Background: Stage 1a adeno survivor 4 years 8 months. Vats surgery LRL. 3 months ago something changed on my CT scan 2 closely apposed cavitary lesions. largest is 1.9cm. PET done greatest SUV was 1.6 the other wasn't even noted on the report. CT follow up 3 months later. I was hoping it was due to inflamation or infection, but doctor said it would be gone by this scan if that was the case.
This follow up showed no change is size or morphology from prior examination. Suggests that because of low SUV from PET, CT in another 3 months is recommended.
My question is what length of time of no change will they not watch it so closely, or move scans back to yearly or 6 months? Or what will make them decide to do surgery and remove them?
My concern is that I also have BRAC 1 mutation and I know it may sound strange but I worry about the radiation I am exposed to.
Reply # - May 8, 2013, 09:25 AM
Reply To: stable for 3 months
Hello,
If there's no growth and the SUV stays low, I'm sure you won't go much longer befrore your doctor decides to lengthen the interval between scans. If at some point there is concern about these lesions, I would expect that your doctor would recommend a biopsy before subjecting you to surgery, especially since most recurrences tend to occur a lot sooner than this. There are a couple good posts on follow-up after surgery here:
http://cancergrace.org/lung/2011/08/19/when-do-recurrences-of-lung-canc…
http://cancergrace.org/lung/2008/08/10/fu-after-resection/
Although your concern about radiation is understandable, the risk of disease from radiation exposure is outweighed by the need to keep tabs on possible recurrences or new cancer. You can read about the risks in Dr. Manning's post here: http://cancergrace.org/cancer-101/2012/06/21/radiation-exposure-from-me…
And Dr. West had this to say:
"In the face of an existing cancer that needs to be followed, I would say that concerns about radiation exposure are almost always misplaced. The risks of radiation-induced problems are so unlikely that they border on theoretical rather than real, and the risks of not attending to a growing cancer in a timely way are almost certainly far, far greater." - http://cancergrace.org/topic/looking-for-alternatives/page/2/#post-1250…
Good luck with your next scan.
JimC
Forum moderator
Reply # - May 8, 2013, 10:50 PM
Reply To: stable for 3 months
I really agree with Jim's comments here. It's a judgment call about when to increase the interval between scans, as well as when to intervene with a biopsy or surgery. However, we often gradually increase the interval between scans after 6-12 months of stability, and interval growth is often the trigger for a biopsy or resection to clarify the diagnosis.
Good luck.
-Dr. West
Reply # - May 9, 2013, 04:07 AM
Reply To: stable for 3 months
thank you for your help. So I should assume no change is a good thing. Last scan they said it was consistent with small tumor, slow growing or infection or inflamation. Since there is no change is it a safe assumption to think it may not be a cancer at this point? Also how slow growing is BAC (I guess that what it would be if it is slow growing). I thought I read somewhere that adeno can double the size in 180 days or so.
Do these things stay around for ever or do they eventually turn to cancer especially do to the size?
Reply # - May 9, 2013, 11:17 AM
Reply To: stable for 3 months
No change is consistent with a nodule that isn't cancer or as you've noted cancer that's very indolent. However if it isn't cancer it won't become cancer later. You're right no change is good.
Like all cancer BAC has a range of aggressiveness. It can be so indolent that it isn't even life threatening but on the other end of the spectrum it can move quickly. When you look at large numbers of people you find a median that doesn't really apply to an individual, individuals fall anywhere on that spectrum, rarely squarely in the middle. My husband for example has/had an extremely indolent squamous cell nsclc that falls well in the outlier field of squamous.
Guessing is something we all do, me more than others. But it's impossible to know what's going on until the suspicious spot has had time to declare itself, or not Unfortunately that is an extremely difficult process to move through.
I look forward to hearing good news.
Reply # - May 9, 2013, 04:29 PM
Reply To: stable for 3 months
Janine provides really sound advice here. Essentially, stability is obviously great to see, as it suggests either a benign (non-cancer) diagnosis or a very indolent cancer. Janine also noted the huge variability in what we see with lung cancer, and you're right to point out that the slowest growing lung cancers are often bronchioloalveolar carcinoma (BAC), other subtypes can also show a range of paces of growth. Finally, while it's possible that a nodule can change its behavior and start growing after being stable for a year or longer, or change from very indolent to faster paced after a long period of observation, the most common pattern we see is that something stable or growing very slowly tends to follow that same trajectory over a long time, and sometimes a very slow-growing cancer may need no intervention at all if it's so slow-moving that it would take decades to have any real clinical impact.
Good luck.
-Dr. West