stupid question, maybe and update - 1261655

Hi catnapt,

I have to gently disagree with you on two points:

First, there aren't any stupid questions here. It's possible to ask an inappropriate question (one beyond the scope of what the GRACE faculty can answer), but you haven't done that.

On the other hand, it's a question without a definite answer, because it's not just a question of the size of a lung mass, but also its location. A relatively small mass in a sensitive location can cause symptoms that the same size mass wouldn't in another spot.

Second, updates are always welcome in this forum. GRACE is not only a place where you can get definitive answers to cancer questions from oncologists and other cancer experts, but it's also a community of people - patients, caregivers, loved ones - who are on the same journey. Many of us have followed each other's journey for quite a while, so you should never feel that no one is interested.

I'm sorry to hear of the devastation lung cancer and other cancers have visited upon your family. It has hurt me personally in several instances in the "real" world, and many times among my friends here on GRACE, so I understand how heartbroken you must feel.

As you say it is most likely that smoking is the primary cause of your family members' lung cancer, but it's also possible there is a genetic predisposition to cancer in your family. You might find Dr. West's post (and the quoted links) on this subject helpful: http://cancergrace.org/forums/index.php?topic=6158.msg42160#msg42160

JimC
Forum moderator

Jim provided a wonderful summary of a complex situation. There really is no threshold size of a nodule or mass to cause symptoms, because location is enormously important. Most small cancers (say, under 2-3 cm) are detected either because they happened to be found in someone who underwent imaging for a separate reason (such as belly films in the ER for abdominal pain that happened to pick up a spot in the bottom of the lung) or because the cancer was next to a blood vessel and bronchial branch that led to coughing up blood. While coughing up blood isn't a good thing, it tends to bring people right to the doctor, sometimes leading to an early diagnosis of a small but particularly located tumor. Others can grow to baseball sized or larger before causing clear symptoms if they happen to be in the wrong location -- and since many people in whom lung cancer develops also have pre-existing shortness of breath and/or cough from COPD, etc., they may take a long time to clearly sense that something is worse.

It's always possible that you have a familial predisposition to cancer, that's not remotely common, and there's really no plausible basis to the "weak lungs in the family" general idea. I don't mean to minimize that as a crazy idea, but mostly to reassure you that I can't envision that being true.

-Dr. West

Most lung cancer is not detected until it causes symptoms. At that point it is usually advanced (stage III or IV) and cure is unlikely or impossible. So it's not a good idea to wait for symptoms.

I understand the anxiety you feel about scanning; there is even a term for it: "scanxiety". But a potential lung cancer should not be ignored. Please try not to imagine the scenarios you describe (finding another tiny nodule, etc.) At the very least it would be advisable to get one more scan to see what shows up and whether the existing nodule has grown. You don't want to get scans needlessly, but in this case the scan is necessary.

Good luck.

JimC
Forum moderator

There's no limit to the amount of CT scans that would be appropriate and should be covered if there is a clear need for it. We do want to be judicious about not doing too many, especially over a long time, but we also don't want to do too few. And we should expect that the scans will only involve less radiation over time.

-Dr. West

Hi, I'm new here and have been browsing around this site for hours, came across this forum and seemed liked a good place for my first post. 2 yrs ago I had a chest scan, I thought just routine and paid no attention to it. The doctor was trying to show me something on the scan, but I could not see it, emphezema runs in my family, sadly to say my sister, mother and grandfather Al dies of it and on my fathers side lung cancer and other cancers ran rapid. Only 1 out of 1 children are alive today ok back to me. My doc wanted me to have another chest scan so I had one 3 weeks ago and have an apt. With her tomorrow. She called me this past Monday and told me the scan showed another nodule, so now I have 2, don't know sizes yet but wild Friday. I was also looking thru some reports of tests I had and came across a scan from 2008 when I was in the hosp for another ailment and it said lung bases demonstrates mild dependent bibasilar atelectasis. No one ever mentioned this to me and the other day was the first time I was seeing it. Needless to say I have been researching lung nodules and this condition of my lung bases.
If I understand what it says about my lung bases is that the lower part of both lungs are collapsed? Do that correct itself. And the lung nodules (now) having a new one) my doc said on the phone she would like to do another scan in 6 mos; and see what it shows. She thinks it is emphezema. Personally I would like to have a pet scan. I wild be a nervous wreck waiting 6 months to see if I have Lung cancer or not.I smoke, and that is crazy with what I saw my family go thru. My doc mentioned to me she ends to make me stop smoking. We have talked about it but I have not stopped. Del not emotionally ready for it, but can be scared into it. Can anyone suggest questions I should ask my doc tomorrow, and what tests I need and should ask for so I can know what is going on with me? Any input would be greatly appreciated.
Lynn

Atalectasis is a limited area of collapse within the lung, but it's very common, and typically not a big deal. It's kind of like the end of a long, thin balloon not blowing up, because there's not quite enough air getting in to inflate the furthest reaches of the airways. So "collapse" sounds worse than it's likely to be if it's more likely just a small, limited area that isn't well inflated. It's also possible for that to look like a nodule.

As for a PET scan, that can sometimes be appropriate, but it really depends on the size and appearance of the nodules. PET scans aren't likely to light up nodules below about 8-10 mm, even if they're cancer, because they're just too small, so there's little point in doing a PET scan to better characterize nodules that small.

And because benign nodules are just very common, it's very appropriate to follow them over time to see if they remain stable or go away before launching into a bigger workup. Yes, it's understandable that this produces anxiety, but it's also just an unfortunate part of CT scans that needs to be factored into the risks and benefits, because we can't do potentially more dangerous invasive procedures just to reduce anxiety.

If it helps, please remember that small lung nodules are very common and most commonly benign.

Good luck.

-Dr. West

I hope you can find some peace about your brother's passing. Please accept my condolences.

At least your own lung nodule sounds like it's very likely to be benign. I hope your scans continue to be favorable.

-Dr. West

catnapt,

I too am very sorry to hear of your brother's passing, and I hope that time will help bring peace and comfort to you and your family.

JimC
Forum moderator

That's a very wise philosophy. Always good to share/vent.

-Dr. West