Monitored for 5 years now Surgery or continue to wait and watch? - 1290613

Thu, 04/20/2017 - 08:05

CT of chest done in March '17, March "16 April "15 July '14, dec "13 sept '12 reviewed. Pertinent findings: There is a 1.5cmx1.8cm LLL lung nodule with a 4mm solid component that has been stable for 2 years. In addition a right lower lobe 8mmx7mm nodule present but stable and a 3mm lingular nodule also present but stable 5 years. Moderate paraseptal emphysema and minimal central lobular emphysema. No lymphadenopathy main concern is the ggo with 4mm solid component that has been followed for 5 yrs there was a slight increase in size compared to 2012. Lung represents a BI-RADS 4B classification nodule. This may represent adenocarcinoma spectrum of lesions close surveillance/histologic sampling recommended. After following for Five years referred to multi disciplinary committee and they referred to Cardio thoracic surgeon for possible resection. So options are CT Guided biopsy, thorascopic resection or continued annual monitoring. so dilemma is what to do? I am 55 healthy with no symptoms do I go get it now and know what it is and hopefully be done with it, wait. a year and take a chance that it remains indolent. Only real concern about surgery now is these kind of lesions may attend to appear in multiple areas of the lung over time and there fore a lung conserving approach may be reasonable. Was leaning toward surgery after pulmonolgist and MDC referred to surgeon. No one will tell me what to do and it is ultimately my choice. Looking for opinions or statistics to help make the best decision. Family and a friend is a retired Cardio thoracic surgeon want to go get it. But the location and and low density of the legion means I need to be prepared for LLL lobectomy. Surgeon gave me all options, but does stability warrant waiting another year?Am I taking any chances in waiting? Looking for advice!

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Hi 2putt,

Welcome to GRACE. It's good to hear that your nodules continue to be stable, which tends to indicate that even if this is cancer, it is a very indolent form. Although no one can tell you that there is no risk involved in continuing to wait and watch, that same small risk was there a year ago, two years ago and back to when the nodules were first imaged.

Dr. West has developed an algorithm for treating slow-growth nodules (in his example, Bronchioloalveolar Carcinoma, often an indolent form of lung cancer), which you can find here.

I hope this will help you make an informed decision.

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So concerned about how quickly an indolent cancer can become non indolent. My father had indolent lymphoma and took the wait and watch approach. He was diagnosed April 2002 and in July did not feel well and was immediately hospitlized had chemo and surgery never left the hospital and passed September 2002.

There was some concern for low-grade lymphoma when I had a PET 5 years ago which showed uptake right hilar and sub carinal lymph nodes had EBUS which ultimately failed to give specific diagnoses..pre trachea lymph node benign...right hilum was non diagnostic...mainly blood present without lymphoid tissue present according to pathology.

However, the main concern now appears to be with LLL GGN, so are there any statistics on how fast they can change over 1 year time while waiting for next scan?

Thanks for your insight ...trying to make an informed decision.


You can't compare your father's lymphoma to what you have. And it doesn't sound like his was indolent if he was diagnosed in April and died in September the same year. Indolent is slow growing like you've seen over 5 years of watching. As Dr. West who is a BAC/adeno in situ specialist says, many people go on living without ever treating it. You have a few nodules that are causing you no problems.
And if I were to have lung surgery, I'd want a dedicated lung thoracic surgeon not a cardio-thoracic one.
Would they do VATS would be my first question and if they don't, then I'd find a surgeon that does. There's no sense going through a thoracotomy for a lesion that small. Then you could have lifetime problems, and I'm sure you don't want that.
Asking about changes over one year when you've had little to no growth over 5 years, should be your answer. Take care, Judy


I agree with Judy that it's not helpful to compare a lymphoma that progressed over a fairly short period of time with lung nodules that have been stable for years. The longer the nodules are stable, the less likely they will begin to progress (even if this is cancer), although I can't point to specific statistics.

If the decision is made to have surgery, I'd wholeheartedly agree with Judy that a dedicated lung surgeon would be the best choice, rather than someone who performs a variety of types of surgery. Such surgeons can be found at teaching hospitals affiliated with medical schools.

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Judy and Jim:

Thanks for your advice... I have waffled back and forth about surgery 5 years ago and surgery has always been an option.Our approach was to watch it for Five years and then hopefully be done with it. But Dr's not comfortable with dismissing it and say close monitoring or biopsy. So CT Scan once a year does not seem like close monitoring. If you have a precancerous skin cancer or colon polyp you freeze it or cut it out because you don't want it to grow. It is just difficult sometimes when you are waiting to see if it grows and if it is cancer and the Dr's say they are confident it is in the adenocarcinoma spectrum. Get it out if benign great news, if precancerous and removed good news, if cancer glad you got it...Is it just that VATS is too invasive, risky or because possibly removing a lobe at worse case scenario is taking too much in case you develop another GGN?

Certain risk factors for considering surgery that I have read about are initial size 10mm plus with a solid portion, spiculated border, cancer history, smoking, gene mutations. Guidelines to consider surgery...GGN over 15mm, solid portion 5mm plus, significant increase in size (2mm ?) or appearance of solid component. Are these correct risk and guidelines? Will be meeting with Dr next week any other questions I should ask i.e. other tests, etc,.. and why the multidisciplinary committee referred to surgeon. So real question I think isWhy Now? ..if not Now When?


The size of the nodule is very small compared with many. They don't even do a biopsy until it reaches 1 cm.
VATS is the least invasive surgery and this is what you'd want to have with a nodule that size. Before surgery, you'd have to have a pulmonary function test to see if you're eligible for surgery with the emphysema. If this turned out to be adeno in situ, you would not likely be done with it. More nodules can pop up over the years. Not sure if you're in the states or not, but you'd want to go to a top rated NCI cancer center. I'd get a second opinion at one of these centers. Most people with cancer have tumors grow in the short term and have it removed within a short time from diagnosis in the lower staged LC.
Did you read the algorithm Jim provided by Dr. West?
Take care, Judy