Mom dx'd lung cancer in 1995; lung removed, no chemo or radiation, successfully reached 5 year "cure" mark.
No issues, no smoking since then, but smoked before for 20 years.
Clear chest x-ray in January 2014.
Repeat episodes of bronchitis since February 2014, weight loss of 16 pounds in 3 months (small-framed lady to begin with).
Doc requested lung ct scan (no contrast) last week. Report reads "There is a focal area of oval-shaped nodular pleural thickening, about 1.7 cm in size with overlying groundglass haziness in the lung parenchyma at the right base posteriorly. The etiology and significance of the oval-shaped nodular prominence along the pleura is undetermined. Focal groundglass opacity in the lung parenchyma over this nodule is nonspecific, differential diagnostic considerations would be for BAC (bronchoalveolar carcinoma) or a focal area of airway disease."
Awaiting follow-up meeting with PCP. Pleural thickening concerns me most - if it is cancer, does this indicate the pleura is impacted? Is follow-up in 3 months the best course of action or should there be a more immediate action? Thank you!
Reply # - May 12, 2014, 12:56 PM
Reply To: CT report: 1.7 cm nodule along pleura
Welcome to Grace. I'm so sorry your mom is facing the possibility of cancer again. I hope it's something else. Here Dr. West talks about some of the possible reasons for pleural thickening, "Focal nodular pleural thickening means that there are some specific areas where the lining around the lung is thicker, which could be from inflammation, or infection, or possibly cancer." http://cancergrace.org/forums/index.php?topic=1036.0
He goes on the say this about recurrence vs new primary, " It's also increasingly unlikely to see a recurrence of an old cancer as time passes, particularly more than 3 years out from prior surgery and/or other treatment. It does happen on occasion, but most lung cancer recurrences will be within the first 2-3 years, and after about four years, the likelihood of the old cancer recurring is about the same or less than the likelihood of a new cancer. So the routine scans that we often continue to do even after 4-5 years is as much or more to screen for a new cancer than expecting to detect a recurrence of a lung cancer treated many years earlier."
We have tons on info on BAC if that becomes the issue. Many forms are very indolent and can be treated for the long term.
Otherwise, what a cancerous pleural thickening means is unclear to me so I'll ask a doctor to share info.
Again, I hope this isn't cancer and can resolve itself.
All best,
Janine
Reply # - May 12, 2014, 01:00 PM
Reply To: CT report: 1.7 cm nodule along pleura
Thank you, Janine! I read some of Dr. West's previous info on focal nodular pleural thickening and am interested in hearing what he or another doctor might think about these specifics. This is a great forum for sharing information.
Reply # - May 12, 2014, 02:46 PM
Reply To: CT report: 1.7 cm nodule along pleura
I would completely agree with the comments from Dr. West that a recurrence of the original lung cancer would be unusual at this point. It sounds like this is most likely inflammation from either an active or resolving infection, and this has led to the groundglass haziness in the lung and the pleura is reacting to this process. Was she having fevers and a productive cough during these bouts of brochiolitis? If so, did the symptoms get better with antibiotics? The weight loss is certainly concerning, but that can happen with an infection as well as cancer. Is she still losing weight? So much of what to do next depends on what this actually looks like on the scan. It is described as oval-shaped and 1.7 cm in size, so it may be possible to consider biopsying this, though usually a biopsy is not possible just with pleural thickening and haziness. Most likely follow up with CT imaging would be the next step, and a three month interval for a scan is reasonable, but whether do scan sooner or push for biopsy would depend upon how sick she is whether it is felt an infectious etiology is likely.
Reply # - May 12, 2014, 03:06 PM
Reply To: CT report: 1.7 cm nodule along pleura
Thank you, Dr. Evans! She was not having fevers but did have a productive cough (no blood) with her bouts of illness, and did seem to respond well to antibiotics before having a recurrence. She has not gained weight and may have lost another 2-3 pounds but she wasn't actively monitoring until this weekend so the difference may be due to using the scale at her doctor's office vs. her scale at home. She feels well now and has regained most of her strength since the illnesses. Hoping to follow-up with her PCP very soon to review the images. Thanks again.