Adenocarcinoma in Situ or Ground Glass Opacity Nodules

Mon, 03/26/2018 - 00:00

March 26, 2018 at 8:36 pm #1294136

I’ve got two stable ground glass small lesions (one 5 mm and another faint one 5x9mm) in my right lung and have been reading about other people’s experiences with them on the web.

On a different forum it is often stated that these lesions rarely grow large, but I thought it was the case that they can grow large but are not called AIS when they grow to larger than 3 cm so it is only a question of definition rather than related to the natural life history of these lesions.

Can a sub-centimeter ground glass lesion that is stable for over a year grow large or does it usually stay small?

This topic was modified 3 days, 11 hours ago by onthemark.
This topic was modified 3 days, 11 hours ago by onthemark.
March 27, 2018 at 6:07 am #1294139
JimC Forum Moderator
JimC Forum Moderator
Hi onthemark,

Such lesions rarely grow large, and the longer you follow a small ground glass lesion without growth or with only very slight growth, the less likely that it will ever grow significantly. You may find the comments by Dr. West and Dr. Pennell in this discussion informative. Despite the age of the discussion, the principles remain the same.

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March 27, 2018 at 7:53 am #1294142

Hi Jim,

Thanks for your reply and for linking the thread. I read through it and I see how it discusses growth rates and has a lot of information about observing their growth and the importance of not over treating indolent lesions, but I don’t see any discussion of a maximum size or a limit on how big these lesions get if you wait long enough.

If the volume doubling time were long, let’s say 2 years, then the linear size grows by the cube root of 2 = 1.26 in 2 years.

In 10 years, the linear size grows by (1.26)^5 = 3.18
and in 20 years it would be the square of that which is 10.09.

So even a sub cm lesion would become huge if you waited long enough, unless there is some absolute limit on the growth of these lesions.

Of course this is also assuming the growth was uniformly exponential rather than episodic and that there was no intervention and also that the lesion didn’t undergo a transformation to an invasive cancer with a higher growth rate.

I’m 54 and have been previously operated (left upper lingula preserving lobectomy) and had chemo for lung cancer. My life expectancy without lung cancer is sufficiently long that slow growth lesions might impact my health. My next scan is in July and then it will have been 2.5 years since the original detection of these lesions with my pre-op ct. Up to now they haven’t grown but it will have been a year since my last scan. I don’t think any one likes the idea that there is a cancer growing in them even if it is slow for lung cancer. It would be comforting to think there’s an absolute limit on their size.

March 27, 2018 at 10:53 am #1294145
catdander forum moderator
catdander forum moderator
If the nodules don’t and haven’t grown then they probably aren’t cancer or even AIS. They may just be benign nodules that never grow nor cause symptoms, this is very common. If it is cancer or AIS then it can and probably will grow. Your right about the growth rate not following a consistent rate of growth and there is no limit to how large a cancer can get. AIS is a newer name for BAC which is usually slow growing (hence in situ) on the CT BAC looks cloudy instead of the solid white of typical lung cancer. It can grow throughout the lungs but doesn’t usually metastasize outside the lungs. BAC can change behavior and become more like a typical lung cancer where the rate of growth usually changes.

If these nodules were never biopsied and haven’t changed in over 2 years then it’s probably not cancer. I hope it’s not.

All best,

March 28, 2018 at 1:49 pm #1294153

Thanks Janine and Jim for your responses and well wishes.

I’ve apparently had these 2 ggo’s since the very first scan, prior to surgery, but they were first mentioned in the radiology reports as “subtle” ggo’s after I finished adjuvant chemotherapy. That was a big surprise to me at the time.

I was having three month scans for awhile and the lesions were reported as stable. In my most recent scan there was no reference at all to the ggo’s and I told my oncologists that i was unhappy about getting all that radiation (these were not low dose CT’s) and getting shoddy reports. I asked to have a new report but that didn’t go anywhere.

After that I decided to wait a year+ till my next scan, more out of frustration than anything. Unfortunately in Canada we can’t decided which hospital we go to, or who reads our scans, or who our specialists doctors are. That’s one of the downsides of socialized medicine. The upside is not having to deal with insurance companies. Anyway the ggo lesions in my right lung were noted as stable from Nov 2015 to Feb 2017, while the last scan I had 3 months later didn’t mention them at all. My next scan is early July 2018.

I realize I’ve had it a lot easier than many other people with lung cancer. My impression is that the vast majority of persistent ggo’s over 5 mm are thought to be either pre-cancerous or outright cancer, but I don’t have any knowledge of data to back that up. I am hoping to have the very slow growing kind.