cathcar48
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Posts:8
I attended with my thoracic surgeon today after having a new CT Scan (had a wedgectomy in October 2011 and findings of nodule in left lung was malignant and margins were clear and nothing had spread into lymph nodes. He said today that the left lung looked great but that right lung still has ggo from before which has gotten smaller but that there are 3 new ggo about 3mm. He has booked another CT Scan in six months. Should I be going to an oncologist or should the doctor be more proactive with this ggo and be checking to see exactly what it is and should I be getting some type of treatment? Thanks for any input.
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Reply # - May 10, 2013, 09:39 PM
Reply To: f/u with surgeon today
If these new areas turn out to be anything at all, this sounds most like is what is generally referred to as "multifocal bronchioloalveolar carcinoma (BAC)", which happens to be a particular expertise of mine. I recently wrote a chapter about optimal management for a lung cancer textbook, arguing that it can often follow such an indolent pattern of progression over time that there is a very real risk of over-treatment. Here's a post that describes my general approach:
http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/
You'll see that it's very reasonable, and probably optimal (in my mind, at least) to monitor things over time but definitely not rush into treatment, which often turns out to be over-treatment. There's certainly no rush to intervene before you get a good idea of the tempo of the disease, since it may well require no intervention for years and years, if ever.
Good luck.
-Dr. West
Reply # - November 13, 2016, 04:19 PM
Hi Dr. West;
Hi Dr. West;
I attended one week ago to my now yearly CT Scan. I was called in and Dr. Christian Findley, Thoracic Surgeon from Hamilton Heath Sciences, Hamilton, Ontario, who is now my doctor said that I have 1.6 cm nodule and he has made arrangements for me to have a PET Scan in two days. My last nodule was in October of 2011 which you were very helpful in helping me make some difficult decisions as I had a small nodule which was in the left lower lung and I had a wedgectomy which I was told came back malignant. The doctor says that this present nodule is not as easy to reach as it is near many blood vessels and it is more embedded. He says if the PET show activity he will operate within two weeks and he will have to take out a lobe. I asked him, because this was re-ocurring, should I be seeing an oncologist and have some sort of treatment to try and stop the re-occurrence of another nodule. Eventually, I will run out of lung at this pace. He said that he could give me a some chemo not the regular type that your hair falls out etc. My question is should I be taking some type of treatment to try and control this. I live a very healthy lifestyle; I don't drink or smoke and I am wondering should I be doing more. Is there an immunotherapy I should have. I feel I should be doing more. I do live very near the Juravinski Cancer Centre, Hamilton, Ontario, and wonder if I should be referred there. My thinking is that surgeons do surgery and should I be seeing someone that helps control the nodules. Thank you for having this wonderful site to help people turn somewhere. I could get a second opinion but that takes time and I don't want it to grow any bigger. Any of your thoughts would be greatly appreciated.
Reply # - November 13, 2016, 10:05 PM
Hi cathcar38,
Hi cathcar38,
I'm very sorry you have this scare and hope it's not cancer. It could be inflammation or infection that would otherwise go away without your knowledge but for the CT scan. So it may just go away. It's really unusual to have a recurrence of lung cancer after a year or 2. This is actually an excellent opportunity to have a medical oncologist get his head in on your case. It's much easier to have a few extra CT scans to see what the nodule does. Anything else is invasive. Your right surgeons do surgery but it may or may not be the best option. A second opinion can help you know for sure you're doing the right thing and waiting even a few weeks doesn't seem to change anything. Cancer shows itself by growing and it's very common to watch a nodule do nothing for ever or go away because it's an infection that body can handle without any outside help.
I wish I could just say don't worry it's probably nothing but I know you will. Keep us posted.
Janine
Reply # - November 14, 2016, 05:29 AM
Hi Dr. West and thank you for
Hi Dr. West and thank you for your reply. So if the PET shows no activity I should wait and watch. Last years CAT Scan showed something in the right lung but this must have cleared b/c there was no talk of that change. I did ask to wait until April and see what happens but he said that was too long. In a teaching hospital I guess I am a little sinicle about surgeons jumping too fast. This is 1.6 cm and he says looks solid. I guess it has grown fron last year's CAT b/c there was no mention of it then.He also said b/c there is scar tissue he wont know until he gets in if he is unable to do VATS which scares the bejebers out of me.
Reply # - November 14, 2016, 08:07 AM
Hi cathcar48,
Hi cathcar48,
Many of us here have had experience with watching and waiting to see if a nodule grows, so we understand just how worrisome it can be. However, as Janine said if your last nodule was in 2011 it would be unusual (though not completely impossible) to have a recurrence. It is actually more likely to have a new cancer than a recurrence, but everything that appears on a CT is not cancer. As you saw from last year's scan, whatever was seen then is no longer present, indicating a non-cancerous cause.
The PET scan should provide information that hopefully will rule out any other metabolic activity and possibly indicate low activity in the 1.6 cm nodule, which will provide more incentive to hold off on surgery and re-scan after an appropriate interval. One problem with initiating systemic treatment now is that if this nodule is not cancer and is going to disappear anyway, you won't know that it wasn't the treatment that made it do so.
Good luck on getting good PET results.
JimC
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Reply # - November 14, 2016, 08:22 AM
FYI, no one should ever have
FYI, no one should ever have lung surgery without doing a pulmonary function test. This shows how much lung capacity you have and what you could possibly lose from surgery. As Dr. West said a few years ago, this sounds like BAC which is now called adeno in situ. It rarely ever spreads outside the lungs and many are overtreated. Reread his link above about his general approach to BAC.
Take care, Judy
Reply # - November 14, 2016, 11:06 AM
Thanks again to all replies.
Thanks again to all replies. It makes it so much easier to handle when you have people that have survived this. I have a PET Scan early tomorrow morning and see the surgeon on Friday. He did say he was going to set up pulmonary testing prior to surgery. I was looking at my report from 2011 and I actually waited a full 8 months before I went into surgery but this doctor says it is too long to wait until April. I also wonder why he has to take out a whole lobe on a 1.6 cm nodule but maybe it is where it is located. Terrible to say but I get the feeling he wants to teach his intern learning under him VATS on someone in good health. I feel ashamed of myself for doubting him but I do. He says that this nodule looks solid. I think if the PET does not show lots of activity I may wait until April to see if anything changes and have CT scan in between. After 5 years, I thought this was behind me.
Reply # - November 14, 2016, 12:24 PM
It doesn't matter about a
It doesn't matter about a surgeons feelings. If he has a big enough ego to cut into people he can handle you taking up for your life. Besides most oncologists welcome a 2nd opinion and often discuss the case together to form an even better understanding of what's happening. You're right it's not it's not out of the question that he just wants to do this surgery, which brings me to another thought. You want a surgeon who does this type of surgery everyday not just once in a while. There's a difference between a dedicated thoracic surgeon who only does lung surgeries and a cardiothoracic surgeon who does mostly cardio and some lung surgeries. I hope you recovered well from your previous surgery but know that it's not uncommon to have lasting problems from a thoracotomy especially if it's a difficult to get to place. Another reason to make sure surgery is right for you; if you have cancer and it's from the same cancer you had before you will continue to have nodules and you will need as much lung function as possible. Taking out every nodule that appears isn't going to give you more life to live if you have too little lung.
A nodule 1.6 cm is small enough to wait for a 2nd opinion. Getting it right is very important at this juncture.
Reply # - November 14, 2016, 01:48 PM
Thank you catdander for your
Thank you catdander for your input. It is much appreciated.
Reply # - November 15, 2016, 06:07 PM
Update: Attended at my GP's
Update: Attended at my GP's office yesterday and was told that the thoracic surgeon's report was already in their office and the surgeon intended on operating regardless of the outcome of the Petscan. I had the Petscan done today and was asking myself why I was having it done if the surgeon intended on operating regardless of the outcome of the Petscan. I wonder if the position of the nodule on the lung determines if they have to operate. He did say that this 1.6cm nodule was near blood vessels in between the lungs and looked solid. Anyone have any knowledge if the position would detetmine the urgency of the immediate removal of the nodule before all imaging is in. Thanks forany input.