Pure GGO repeat scans

This topic contains 4 replies, has 2 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 6 months, 2 weeks ago.

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August 22, 2014 at 11:55 am  #1265549    

awaitingdx

Dear Dr. West and other contributing physicians,

I am a now 32 year old male. 2 years ago at 30 years of age in early March 2012 a 4mm pure GGO was discovered in my right lower lobe of the lung using a CT scan. No other symptoms were discovered (no lymphadenopathy, pleural effusion, coughing, etc.). Later that year in October, I did a repeat scan and the 4 mm pure GGO was still there, with quote: “absolutely no change whatsoever” and no symptoms, either. My pulmonologist said that the “likelihood that this represents cancer is exceedingly small”. However, he recommended a follow-up (3rd) CT scan in 1.6 years to complete the follow-up.

Thank you VERY much for having posted all the great analysis on GGOs. My questions are as follows:

1) The fact that the GGO is still there… that’s a bad thing right? i.e. the fact that the GGO is still there points to nascent cancer?

2) What other diseases could this finding represent? I have absolutely no symptoms associated with any lung disease, so does this fact make it more likely that the GGO represents nascent lung cancer?

3) Aren’t two scans enough? My young age and coupled with the fact that there is absolutely no change whatsoever in the GGO and that cancer is exceedingly unlikely, wouldn’t the third CT scan seem superfluous?

4) Moreover, wouldn’t a 3rd CT scan increase my chance of cancer from exposure to X-rays (ionizing radiation)?

Thank you for any insight you may provide me with!! Note: I’m not asking for medical advice on my case, regardless of how these questions are answered, I will get my 3rd scan anyway :-)

August 22, 2014 at 1:09 pm  #1265550    
JimC Forum Moderator
JimC Forum Moderator

As Dr. West said in your previous thread two years ago, the chance that you have lung cancer at age 30, although not unheard of, is extremely small. Add to that the fact that the nodule did not grow over a seven month period, and those chances diminish even more.

That being said, it is fairly normal practice to rescan but lengthen the scan interval. If there is no change at that point, then it either isn’t cancer or on the small chance it is, the cancer is so indolent as to be unlikely to cause a problem. The danger of the radiation from the scan causing cancer is extremely slight.

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 22, 2014 at 1:20 pm  #1265551    

awaitingdx

Hi, I am sorry for double-posting. I realized now that I asked the same question about 2 years ago and must not have seen the response back then. In any case, thanks again for the informative website!!

January 31, 2018 at 12:39 pm  #1293917    

awaitingdx

Hi,

I’m a 36 yr. old male. I have no respiratory issues.

After the initial January 2012 scan finding the 4 mm pure GGO in my right lower lobe, the 2 subsequent follow-up scans (on 10/12 and 9/14) showed the GGO to be stable, no change whatsoever. Based on these results, on 9/14 the pulmonologist recommended no follow-up is needed based on the 2014 ACCP guideline stating:

“6.5.1. In the individual with a nonsolid (pure
ground glass) nodule measuring _ 5 mm in diameter,
we suggest no further evaluation (Grade 2C).”

Now 6 years after the initial scan (1/12) and roughly 3.5 years after the final scan (9/14), I asked simply for confirmation that nothing further needs to be done with this. The doctor responded that the recommendation cited above is 2C and therefore not based on very solid data. So he now suggests doing a CT scan again just to be cautious and make sure it’s not a rare very slow growing nodule.

1) Does it make sense to do this scan given the radiation exposure? It would be my 4th in 6 years.

2) Could this still be cancer even though I did a 2.5 year follow-up and all was reportedly stable?

3) Should I get the scan?

Thanks for your help!

February 2, 2018 at 6:08 am  #1293918    
JimC Forum Moderator
JimC Forum Moderator

Hi awaitingdx,

There are two methods of judging progression of a cancer or suspected cancer – change over time on follow-up scans, and clinical evidence. In your case, the GGO was followed without change for a lengthy period, and during that time and in the three and a half years since your most recent scan, you have not experienced symptoms consistent with a progressing cancer. In light of those factors, plus your age and the fact that GGOs often do not represent cancer, it seems even less likely that this is cancer.

That being said, we cannot advise whether you should have the scan, but I do think that a concern about radiation exposure should not be a factor in your decision. Dr. Weiss discussed this issue here.

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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