Ground glass opacities - 1288818

lablady
Posts:24

Husband had stage 1b nsclc. Had a lobectomy followed by 16weeks of chemotherapy. Then, did a 1year clinical trial of immunotherapy. He has been having follow up CT scans every 3 months as part of the clinical trail and a GGO showed up 6 months ago. The radiologist thought there was a change in the length but not the width and there were no solid elements. What are the significance of GGOs and what exactly are they. I understand that if it grows or becomes more solid this could indicate malignancy. Is this related to the original cancer? How are GGos managed? At this time we are waiting for the next CT scan to see if there have been any changes in the last three months. CT scan will be next week, what questions should we ask our oncologist. My husband is in excellent health otherwise and has never smoked

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Reply # - October 1, 2016, 10:00 AM

JimC
Posts: 2753

Hi lablady,

As Dr. West states, ground glass opacities are small hazy areas that can represent a form of cancer:

"...often a non-invasive adenocarcinoma (sometimes termed bronchioloalveolar carcinoma, or BAC, but shifting in terminology to adenocarcinoma in situ, or AIS) or minimally invasive adenocarcinoma (MIA), in which the invasive component is less than 5 mm in diameter. Even when they grow, it can be at an extremely slow pace."

Dr. West, one of the leading experts on BAC, always cautions against the over-treatment of BAC, as it is often so indolent that treatment is never necessary. You can read a couple of his posts on that subject here: http://cancergrace.org/lung/tag/ground-glass-opacity/

He has also devised an algorithm for making treatment choices (or often non-choices) and posted it here.

JimC
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Reply # - October 1, 2016, 06:48 PM

lablady
Posts: 24

Jim,
Thanks so much for all the information on ground glass opacities. I now how some basis for questioning our oncologist at our visit next week. The quick response and the quality information provided by Grace has been a god -send in the journey through lung cancer. Size, rate of growth and the presence of solid matter seem to be the deciding factors in what if any treatment is needed for ground-glass opacities.

Reply # - October 2, 2016, 03:23 AM

cards7up
Posts: 635

Do you have a size at all? If it's mm and it's only one, then you'd have to wait and see if it grows enough for a biopsy. Only a biopsy or surgery to remove it for biopsy, can prove if it's cancer or not. Many of us have nodules that are not cancerous even though we have or had LC. If it is in fact BAC/AIS, then many times no treatment is necessary as the cancer is very indolent. See the algorithm link Jim posted.
Take care, Judy

Reply # - October 2, 2016, 01:07 PM

lablady
Posts: 24

Thanks Judy,
No, we don't have a size. We were so surprised that we didn't ask any questions. The oncologist has been watching this spot for the 3 previous CT scans but never mentioned it to us until the last time because the radiologist thought that it had grown. She said we need to wait for the next scan (3mons) to see what it showed. So, That scan will be October 4. We wanted to be prepared with some intelligent questions. After reading the Grace information I have a better understanding of what ground glass opacities are

Reply # - October 2, 2016, 03:19 PM

catdander
Posts:

Unless the masses are causing trouble it may be most appropriate to watch and wait as has been stated. I can only imagine how difficult it can be to wait for something to cause problems before taking action but in the case of a very slow growing lung mass that may very well to the best thing to do.

I look forward to good news following the scans next week. Fingers crossed :)

Janine

Reply # - October 2, 2016, 03:28 PM

lablady
Posts: 24

Thanks Janine,
My husband has no symptoms. He feels very well . We have great faith in our Doctor and after having read all the information we would be more comfortable with the watch and wait approach if that is what she recommended. Without having this information, we wouldn't feel to happy to do nothing. Good to have Dr. West' expertise.

Reply # - October 6, 2016, 07:21 AM

lablady
Posts: 24

We received some good news yesterday re my husband's latest CT scan. He has a 6mm nodule in his right lower lobe. It is solitary and has not changed since his last scan. Our oncologist recommended the watch and wait plan. Since he was on a clinical trial, he is very well monitored and thanks to Dr West's information we are happy with this approach.

Reply # - October 6, 2016, 09:22 AM

JimC
Posts: 2753

That's terrific news! I hope that future scans continue to provide such great results. Thanks for keeping us up to date.

JimC
Forum moderator

Reply # - March 29, 2017, 07:00 PM

lablady
Posts: 24

When the ground glass opacity first appear and before we were aware it was 4mm with no solid area. When we were told about it the measurement was 6mm and the plan was watch and wait. The March
CT scan measured the opacity at 8mm. So it has doubled in size in about 8 months but it still has no solid area. The plan is still to watch and wait. The oncologist consulted with the thorasic surgeon who was also good with waiting. The oncologist said this is not a reoccurrence of the original lung cancer but likely a new one. Is there a point when growth alone without any solid part becomes a concern?

Reply # - March 30, 2017, 09:59 AM

catdander
Posts:

Hi lablady,

I'm sorry the ggo continues to grow. A solid tumor is difficult to biopsy when it's less than 1cm (10mm) and GGO is even more difficult to capture at that size. There really isn't anything to do short of surgery and the surgeon has ruled that out at least for now. If symptoms were a concern there may be reason to act but symptoms usually only show up when the ggo is multi focal and or comprising several cm of area.

I know the thought of something doubling in size is dramatic but the fact remains you're talking millimeters which is still tiny in respect to lung cancer and can be misread by even the most competent radiologists. Add to that the boarders are hazy and are not clearly defined. Also consider the scan pictures are taken every 2 or so millimeters at best so the resultant CT can look different when viewed side by side even if they were taken the same day. Think about it like slicing a football, each slice will be a different size so 2 pictures will look different when considering such a small difference.

Anything that could be done now is invasive and could easily cause your husband to suffer life long debilitating problems. He feels well now and that's a wonderful thing and a great place to hang your hats for now.

Keep us posted and best of luck.
Janine

Reply # - March 30, 2017, 10:19 AM

lablady
Posts: 24

Thanks for your quick and reassuring response.,Janine. It always helps to to hear from someone at GRACE. One thing we have tried hard to do is learn to be patience, which is very hard for me especially. However , my husband is feeling good and being closely monitored and we have great faith in our oncologist . So it's watch and wait for now.

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