Following an early lung screening CT that found a small 1/2 cm upper R lobe lung nodule, I've been diagnosed with presumptive Stage IIIA NSCLC, poorly differentiated squamous cell. Mediastinsocopy found 2 malignant lymph nodes (at 4R) after PET/CT found elevated hypermetabolic activity (5.5) . Three different sets of pathologists/cancer centers reviewed the lymph node slides & ran flow cytometry tests, which also ruled out Lymphoma. But the 1/2 cm lung nodule (only 1.2 SUV on PET/CT) was found to be benign on core biopsy, with inflammation.
A CT 8 years ago found that same nodule, same size then, but with changed (spiculated) borders now. Aggressive testing, Upper GI and ENT endoscopies, combination PET/CT, etc found no evidence of cancer anywhere else. An Esophageal nodule was benign. Tumor of Origin test=70% probability of LC.
The working theory by 2 different cancer centers is that my immune system took care of that lung nodule, but not before the malignant cells reached the mediastinal nodes. After 2 rounds of inductive carbo/taxol, the next (2nd) PET/CT found no hypermetabolic activity anywhere and no enlarged lymph nodes, so cancer appeared to be chemo responsive. The next recommended tx modality is a robotic lobectomy with full lymph node dissection with curative intent (to be followed by either chemo or chemoradiation).
With a benign tiny lung nodule, but with malignant mediastinal nodes, I hesitate to undergo a lobectomy without definitive lung cancer. One other major cancer center says it's possible the mediastinal nodes ARE the primary, but this would be exceedingly rare.
In general, can a lung cancer exist at a micro cellular level without a significant tumor yet metastasize to a nearby or regional site, despite the thinking that lung tumor size and growth pattern are key to diagnosis and staging? Or is such an unusual finding more likely to be a Cancer of Unknown Primary, and if so, what questions might a patient considering asking?
Reply # - June 10, 2014, 06:59 PM
Reply To: Malignant Mediastinal Nodes – But Benign Lung 1/2 cm
We see such rare things from time to time. It's not clear whether there's an occult nodule somewhere or just the lymph nodes involved. I can understand the idea of surgery, or alternative pursuing chemo and radiation to the involved nodes.
Cancer can do anything, and this is just one of the rare case presentations -- but certainly not unprecedented.
Good luck.
-Dr. West