suemcp
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Posts:5
A 16mm nodule was discovered in my lung through a ct scan. I have had nodules before but they stopped looking at them a few years ago. How often should I expect this to be scanned? How do they tell whether it is malignant or not? And will a nodule this size - 16 mm, show up on a chest xray?
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Reply # - June 26, 2017, 01:42 PM
Hi Sue,
Hi Sue,
A CT scan is more appropriate than an x ray for following a nodule. A growing nodule of 1.6 cm is large enough to biopsy and a pulmonologist is likely to want a biopsy if possible. If a nodule takes a year or so to grow from smaller than to 1.6 cm it's quite indolent and even if it were cancer may not be life threatening. There is no standard schedule for following with scans but it's important enough at that size to want to know what's happening. A biopsy or a followup scan in about 12 weeks is appropriate.
I hope all is well and no need for any invasive procedures.
All best,
Janine
Reply # - June 26, 2017, 05:32 PM
Thank you for that, Janine It
Thank you for that, Janine It was very helpful. I am wondering, too, if a radiologist can tell immediately from the ct scan that it is not malignant, and thus does not need to be followed up until a year later or should it always be checked up on.
Reply # - June 26, 2017, 06:29 PM
A diagnosis can't been made
A diagnosis can't been made from a scan alone. Cancer is unlikely if the nodule isn't solid looking on the scan or if the nodule has been picked up on a previous scan and shown not to be growing. Many or maybe most people have lung nodules that aren't cancer and wont hinder health. You should be able to discuss this with the doctor who ordered the scan to get a better understanding of why he/she doesn't feel the need to investigate further.
Reply # - June 26, 2017, 06:55 PM
The internal medicine
The internal medicine specialist who ordered the scan didn't talk to me about it, just sent me off to see a thoracic surgeon, to see what needs to be done, if anything. I just want to be prepared, when I see him, to ask the right questions, since very little actually gets explained during the appointment (from experience). It's a new nodule, not there 3 years ago, and larger than most. But they say it contains a vacuum, which connects with what you are saying. - not solid.
I had an episode of coughing up blood - pure, bright red blood with bits of something in it, and yet from the couple of reports I have seen that is now described as sputum with blood in it, that the patient coughed up during the course of the day. I am concerned that things are getting distorted and that a busy thoracic surgeon may make a hasty decision one way or the other. The radiologist said it didn't look malignant, but how does one know for sure? As you suggest, it probably takes more than one test to make a proper diagnosis. But these days, with the healthcare system the way it is, sometimes physicians aren't as thorough as they should be.
Reply # - June 27, 2017, 08:25 AM
Hi suemcp,
Hi suemcp,
As Janine stated earlier in this thread, the only way to confirm or reject a cancer diagnosis is to biopsy (or remove surgically) the nodule in question and test it for cancer cells. A scan cannot positively distinguish between malignant and benign nodules, although there are certain features of nodules which can make such a nodule more or less suspicious for cancer. Dr. West describes some of these features here. The fact that the radiologist did not find this nodule particularly suspicious is good, especially since radiologists tend to raise every possibility in their reports, at times overstating what is actually present.
Your questions should probably focus on those imaging features, as well as the advantages and disadvantages of any possible surgical techniques, ranging from the various methods of biopsy all the way to the differing types of procedures to surgically remove the nodule. You will probably want to discuss the risks and benefits of watching and waiting; i.e., re-scanning after a few months to see if the nodule is growing. Although I'm sure you are anxious for answers, scanning again at too short an interval would be unlikely to provide a helpful answer, as any growth at that point might be too small to image, or within the normal variance seen in two scans taken a day apart.
Good luck with your meeting with the surgeon. Please let us know if you have further questions.
JimC
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Reply # - July 10, 2017, 12:07 PM
The initial visit with the
The initial visit with the thoracic surgeon, to discuss the results of the CT scan and how to progress from this point, ended with us agreeing that a second ct scan 3 months following the first one would probably be the best thing to do, and the surgeon would also speak with the radiologist to go over it. (the first CT scan, with IV contrast, was done at a different hospital, why, I do not know). The second CT scan, I have been informed, will be in October, 4 1/2 months from the date of the first one and will not be IV contrast. scan. The pulmonary test the thoracic surgeon said he would send me for was not mentioned in his report, so I have called about it, and about the lack of contrast for the scan.
The thoracic surgeon said a 1.6 cm nodule was not large enough to biopsy. Also, it is described as "with apparent central cavitation (versus adjacent to centrilobular emphysema)". I'm not sure what that means, except it isn't solid, which is a good thing.
A different nodule, measuring 6mm, has irregular edges. I am supposing that in 4 1/2 months it wouldn't grow large enough to make a difference in prognosis. But then, I know they are a busy department and mistakes are made. I should also think a contrast scan would make more sense.
There were these three new nodules since 2015.
Any further insights would be helpful, I'm sure. My mind is not eased through the way this is being pursued, I never did have a chance to discuss the situation with the surgeon after he discussed it with his local radiologist. He talked to me first, then talked to the radiologist then decided what he do next. He is the Professor of Surgery Chief, Department of Thoracic Surgery.
Reply # - July 10, 2017, 01:30 PM
A professor of surgery and
A professor of surgery and chief in a department of thoracic surgery sounds about as competent as a bio can. Not all surgery centers who do thoracic surgery have a thoracic surgery department.
A lung function test by a thoracic surgeon is to make sure your lungs are strong enough to endure lung surgery. If you may not need surgery then there's no reason to follow up until you know for sure. It's a quick non invasive procedure that can easily be done if needed later.
It's probable that since the nodule is not solid and fairly small a biopsy would not capture enough tissue to make a certain diagnosis.
I don't know why the surgeon would want the CT without contrast. It could be that he/she feels the contrast material would cause a reaction. It's not uncommon to get CT without contrast to follow lung nodules (my husband gets CT without because his veins are mostly nonexistent after all the chemo). If there is enough change to warrant further workup comparing the with and without contrast CT should be fine but comparing both with contrast would give the most detail.
It sounds like you're in good hands. I hope you are fine maybe your body is fighting an infection without you even being aware of it, that's pretty common.
All best,
Janine
Reply # - July 10, 2017, 01:56 PM
Chiefs can be competent but
Chiefs can be competent but forgetful and very busy. No, he forgot to order the lung function test, that he said verbally he would do. But I did talk to his nurse who said she would talk to him and arrange it. I have had many over the years, but my last respirologist quit on me a couple of years ago, saying that my lungs (my nodules) were stable and that if I needed to, I could mention any problems to my family doctor and get referred back.
I was sent to Thoracic Surgery because of the initial problem that I was taken to Emerg for. It doesn't mean I necessarily need surgery.
I question the decision for ct scan # 2 without contrast. Usually, when one wants to compare this and that, it helps that they are done using the same format. In this case, when I asked today, the nurse said the first CT scan appointment was made at a different hospital by mistake. I live in London, Ontario, home to research hospitals. I wonder if was a mistake that the second one was made non-IV contrast by mistake. I was told it is not good to have patients do the contrast scan as it is not good for them that's how admin assistants explain it, I guess. Should I persist, and call again? It doesn't make sense to me that one is contrast, the other not.
Having an expert on the case might be enough to make one feel reassured, but I can see the mistakes that are already being made so am reluctant to trust blindly.
Reply # - July 11, 2017, 08:56 AM
Hi Sue,
Hi Sue,
I'm sorry you're having trouble trusting your providers. We can't tell you what you should do but people often double check with their healthcare team to get explanations about decisions made.
Dr. Weiss explained the difference in a similar situation, "For the lung itself, contrast doesn't add much. It can help with evaluation of nodes and vessels. It is possible that the radiation oncologist feels that he/she can delineate the boundaries clearly without the benefit of contrast in your husband's situation. It is also possible that he/she would have liked contrast, but feels that the risk to your husband outweighs likely benefit. The best way to understand just how useful it would have been in his particular radiation plan is to directly ask the radiation oncologist." http://cancergrace.org/forums/index.php?topic=3554.0
Hoping all goes well,
Janine