I Have 4 sub-centimeter ground glass nodules in my right lung and 2 mm, 3 mm and 18 mm nodules in left lung. Ground glass "focus" at base of left lung is less apparent, and diffuse and con fluent ground glass opacities also on the left after second scan. Some nodules were no longer visible, smaller, stable or unchanged with improvement of left lung "activity" after first scan. Bronchoscopy washings all negative for malignancies, both needle biopsies positive for adenocarcinoma. No involvement anywhere else. Just finished 4 cycles of carbo/taxol/avastin. What I'm not clear about is what all the ground glass features mean. Every "definition" I find defines it with something like bronchograms, consolidation, solid, partly solid, pure, attenuation, I'll-defined and other unfamiliar terms. I am looking for feedback because I am getting ready to begin maintenance, but I have no idea what "ground glass" nodules or opacities mean in terms of my treatment. I have already had a rather toxic regimen after which I am considered "stable". Any others have similar lungs? I have never heard the word tumor, mass, lesion in discussions of what's going on in there, and I wonder if additional irreversible lung damage can be done because I have had chest pressure when I breathe deeply and shortness of breath after minimal activity. (Already checked for anemia, pulmonary embolism, etc. ) Thanks for your input.
Ground glass? - 1270126
cindy121
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Reply # - June 15, 2015, 07:43 AM
HI Cindy,
HI Cindy,
Welcome to GRACE. It's good to hear that you are stable after treatment, and that some of your nodules are no longer visible or have reduced in size. As far as the terminology you've heard, the terms nodule, tumor, mass and lesion tend to be interchangeable, although "mass" and "tumor" tend to be used with larger findings while "nodule" and "lesion" usually refer to smaller spots.
The terms used to describe ground glass opacities (GGOs) are somewhat vague because they tend to be less solid and more hazy than other nodules. You could view it as the difference between falling snow, with varying amounts of space between the snowflakes, and a tightly packed snowball. It's all the same stuff, but there's a difference in how fully developed it is.
The important difference in lung cancer is that less well-formed the cancer cells are, the slower they may be to grow and spread. Dr. West, a leading expert on this type of lung cancer, has written a number of posts on this subject, and he often points out that if the cancer is slow-growing there is a risk of over-treating it. You can read a couple of his posts here:
http://cancergrace.org/lung/2010/03/02/watching-ggos-over-time/
http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/
JimC
Forum moderator
Reply # - June 15, 2015, 09:36 AM
Jim, That is very interesting
Jim, That is very interesting and definitely does address the confusion I was trying to explain in my post. My first biopsy was conclusive for adenocarcinoma, and I was staged at IV when the other lung biopsy got insufficient tissue, but further slides, tests and comparisons diagnosed the second lung as adenocarcinoma also. My diagnosis is listed as metas tic lung cancer. Are "in situ" ground glass nodules and opacities not biopsied to confirm that they are or are not cancerous. Likewise, if both of mine HAVE been biopsied and determined to be cancerous, isn't chemotherapy treatment "standard" treatment? It sounds like even some biopsied patients have chosen a "wait and see" approach (to surgery at least), but I was a candidate for surgery when it was just the one lung, but both lungs, even with no activity in lymph nodes, adrenals, pleura, etc. made me ineligible for any kind of surgery. (The other lung is considered a met?) I have had the question of "over treatment" causing lung damage in the back of my mind (with the rest of my ongoing confusion and questions). Trusting my oncologist is imperative in this process, but every patient must question every treatment variation after hearing repeatedly that disease variations are as numerous as the number of patients.
Reply # - June 16, 2015, 10:22 AM
Cindy,
Cindy,
I'm very sorry about your diagnosis and your confusion. Unfortunately when there is cancer in both lungs one is considered to be a metastasis and so would be considered stage IV. I see you stated there were 2 positive biopsies. If cancer was positively biopsied in each lung there shouldn't be a question of cancer stage. However if the positive biopsy was in just the one side then there still may be a question of whether or not this is truly stage IV. If there is biopsied proof of nsclc in one lung and in the other lung there is a nodule that slides, tests and comparisons seem to show the same cancer then in the overwhelming majority it's proven to be cancer. Sometimes that proof comes with time if a biopsy isn't possible.
Once metastatic cancer has been diagnosed biopsies are only taken for identifying genes and other mutations that may change treatment, such as EGFR, ALK, ROS1 that have approved drugs that extend both life quality and longevity.
Once nsclc is determined to be metastatic surgery is usually not considered of benefit. If early stage cancer can be cured then surgery and maybe chemo and radiation can cure the body of the cancer. If there are mets then the cancer is believed to be in the blood and or lymph systems in micro mets and individual cells that will take hold somewhere and grow. Taking tissue from the lung and the considerable risks of doing so is not considered beneficial at this point.
Treatment for quality and longevity are the endpoints of all treatment with stage IV nsclc.
If you're not sure the diagnosis or treatment plan is right for you then there should be no reason not to get a second opinion. Dr. Weiss has written an excellent post on the subject, http://cancergrace.org/cancer-101/2011/11/13/an-insider%E2%80%99s-guide…
About maintenance treatment, http://cancergrace.org/lung/tag/maintenance-chemotherapy/
I hope some of this is helpful.
Janine