Lung nodule growing - 1263339

Hello porcelana, Welcome to Grace. I hope this is just a quick stop to find you don't have cancer.
Remember this isn't cancer until there are cancer cells under the microscope. That's because it so often happens that everyone thinks something is cancer and all the tests point to cancer but it ends up not cancer. So hopes are for not cancer. There's not enough info to say what the probabilities are and even so probabilities are for those playing the odds.

PETs can give a false positive because several things light up on a pet. infection, inflammation, anything with a rapid cell turnover like brain, heart, stomach. A false negative, if it is cancer could mean the cancer is indolent. Cancer usually doesn't light up on a pet if it's under a cm.

There really isn't anything you can do to prepare for surgery except go in with as healthy a body and attitude as possible. Obviously it's good that you've stopped smoking whether or not you have cancer. For one thing healing is much better without smoking.

Recovery from VATS is less lengthy than that from an open lobectomy but it's still surgery and can for a few cause problems. Everyone is different. From what I understand if a surgery is going to be performed instead of a core needle biopsy the surgery would be to take the whole tumor so there's no need for another surgery. There are lots of individual aspects to just about everything lung cancer so there must be a reason for VATS plus open thoracotomy. I'd be curious.

Thoracic surgery is complicated and should be done by someone who does it on a daily basis, a dedicated thoracic surgeon not a general or even cardiothoracic surgeon.

Here is a link to an explanation of work up and dx of lung cancer. Our search is very helpful as well (though you may need to log off first depending on your browser). http://cancergrace.org/lung/2010/05/12/general-work-up-and-staging-of-l…

Hoping for a benign result!
Janine

porcelana,

Janine really covered the issues well. I'll just add a few of my own thoughts, largely reiterating the issues.

A growing lung lesion really needs to be removed, even if it's not hypermetabolic on PET scan. It's presumed cancer until proven otherwise, and I think it's quite likely to be malignant. Even so, the rate of false positive nodules that end up taken out but prove to be benign is in the 18% range.

Indolent cancers are often PET-negative, so I would not be dissuaded by a negative PET if the lesion is growing. However, a negative PET does suggest that, even if it is cancer, it is likely to follow an indolent pattern and have a much more favorable prognosis than cancers that light up significantly on PET.

A VATS typically has a 1-3 day hospitalization period, and I suspect you'd feel close to baseline within a couple of weeks. But there aren't stats to speak to what to expect in a 36 year-old undergoing VATS surgery -- that's not most people with lung cancer.

It's very possible to resume sports after a lobectomy, especially if you're no longer smoking -- though again, there isn't a medical literature about how soon to resume playing soccer after lung surgery. The remaining lung lobes typically enlarge over time.

I really want to underscore a key point Janine made -- the most important thing in optimizing your clinical outcome is to have it done by a very experienced, ideally board-certified thoracic surgeon -- NOT a general surgeon or cardiothoracic surgeon who does lung surgery when cardiac surgery cases slow down. Frankly, I'm a little surprised by the recommendation to wait until June. This isn't an emergency, but we usually don't choose to take 2 months to do surgery once it's determined that surgery is the right approach.

Good luck.

-Dr. West

Well, that delay makes sense -- it's just the reality of the system. Fortunately, if there is anyone in whom a delay is unlikely to make a significant difference in the prognosis, it's someone with a slow-growing, still small, and PET-negative lesion (presuming it's even cancer).

And yes, the implication of the PET is that, if it is a cancer and the PET is a "false negative", it's still providing an index of the growth rate and prognosis that is helpful to know (and favorable).

-Dr. West

Ana, It sounds as if you're in good hands and have a good plan for a cure. I'm sure your body will let you know when it's time to work out again and how much. Be careful about the contact end of things. One thought I had was to ask about (and look up info on) respiratory therapy after surgery. For some reason it never became close to standard practice even after being proven to be helpful post lobectomy. From my husband's experience and from what I've read from others online doctors aren't even bringing up the subject.

I think I misunderstood the VATS and lobectomy plan. Now I understand it to be a VATS will check for malignancy on the spot and if positive the surgeon will perform the lobectomy, all in one "surgery". It takes me a little time sometimes for things to sink in ;) .

I'm glad you're in such good hands. Please let us know how you fare and of course don't hesitate to ask when you've got questions.

Janine

if there was such a thing I'd say, he sounds perfect.
I know you asked for a doctor's reply and your get one. It's the beauty of Grace. I found Grace when I was looking for info and didn't even see or want to look at a forum; until I realized oncologists answered or made sure all answers were appropriate. But I have to say with the info you've given, one tumor under 3 or 4 cm and no node involvement is very curable. You may not even need chemo afterward. You're in an excellent position to be cured and have an otherwise normal life. They will likely want to do CTs from now on, but that will go from every 2 or 3 months to once a year. So that's my plan for you. :)

If you get curious and haven't found this yet, This is a link to blog/posts on early stage nsclc. You'll want to know that they are in order of latest added and some of those are on genetics/molecular treatments that don't "yet" have a place in treatment.
http://cancergrace.org/lung/category/lung-cancer/core-concepts/early-st…

I agree that he sounds eminently qualified.

Good luck.

-Dr. West