2cm stable spiculated lesion grows after ten years - 1263219

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malki13
2cm stable spiculated lesion grows after ten years - 1263219

In 2003 my mom saw a well respected thoracic surgeon at a top hospital in ny. Her tumor was described as irregular left lower lobe 2.4 cm. she came to this doc after bronchoscopy showed no malignancy. Doc who did bronc wanted to still remove it. We went to the respected doc because of this. He stated for many reasons to watch it conservatively. She had it followed for three months over a period of a year pet scan showed no metabolic growth considered negative. After yearly ct scans no growth. Coumidin pacemaker former TB in her 20s 2009 ct scan show same 2cm spiculated lesion. In 2011 local pulmomologist checks her functioning but no ct scans since 2009. Notes from him say benign opacity negative pet scans 10years.

April 8 2014 mom presented with an xray showing density...ct scan then showed growth to 4.3x4.7x 5cm.trace pleural effusion.same are left lower lobe parenchymal mass.

Told results are consistent with malignancy. Mom beautiful 85 year old. Has been feeling weak at times. Says it's old age. What now? Do benign tumors grow after 10 years? Or was this never benign? Doc at top hospital stated in 2004 he does not know what it is....differential diagnosis ....BAC ....inflammatory ....septic emboli pacemaker told her mandatory to watch.

malki13
Reply To: 2cm stable spiculated lesion grows after ten years

Just to be clear that should read that the mass is in the same place left lower lobe. Thanks

Dr West
Reply To: 2cm stable spiculated lesion grows after ten years

I suspect that it may have been benign or an extremely indolent lung cancer that wouldn't necessarily need to undergo surgery based on the pattern up until the most recent scan, even if it were biopsied and found to be cancer. The truth is that there are some lung cancers that demonstrate no growth or remarkably slow growth. If they behave in an exceptionally indolent manner, the risk of surgery may well exceed the risk posed by the cancer over the next several years.

Although a cancer that is very indolent is most likely to continue to behave in a very indolent fashion in the future, there is always a risk that a lung cancer that is very indolent will change behavior and behave more aggressively based on a new mutation. I describe the potential evolution of a cancer in this presentation I recently posted:

http://cancergrace.org/cancer-101/2014/03/23/cancer-evolution-adaptation/

Perhaps the risk of an indolent lung cancer suddenly becoming aggressive is 2%/year. In any given year, 1 in 50 people with this cancer will have it become a threat to them, but the other 98% would do well by watching it, since there are real risks to major lung surgery as well, especially in patients who are older. There are always risks of all sorts of things as time goes on, and the risk of a life-threatening car accident is likely to be another small but real ongoing risk as years go on, especially in older patients. The risk of dying of heart disease or some other issue may well exceed the risk posed by the cancer.

We don't know if her lesion is actually cancer, and we don't know if her symptoms are from cancer. Plenty of 85 year-olds without cancer feel weak. Even if it's cancer, it may be that it is still growing so slowly that it may not pose much of a threat to her over the next 3-5 years compared with other issues.

I'd say that even if this is and always was technically a cancer, it may have been a fine idea to have left it alone since 2003.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

malki13
Reply To: 2cm stable spiculated lesion grows after ten years

Dear Dr. West,

Thank you so much for your response. We have a doctor friend in our family past president of chicago medical society and he deemed her scan malignant based on the radiologic report. So we have been a bit worried needless to say. But what you say makes sense which is why I reached out here. We have an appointment with a different top Thoracic Surgeon at the same hospital, as the one we liked from 2003 is now retired.

I assume that appointment is something you would definitely agree needs to be done.
If you have any other advice on what to bring to that doctor or ask, I would accept any guidance you would offer.

Thank you again
Malki13

malki13
Reply To: 2cm stable spiculated lesion grows after ten years

This question also came to mind. If it turned out to be a mutation of such an indolent tumor, do these have a prognosis history or associated cure rate?

Thanks

catdander
Reply To: 2cm stable spiculated lesion grows after ten years

Hi malki, I'm sorry your mom is going through this scare and hope the she, you and the doctors decide it's worth watching only. Any scan that shows a nodule that "looks" like cancer can always end up being some other process.

I'll ask a doctor to comment on your newest questions. As our doctors agree, 2 heads are better than one.

All the best of luck,
Janine