9mm lung nodule and lytic rib lesion - 1268659

Thanks for the encouraging response. Now more tests to find out what both things are. Best case we are hoping for benign 9mm and the rib is something also benign. Just scary when there are 2 findings together. On CT quite a large length of the rib is involved.

Update as of 3/14/15: 2nd Ct scan of chest reported a 1.1cm nodule in other lung and hiatal hernia. Bone scan reported only the 1 expansile lytic rib lesion. Went to Boston for consultation, were thrown a curve ball when their dr/radiologists told us, they suspect possible esophageal cancer. That was not reported on any other tests and we were not prepared for that added news! However, hubby has been having problems in that area for at least 6 mos and I've been trying to get him to ENT for swallowing issues, so it's not totally new news, but had no idea of possible EC. Onto PET scan soon and GI endoscopy.

It's a little unsettling to uncover so many things at same time, still hoping they are all unrelated, but scared!

Now fighting ins who denied pet scan. Dr wants pet b4 endoscope biop because the info from pet will help guide where to take biop and if biop done first that will cause biop site to light up on pet. However ins is denying stating he's not had a biop of cancer yet and so won't approve pet. Ugh! So frustrating that nothing is getting done.

Ins denied once, denied on peer to peer and denied first appeal. Dr is doing 2nd appeal.

Sorry had to vent!

Well insurance company won, we had to get upper GI EUS done first, and as suspected GI dr is saying 90% chance its esophageal cancer T4. They biopsied it along with one lymph node. Now ins will probably allow PET after biopsy results come back. So scared.

Thanks for all the responses of hope.

Update 4/8/15, confirmed stage IV esophageal cancer, adeno, G3. Waiting on brain MRI. Confirmed met to rib. Getting chemo port put in next wed. Waiting her2 status.

Still feel like I'm in a nightmare and will wake up soon.

Also going to chemo class next week. Dr said he will get 5fu, will get more details next week.

Praying we can beat this beast for as long as possible.

Thanks so much Janine, I remember doing those screams when my Mom had cancer. Lately I listen to my favorite keep me going song "strong enough" by Matthew West.

Chemo starts next week Wed. Will be folfox with 5fu pump 2 days at home - every 2 weeks. Not sure what to expect, don't know anyone whose had chemo. Guess we will be learning lots.

Thanks again for your response.

Hi, slight delay in chemo due to little skin infection near chemo port. Starting the 29th now.

Was reading endoscopy report . . . have a couple questions.

Mass found from 37cm to GEJ at 41cm, appeared to extend to castric cardiac. Bx taken of cardia component separately. What is castric cardia?

Several perigastric nodes were seen. These were round, well defined and hypoechoic. What does this mean?

Thanks.

Update 6/15/15:
Completed 3 rounds of folfox with 5fu pump at home for 2 days. Tolerating chemo pretty well, has the cold issues and slight numbness in hands and feet for 5 days or so following. After first round of chemo, hubby ended up in the hospital due to passing out, guess we learned real quick about hydration!! Funny thing is, he's got practically no issues swallowing except a pill here or there. Also no pain from the rib lesion. So thats all good.

Getting scans on 7/1 after 4th chemo to see whats going on.

Last few days developed a hoarse voice, so hoping thats just a cold and not something spreading. Also got a bad flare up of his gout in wrist, can't even move it at all. That usually passes in a few days.

Very curious what will happen after these 6 rounds, guess it all depends on those scans. If things are good, perhaps a little chemo break? If things are bad, we will see what is suggested.

Will update after 7/1.

Update 7/2/15:
Completed 4 rounds of folfox with 5fu pump, we believe the hoarse voice was from thrush infection got a prescript for that which is helping.

Got CT scans and were pleasantly surprised with a good reduction in tumor size (40%+). Plan from our oncologist at MGH is to continue with folfox. 4 more rounds and another scan.

Only issue with blood work is platelets continue to drop, presently below 150. Eventually those could cause a delay in one or more chemo treatments. But thats really not bad for overall experience with this folfox. The hands/feet numbness and problems with cold continue, but subside after 4-5 days post chemo.

Maybe with enough tumor reduction, there could be a chemo holiday of a month or two in the future. This esophageal cancer is well nick named as "the beast".

For now we will relax with this good news that this chemo is working.

Waiting for results of next scans after 8 rounds of folfox. Looking at older ct RPT, can anyone tell me what neoplastic etiology means?

IMPRESSION:
Indeterminate 2 to 8 mm noncalcified bilateral scattered pulmonary nodules. The differential diagnosis would include neoplastic etiology, noncalcified granulomas, and intraparenchymal lymph nodes.

Thanks!

Update scans from Aug 20, 2015 show everything is stable, nothing new to report. Dr. says stable is good, however it's scarey, makes you wonder does this mean next will be progression, it's nerve wracking! Chemo #10 was completed. Some blood counts are moving too low like RBC and BUN. But was given ok for chemo, so guess they aren't too far off yet. This past week has seen some symptoms return, first the rib pain is back, he's got tumor in 5th and 7th ribs that were reported more sclerotic and less lytic, they had not been given any pain up to last week. Stabbing pain when he rolls out of bed, but it goes away quickly. A little more trouble swallowing pills and chocked on scrambled eggs yesterday am. Additionally the constant throat clearing which had gone away is back a lot of the time. Also a fair amount of coughing. All of these things make us nervous of progression. Will mention on 9/23 at chemo appt. :-(

Can't figure out how to get the signature with history on my ID, any link to how to do that?

Update after 12 rounds of folfox, ct scans on Oct 11 15 showed everything previously noted is stable. But it did note a new finding:

There is new patchy ground glass opacity in the posterior aspect of the right upper lobe maybe represent a focal area of infection or aspiration.

Wish they would have mentioned the size of this new area. Waiting to get ct images and try to find it.

But since all else is stable, going onward for chemo 13-16.

Update Dec-9-15: Completed 16 rounds of folfox with 5-fu pump. Waiting re-staging scans fri Dec-11.

Hubby was having severe issues with dexa, rage and extreme agitation episodes. He was taken off the dexa for chemo #15 and it is the first time he got sick, developed horrible chills on way home from hospital and was throwing up in the car, had fevers for 3 days. So for chemo #16, the dr thought lets chance it again, maybe coincidentally he had some bug during the prior session.

So chemo #16 starts and before the oxiliplatin is done infusing, he starts with the same horrible teeth chattering chills, they stopped the bag. He said he was not nauseous just chilly. They hooked up 5-fu pump and we tried to go home. In lobby of hosp he got real sick again. He looked so weak, that I put him in a wheel chair and brought him back upstairs to infusion center. In there he passed out and they did an EKG, after which he passed out again with seizure like movements of head and arm, they stopped 5-fu and went into emergency mode. After many many tests, all looked ok, they assume hes now become allergic to the chemo.

Going to allergy testing Dec 16. He's very weak still even 1 week after all this. Worried.

Janine, thanks for the response. Was thinking hubby made it thru 14 cycles with dexa without issue. Its too coincidental that the 2 where dexa was skipped, he had issues. In any event, he will be allergy tested to see if skin test is positive. His Esophageal Cancer is being kept at bay, but not shrinking, so I'm not sure what next steps will be. I believe they are talking to use the desensitize option, they don't want to stop this drug before they absolutely need to. Will update in a few weeks.

Ok got ct scan results. I've spent some time comparing to last 5 sets of scans. I'm nervous that things look ever so slightly progressed.

But what is strange, I see something new that was not on any prior scans all the way back to last Feb. It's in bottom of left lung and its shaped like a mini tornado, very long stringy thin part going to a thicker base. I'd say 6mm at widest, and perhaps as long as 19mm. It's not white, it's got same looks as other soft tissue looks in that area. Are tumors always round?

Waiting is the hardest part, won't see onc til Dec 18th. Hopefully it's something else weird showing up.

Thanks so much for the response Jim, yes, I understand that I may not have the same slice on current CT matching properly with same slice on previous CT. I've looked at every set up to now and I was correct there was no progression in the last 4 scans. This new item shows up in many slides for the length of it, in the 1.00 slices it shows up in about 19 slides, it was not in any of those last 5 scans. It did not exist in any view before axil or sag or cor. But its in all of them for this set. He did have the issue of a seizure and they took a chest xray 2 weeks ago and at that time, it noted reduced lung volume then, who knows maybe it's a side effect of the episode and will go away. Thanks again for your response. Cheryl

Skin testing was negative for oxiliplatin, but Dr says negative doesn't mean not allergic, just means skin testing didn't cause a reaction.

I see this on ct scan report online: Tiny hepatic hypodensity too small to definitively characterize but somewhat concerning as it is new or more conspicuous than prior. Esophagus and rib unchanged.

Found chest X-ray report which states the following: Patchy opacities appreciated at the left lung base, may represent atelectasis, aspiration or pneumonia. This is what I'm seeing in lung.

Still waiting for chest ct report.

Meeting with Onc Fri to see how we will proceed.

CT chest report: There are new nodules in the left lower lobe, along the right major fissure and in the left lung base measuring up to 4 mm. Impression: Indeterminate new lung nodules. The possibilities include inflamatory nodules and metastases.

Are new nodules a sign chemo has failed? Time for trying new chemo?

Met with Onc today, since all new findings are tiny and known cancer locations are unchanged, we will continue with folfox until absolutely necessary to move off it. Plan is inpatient desensitizing infusion for next round, awaiting date from hospital.

Meanwhile on NBC nightly news last night was a segment on EC. Getting word out there, new cases are growing at alarming rate.

Chemo sessions #17,18,19 folfox
Drs are thinking oxiliplatin allergy, did inpatient desensitizing folfox, added back steroid (prednisone). Bad agitation attacks came back, had 2 just now.

Last scans in Dec 2015 showed new lung nodules and new concerning spot in liver. Since all are new and tiny, waiting for next scans after #20.

Hubby getting tired of it all. I just don't know how to help him.

Thanks for reading.

Thanks Janine, hubby always feels like its time to stop when he's having one of these attacks. But afterwards his mind is set to continue and fight it with more Chemo. He's usually nervous to report any side effects because he's afraid they will stop this first line of folfox. But then again in the throws of bad reactions, he's saying he wants to stop. It's such a double edge sword. On one hand he knows the treatments have given him these past 10 months with relatively no issues from his esophageal cancer, just dealing with chemo side effects. On the other hand he just waiting for the other shoe to drop and for the folfox to stop working and that's got him really on edge. When my Mom had terminal cancer back in 2011, it was such a different experience, she was accepting and happy go lucky. I'm still struggling that he's struggling so bad. So tough. Cancer sucks.

I've been charting hubbys ALC, AMC, NLR, PLR & ANC since last April. Recently for the last 2 blood works done before chemo, his:
PLR has doubled from around 100, to now around 200
NLR shot up to over 5 (from 3 or less).
ALC cut in half (from around 1500 to 800).

Not sure what any of that means other than those ranges are in the "higher risk" ranges and its making me worry that progression will be the topic for next scans coming around week of Feb 15th. Although he's still symptom free from the esophageal cancer itself (thank goodness for some blessing).

Day by day.

Hubby has been getting severe panic attacks the day after chemo. They tried chemo without dexa steroid and that caused worse issues. Now doing prednisone and still having the attacks. Just had 2 tonight, these are horrible to watch, he's beside himself, arms, legs flailing, lying in bed crying, moaning, moving side to side, can't talk. He says it starts with feeling of indigestion in chest, not pain but bad discomfort. We tried preemptive strike of ativan every 4 hrs today, but yet he still had the attacks.

Anyone have suggestions or experience with this?

Thanks so much.

Update Apr-2016. Hubby is back to outpatient chemo. Hrs had 24 folfox. Still struggling with severe panic attacks only the day after chemo. Klonipin not helping. No cancer pain, no trouble swallowing. Chemo keeping him exhausted and tough to eat. Has lost 35lbs in the year.

I always look at the scans, I measured esophagus at 43mm before chemo, every scan after chemo was about 31mm to 33mm. Up to feb-16 scan, I see a jump to 38mm, confused why report says no significant change and still stable disease. I use the super thin 1.0 slices and find the same slice by using surrounding artifacts.

Additionally I look at the rib mets, can clearly see huge activity in pre chemo scan, almost all white bone in later scans until feb-16 one, now seeing dotted patches in rib.

Will ask onc why report says no changes when I see changes. But was curious, would progression only be documented if they see progression when comparing latest scan to original ones? Or would they report progression when comparing last scan to current?

Thanks for listening.

Update May 2016. Hubby doing OK physically, very tough mentally. 26 chemos down, no end in site is taxing.

Latest issue was infusion center getting his meds wrong twice in a row. First they forgot his zofran premed and he ended up reacting during infusion. Next time they overdosed his steroids, giving him dexa after he just took 60mg prednisone. Then more prednisone 2 hrs in. Unfortunately I was out of room both times, once was down with soc worker and the other down at cafe. What is scarey is that he doesn't know to question these things. I need to give him a checklist of meds to follow. They did install a new computer system at hospital and I can see clearly that it's very difficult to use but when it compromises patients meds, then something needs to be done.

Still getting panic attacks day after chemo. Still very odd that they only happen day after. We think steroid induced. Klonipin not preventing them. Ugh

Noticed hubbys ALP keeps rising, started 90-100 is now over 300. Has never reduced, reading the things that can mean and like anything else it's all over the place.

Next scans after chemo #28.

Update June 2016, 28 folfox chemos down. Increasing difficulty swallowing. Scans were done Wed this week. I'm seeing further progression of esophagus diameter. Also something new, a new 1cm met to liver with a faint hint of possible another smaller one. 8 weeks ago there was nothing there. Waiting for official reports online and to talk with our oncologist.

Thanks Jim, official report in, there are 3 1cm mets to liver. However they still say esophagus is no significant change, which I continue to be baffled about. In Dec it measures 36mm across, now in June it's 48. Anyways now waiting for Wed appt with onc.

Moved onto Taxol/Cyramza, had first infusion this week. I guess only time will tell how his EC cancer responds to this. I read about the Rainbow clinical trial and this combination was better than Taxol alone, but all the numbers were disappointing.

I had a question of what does ORR (overall response rate) mean in a study? It was 28%, does that mean percentage of patients where the tumors actually shrunk? Versus stayed stable? Because then later on in the study it said disease control rate was 80%. TTP at 5.2months.

I'm still a bit confused on one fact, I saw progression in the scans starting Feb, each written report however stated "no significant change". I asked after April scan about this and was told the radiologists have poetic license. It wasn't until this scan in June, that finally the chest CT report stated the increase in esophagus tumor of about .5 cm increase measured in 3 diff areas and conclusion was increased tumor size. However the abdomen CT report still said "no significant change". I would think that 2 reports from scans taken on the same day should have the same conclusion. This actually scares me a little. Seems to me the radiologist should simply report sizes of what they see every time and let the Onc decide what is significant. But I'm not a radiologist or a Dr, just wondering should he have been moved onto a diff Chemo sooner and we would not have liver mets right now. Who knows.

Thanks.
Cheryl

Thanks so much Jim, so this means it has a good 80% chance to at least keep things stable, but only a 28% chance to reduce things. One day at a time right now. Have a good July 4th weekend.