Diagnosed with 2.6 cm nodule - 1263412

Hi Jeff, welcome to Grace. Short Story , right, ;) I admire a person with a sense of humor about their cancer, at least an initial post on a public forum. I'm sorry but we can't say what someone should do. While not everything is opinion it does depend on lots of individual facts.

The standard of care for a nodule found in the lung not causing trouble is to watch and see if it grows. So the question is did it grow between the 2 CTs and how likely is it a metastasis from the kidney. Many people and most ex smokers have lung nodules that are benign. 6 months from now does sound long for someone with recent kidney cancer. Know too that CT without contrast tells multitudes more than an xray and is considered appropriate work up tool for someone with lowered kidney function.

I'll ask a specialist to comment.

All the best and hoping for a benign process,
Janine

Hi jeff,

We can't tell you what you should do (that's beyond the scope of what GRACE can do legally), but we can provide information on some of the considerations involved in deciding on your next step.

If I read your post correctly, you had a CT in March which showed your lungs were clear, but that another CT just a couple weeks later revealed the nodule. That's very fast for cancer growth, but at times cancer does surprising things. You may want to read Dr. West's post on solitary pulmonary nodules for some background information which can help you understand how doctors decide what to do about such nodules: http://cancergrace.org/lung/2007/11/10/risk-of-ca-among-spns/

Is the choice really between seeing the specialist and waiting six months for another scan? Instead, is it possible to consult with the specialist and then based on what he/she says, decide whether to opt for further follow-up or wait six months for another CT? Looking at it that way, the consultation with the specialist is more in the nature of a second opinion, and that's never a bad choice.

JimC
Forum moderator

I would only add that I have pretty close to no faith in a chest x-ray compared with a chest CT. The whole story doesn't make much sense, and I'd say it's almost unfathomable (or at least very unlikely) to have a cancer grow from nothing to 2.6 cm in a month's time. I think it'd be reasonable to repeat a scan, perhaps in less time than 6 months (that's really a matter of debate), but I will just reiterate that I find that chest x-rays provide misinformation almost as often as they provide helpful information and are a very inferior substitute for a CT.

And one more point is that a non-contrast chest CT would be exceptionally likely to provide a very clear answer of whether there's a 2.6 cm nodule or not, with no risk to kidney function.\

Good luck.

-Dr. West

Just to be clear, I'm assuming that the last 3 references in your post to "Aug 14 scans" actually refer to the March 2014 scans. And it seems that you're saying that the CT in March 2014 showed no nodule, while an x-ray a couple of weeks later revealed it. Given the much higher resolution and three-dimensional nature of CT scans, it seems extremely unlikely that the CT would have missed a 2.6mm nodule. In that sense, it doesn't seem likely that the nodule appeared over the course of 6-7 months, but rather in the interval between the two scans in March. As Dr. West stated, chest x-rays can provide a great deal of misinformation, so between the short interval over which the "nodule" appeared and the unlikelihood that cancer could grow that quickly, cancer seems the less likely diagnosis. And I hope that's true!

JimC
Forum moderator

Jeff, Thanks for the clarification. Unfortunately it's much more likely that cancer grows 2 to 3 cm in a 6 month time frame making the nodule more worrisome though still very possible it's something else. Otherwise a 2.6 cm mass grown in just a month or 2 is likely to be inflammation or infection. I like the idea of an earlier scan or if your doc is not agreeable to CT scanning sooner, say 3 months, a 2nd opinion is never a bad idea. Dr. Weiss wrote an excellent blog post on the subject, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…

Use that sense of humor to stay sane and we'll be here when you have questions or just want to vent (even without the jokes :wink: )

Janine

I would think any finding that is 2.6cm needs follow-up earlier than six months since you've already had and been treated for RCC. I'd definitely get a second opinion. Good luck!
Take care, Judy

I think we would be vigilant about any new or growing nodule and favor either a biopsy or closer follow-up than a 6 month repeat scan.

-Dr. West