Hi,
I'm a 51 Year Old former smoker (1978 to 1999). I've had 2 X-Rays, a CT Scan and a PT Scan in the last month. The X-Rays showed a suspicious nodule. The CAT Scan showed a 1.4cm nodule. Yesterday my primary care physician called to tell me I have a mass with uptake in my lower right lobe that is suspected to be malignant. The Scan did not show any evidence that it had spread to my spine, lymph nodes, cervical region, or anywhere else. I should have asked her why she used the word "mass" instead of nodule, but I was busy hyperventilating (ok, not really, only sort of). Today I have an appointment with my pulmonary doc (I have moderate asthma), and I've written down my questions so I don't forget to ask them.
My question is, does anyone ever just opt to have the whole mass removed, and have that biopsied, instead of having a biopsy and then have the mass removed? I know I'm jumping the gun - I'm just doing a sanity check to see if my gut reaction is even a possibility.
Thanks. I'm bummed to be here, but I'm glad to have found this site.
JoAnn
Reply # - February 6, 2014, 06:14 AM
Reply To: Does anyone ever skip the biopsy and go straight to a
Hi JoAnn,
As far as the difference between the terms "mass" and "nodule", Dr. West has written:
"As for the terms of “mass” or “nodule” or “lesion”, that’s just semantics. While technically a nodule is supposed to be under 2-3 cm and a mass is larger, people use the terms interchangeably, and “lesion” is just a medical term for a spot." - http://cancergrace.org/topic/pet-scan-now-really-scared#post-1253324
Although it's certainly possible to skip the biopsy, a lobectomy is not to be taken likely. In Dr. West's words:
"the surgery itself is a pretty significant intervention to go through that is justified if it’s with a realistic hope of curing a lung cancer, but it wouldn’t generally be done for such unclear benefit, given the very real risks involved." - http://cancergrace.org/topic/lobectomy#post-1246645
A mass with uptake can represent inflammation or infection rather than cancer, in which case going through the trauma of a lobectomy would be unwarranted.
JimC
Forum moderator
Reply # - February 6, 2014, 11:03 AM
Reply To: Does anyone ever skip the biopsy and go straight to a
Thanks Jim - I just met with my Pulmonary Doc, and while my Primary Doc was pretty doom and gloom about this and went right to malignancy, the Pulmonary Doc thought that this looked more like infection and less like cancer, when everything was taken into consideration. He suggested waiting a month and returning for another CAT scan, but said that if I wanted to be aggressive, I could have the nodule removed. He did not recommend a biopsy because he said that it could come back as cancer, but if it didn't that still wouldn't mean that it wasn't cancer.
Now I have to figure out a next step.
Thanks again for your super fast answer and your awesome words of wisdom!
JoAnn
Reply # - February 6, 2014, 11:18 AM
Reply To: Does anyone ever skip the biopsy and go straight to a
Hi JoAnn,
He may be thinking that if the next shows no growth, the chances of cancer are lessened. With a nodule that small (1.4 cm) it's not unusual to wait and watch, possibly avoiding any procedure such as biopsy or surgery.
Good luck with your next scan!
JimC
Forum moderator
Reply # - February 6, 2014, 01:43 PM
Reply To: Does anyone ever skip the biopsy and go straight to a
It's a possibility that a fine needle biopsy could be a false negative. A bronchoscopy could be done to try and get a biopsy also. I've had three FNA biopsies and they were able to get positive tissue all three times. One of my lesions was 1.3cm (LRL), and the other two were larger. Wait a few months and have another CT scan and if it grows, at least try for a biopsy before going directly to surgery.Take care, Judy
Reply # - February 6, 2014, 09:34 PM
Reply To: Does anyone ever skip the biopsy and go straight to a
This is obviously in the realm of judgment, but I don't think I'd be as pessimistic about the potential role of a biopsy. It's very appropriate to first see if it changes after some time and antibiotics. If it shrinks or goes away, it's almost certainly not surgery, and you've saved yourself a surgery and loss of part of your lung.
If a biopsy is done because the nodule increases, you get a clear answer to move ahead with surgery if it shows cancer. It's true that not showing cancer doesn't prove there's no cancer, but if the biopsy showed a clear alternative explanation, like an infection (perhaps fungal if it didn't respond to a course of antibiotics) or significant inflammation, you'd avoid a surgery that wasn't needed and could identify a better course of treatment.
Even when people have gone through all the steps and think they're doing surgery for a cancer, about 1 in 5 resections of lung nodules is for something that turns out to be benign. You can live through that, but it's not great to completely overtreat a benign lung nodule by taking out 1/2 of 1/3 of the lung and then learning it wasn't necessary.
Good luck.
-Dr. West