status with fibroscaring at surgical site.
A few dicrete nodular irregularities along the right grande fissure. This image muste be followed. No suspect nodules in left lung.

I am very worried as this is my first Ct scan. It’s been 5 months since my lobectomy. Shouldn’t they be able to differentiate at this time ? Surgeon says wait for new Ct in 4 months.

Then it would be along the right lower lobe instead of the upperlobe?

I think I put horizontal fissure as the grande fissure by mistake as I thought the oblique one was the minor one. I am translating from French. Thanks

  • This reply was modified 3 months, 2 weeks ago by  metafran.
  • This reply was modified 3 months, 2 weeks ago by  metafran.
April 27, 2018 at 6:45 am  #1294309    

onthemark

I don’t know which one the ‘grand’ fissure is, but it is either at the lower edge of the upper lobe or the upper edge of the lower one, as you suggest. The nodules are too small to biopsy so the only course is to watch and wait.

I am also not sure what a coronal reconstruction is. That might be a factor in the determining what the few tiny nodules are. I think the only question is when to rescan. 4 months seems reasonable but so would 3. Inflammatory processes can take that long to resolve. You can realistically hope these will go away and are not a recurrence.


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.

April 27, 2018 at 9:35 am  #1294311    
catdander forum moderator
catdander forum moderator

Right 3 months in the US is pretty typical but there are no hard and fast rules about timing of scans. 4 months is reasonable. There’s just no way of knowing what it is until it shows itself to be scar, inflammation or cancer. As everyone here knows waiting can be the hardest part of all this.

Here’s hoping for the best,
Janine

April 28, 2018 at 7:00 am  #1294312    

metafran

Onthemark,
Coronal reconstruction is a view of the lungs iin Ct scan. Seems to be a view that is from front to back instead of top to bottom view of lungs.
Thank you for helping me out here Cat dander and onthe mark
Francine

April 28, 2018 at 7:34 am  #1294313    

onthemark

Watching and waiting can be hard sometimes, especially at the beginning of a lung cancer diagnosis and treatment. But it is more or less a way of life for many people who are living longer with lung cancer than most have in the past.

I have also got some tiny nodules in my lungs but they were there from the beginning. Probably even without these nodules I would get scanxiety and worry a lot sometimes about what I would do if the cancer were to rear its head again.

A scan in 3 or 4 months will actually provide some more useful information while doing anything sooner may not add to your or your doctor’s knowledge at all. There are lots of people walking around with tiny nodules in their lungs, including lung cancer patients. And it is a big problem in screening to figure out how to deal with situations where the risk of cancer is actually quite low. When they are that small they are most likely benign if they were found in a random person, but of course the situation is different if you have had lung cancer because of the possibility of recurrence.

It is good they will be keeping a close eye on things. That is the best one can hope for nowadays. There’s research toward making non-invasive (blood or breath) ways of detecting early cancer or recurrence. I am confident that one day these test will be used in practise and go a long way to alleviating patients worries. In fact, I hope to live long enough to take one of these tests.

https://www.technologynetworks.com/cancer-research/news/a-breath-test-for-lung-cancer-287873

https://www.eurekalert.org/pub_releases/2018-01/rumc-rsb010918.php


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.

April 29, 2018 at 7:39 am  #1294317    
JimC Forum Moderator
JimC Forum Moderator

Hi metafran,

As onthemark stated, the new non-invasive biopsy techniques, using bodily fluids or breath, are currently under investigation, and blood biopsies are approved for use in mutation testing in Europe. Drs. West, Soria and Gandhi discussed the current use and future possibilities for these biopsies here.

Until that technology matures to the point at which it could be used to reliably detect recurrences or progression, the standard remains periodic follow-up scans and clinical evaluation of the patient. I agree that the issues of waiting, uncertainty and feelings of helplessness are some of the toughest aspects of a cancer diagnosis, both for patients and their loved ones.

I hope that future scans will help alleviate your worries.

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 29, 2018 at 8:13 am  #1294320    

onthemark

Hi Jim,

Thanks for your reply. In order to alleviate any confusion, the two articles I linked to are not about biopsies at all. They are not looking at tumour cells or tumour DNA at all, unlike the talk you linked to. One looks at changes in RNA as a result of having tumour(s) in the body and another looks at changes in protein. They are more useful at this point for a determination, yes or no, is there lung cancer in the body that to specifying, as in a biopsy that looks at DNA, what kind of lung cancer it is.


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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