Will a PET Scan Show what it should if Nodule is Dormant?

Portal Forums Cancer Basics Imaging Issues Will a PET Scan Show what it should if Nodule is Dormant?

This topic contains 8 replies, has 3 voices, and was last updated by  johnnyseville 3 months, 4 weeks ago.

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February 17, 2018 at 1:28 pm  #1293974    

johnnyseville

I have an autoimmune disease, Sjogrens. I also have a Pulmonary issue called Chronic Eosinophilic Pneumonitis caused by Sjogrens causing shortness of breath and lung inflammation which started in 2015. The scans done by the radiology company who did the report missed the nodule and subsequent growth, but this is a new report done by a University Medical Center who re-read my scans. Scan of 11/2015 showed 8mm nodule plus lots of opacities due to eosinophils,( original report showed nothing) next scan 7/2016 showed nodule 1.4 cm ( original report showed nothing and stated stable eosinophils). No need to keep doing scans since they found nothing. In july 2017 I had abdominal surgery done for perforation of colon due to steroid.use for eosinophils. In Dec we followed up with a CT scan, showed lungs also, now they see a nodule 1.4 cm spiculated. From 7/16 to 12/17 there has been NO growth of the nodule, they state it is DORMANT. Now they want to do a PET scan. Will this show what this type of scan should. If it is cancer will it show up as cancer due to the fact of dormancy and lots of inflammation due to eosinophils., also has it spread if it is cancer. Will it be conclusive or should we be doing another type of test. THe docs said doing a biopsy would be tough due to its location, might be easier to just take it out. .Most information I have read online states it may not show up properly since it is not acting like cancer, ie fast growth. What test do you recommend?

February 18, 2018 at 7:48 am  #1293978    
catdander forum moderator
catdander forum moderator

Hi Johnny,

Welcome to Grace. I’m sorry you’re having such a difficult time. A PET scan is most often given with a CT so the CT will show the nodule and the PET part of the scan will show whether or not the nodule is quite molecularly active or not. Since there are other things besides cancer that are this active it’s not possible to say if it’s cancer, inflammation or infection. The only way to say if something is cancer or not is with a biopsy. If a nodule isn’t growing or causing problems most doctors want to leave is alone because surgery or even any type of biopsy is invasive and can cause much more damage than good.

Most people with lung problems or who are or were smokers or who are older have lung nodules that don’t grow or cause problems. I don’t know what your radiologist meant by dormant but maybe she meant non-cancerous. Most lung cancers and especially those that will cause issues are growing and will show activity on a PET.

Lastly if a person has a non growing lung nodule that isn’t causing issues a wait and see (with CT) approach is the gold standard.

Here is a “Primer on PET Scans”. Though written 10 years ago it’s still relevant. http://cancergrace.org/cancer-101/2010/09/14/cancer-101-faq-primer-on-pet-scans/

I hope you do well moving forward.

February 18, 2018 at 11:38 am  #1293989    

johnnyseville

Hi CatDander!

I am extremely grateful for your response! I agree with you 100%, unfortunately the doctors do not! I am perfectly fine in leaving thing alone if the nodule leaves me alone. At this time the nodule has not grown at all since July 2016, the radiologist termed it “dormant” since he stated it is stuck in cell cycle arrest. I have a few doctors involved in this and they are leaning toward a biopsy. I have been told it is in a bad location and would be difficult to biopsy and perhaps removal might be an alternative. I have a veterinary oncologist who has treated my dogs, he always said, if a primary tumor is not causing problems or growing, leave it alone, because tampering with it is like opening Pandoras Box. He said it is not uncommon that once your remove the primary tumor all the daughter cells will begin to grow and you are lost, since it is the primary tumor that keeps them from growing. I think he knows more than any of the doctors I have on my case. It may very well be inflammation since it appeared at the same time my lungs developed the Eosinophils, which are highly inflammatory. I know tampering with it may make me regret doing that. I have no issues with keeping tabs on it with ongoing CAT scans and even periodic PET scans, far enough apart, since I have a radiation phobia. If things change and it begins to grow, then I will have no choice but to possibly remove it by surgery or radiosurgery and deal with whatever comes of it

I am an open minded person, so if someone else has an opposing view, I would be happy to hear of it. Even if you agree with CatDander your view is welcome here. This is my first time on this site and I am very impressed by the knowledgeable members here, since I have read many of the responses to questions,not only by the doctors,but also by non medical members. I feel very fortunate having found this site and becoming a member. Thank you for having me!

John

February 18, 2018 at 3:53 pm  #1293994    
JimC Forum Moderator
JimC Forum Moderator

Hi John,

I agree completely with Janine, that watchful waiting is most often the choice in this type of situation. Even in a case of a proven lung cancer diagnosis which has been treated, leaving only one small, non-progressing nodule, further treatment is often withheld until there is evidence of significant growth.

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 19, 2018 at 7:46 am  #1294002    

johnnyseville

Hi JimC,

Thank you very much for adding to CatDander’s response, coming from 2 very knowledgeable members it seems watch and wait is the way to go. I had mentioned in my initial inquiry that my current Interventional Pulomonologist is requesting I have a PET scan done to cover the possibility that if it is cancer due to the report stating the nodule was spiculated we should check if it has spread, so what is your opinion on having this test done. I know CatDander mentioned that it will not prove conclusively if a spot is cancer since it will also “light up” if it is inflammatory or infectious, in fact my Rheumatologist mentioned she thought it could be inflammatory due to the Eosinophils. Also if I see a number of them in different locations, ie brain, abdominal etc it would definitely signify a malignant nature and I would need to do something about it. So do you think it would be a good idea to follow through with this test?

On a side note, this is directed to JimC.

I was reading your signature and my heart dropped when I came to the passing of your wife. I am so very sorry for that turn of events. It seems to me those that never smoked seem to have a more aggressive cancer for some reason, at least it seems like that to me. As I continued to read I came to the point of Jim and Lisa, by the end I came away with a smile. It is funny how life works, from the ashes rises the Phoenix. Perhaps your better halves are also up above together smiling down on the both of you. I wish you both nothing but the best.
John

February 19, 2018 at 7:47 am  #1294003    

johnnyseville

On a side note, this is directed to JimC.

I was reading your signature and my heart dropped when I came to the passing of your wife. I am so very sorry for that turn of events. It seems to me those that never smoked seem to have a more aggressive cancer for some reason, at least it seems like that to me. As I continued to read I came to the point of Jim and Lisa, by the end I came away with a smile. It is funny how life works, from the ashes rises the Phoenix. Perhaps your better halves are also up above together smiling down on the both of you. I wish you both nothing but the best.

John

February 20, 2018 at 7:23 am  #1294005    
JimC Forum Moderator
JimC Forum Moderator

Hi John,

We can’t make a specific recommendation on whether you should have the PET scan, but here are some factors to consider in making your decision.

The spiculated appearance of the nodule makes it more suspicious for cancer, but the lack of growth over a significant time period leads to the opposite conclusion. As Janine stated, the PET scan will not determine whether the nodule is cancerous, but as your doctor said, the appearance of other “hot spots” on a PET would certainly increase the chance that it is cancer. Finally, a small, non-progressing nodule such as this is less likely to have already spread cancer cells to other locations in the body, especially not to such an extent that those cells would form a nodule that could be seen on a PET.

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 20, 2018 at 7:30 am  #1294006    
JimC Forum Moderator
JimC Forum Moderator

Hi John,

Regarding your side note, both Lisa and I appreciate your comments and good wishes. We realize how incredibly fortunate we have been to find each other through GRACE. The bond between us that formed from our mutual tragedies is very strong and has survived additional adversities in the past six years. In addition to the help GRACE provided us during our late spouses’ battles with cancer, we have a very special reason to be grateful for Dr. West and the GRACE faculty and community.

Thank you again for your thoughts.

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 20, 2018 at 12:48 pm  #1294007    

johnnyseville

Thank you for the information, makes good sense. Seems like each time I see anyone about the nodule they automatically start with wanting a PET scan. Seems easy for them, they do not have to go through the radiation. I have never been big on radiation. I used to be pretty resistant to doing CT scans before this happened, but have eased up a bit about doing those, but still have a phobia about the amount of radiation in a PET scan. I have never done one of those yet and really not in a rush for my first, though I know there will be one in my future.

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