New lung nodules after breast cancer - 1246633

Sat, 08/11/2012 - 12:05


I am curious and concerned about a few things. First, I am a survivor of breast cancer. NED in March. :) Second, I've had a few CT scans since December. The first was ordered after a lumpectomy and re excision and it was on this scan that lung nodules were discovered. They are 8mm or smaller and have just a little bit of growth. The growth is between 2-3mm in the past 6 weeks. One of the scans ( in June ) showed 2 new masses that remain indeterminate. The radiology report call these masses "multifocal lung parenchymal opacities". They measure over 1 cm. The last report on August 9 states these masses may be radiation related. This report also states a new right lower lobe opacity "which may represent an area of pneumonitis". Also, there is a note that reads "there is improvement (whatever that means) in the extent of the subpleural multifocal areas. What does improvement mean in this context?

Since I am considered "high risk" due to having cancer in the past (I was diagnosed just last August) I am quite nervous about the outcome of these nodules and masses.

Having the internet has given me more questions about multifocal lung parenchyma. I am learning that often times, it is BAC. My pulmonary care specialist did see this report and the CD when I visited him last week. (I see a thoracic surgeon next week) I had to be tested for asthma (which I now have). He was saying that I have some sort of pneumonia and I am taking antibiotics for 10 days. I asked "so I don't have cancer, right?" He just smiled and quietly said that there is still a chance I do have a new cancer. I read that the first line of treatment is to do the antibiotics, then have an xray of the chest (I do have one scheduled in a month) and then another CT scan. He said the scan would be ordered if the xray shows no improvement.

Honestly, I can't take anymore uncertainty. I just want answers so I can battle whatever it is that lurks in my lungs.

What is your take with this

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Dr West

Unfortunately, bronchioloalveolar carcinoma (BAC) often looks for all the world like pneumonia, and the pneumonitis that is often seen within the radiation field often looks very much like this as well. Because of that, there isn't really a good way to distinguish among these possibilities except for 1) a biopsy, or 2) the pattern of change over time and with interventions. We don't typically rush to a biopsy if there's reason to suspect it very well might be benign, so it's typical to start by looking for imaging changes after empiric treatment with antibiotics (if pneumonia is suspected) or possibly steroids (if pneumonitis is suspected and it's fairly serious -- though pneumonitis can also improve just with time).

Just as the docs there can't say what this represents just by its appearance, even when they can actually SEE it, there's no way someone over the internet could say what this is, with far less information. But in general, while we want to be timely in diagnosing, we'd prefer to avoid invasive procedures if they may be obviated just with follow-up imaging.

It's also important to consider whether treatment options would be different if the diagnosis is made tomorrow or 1-2 months from now. That might be the case for a single area of disease, but if it's multifocal, the treatment options are very likely to be the same whether it ultimately proves to be cancer right now or after another scan.

Good luck. I hope the scan improves and you don't end up needing to go any further workup for the lung findings.

-Dr. West


Hi msgebby and welcome to Grace. I hope we are a short stop on your way to a benign conclusion. I'm lucky to not ever have been diagnosed with cancer but I understand this waiting game is one of the most difficult parts of having it. That should say a lot about how you can look at your need to know asap. It may help put things into perspective psychologically to know how frightened everyone has been at this point. Oddly enough, even when cancer is found most people calm significantly when a plan is made and put into action.

I'm so glad I knew to expect a lot of ambiguities in my husband's scan 3 months after the end of chest radiation. The report suggested a huge amount of growth (practically his entire right lung) that was inflammation from radiation.

Congratulations on getting rid of the breast cancer! I wish you could celebrate that without this new threat.

I hope for all the best of outcomes,


Thank You Dr West

short note … 8mm grew to 1.3cm. TS is not concerned. This nodule is located posterior and between 9th and 10th rib

I've had 3 rounds of antibiotics in 2 months. 2 rounds of steroids in 1 month. Isn't that more than enough to decipher whether or not this is infection or inflammatin?

With the location of the nodule .... is a needle biopsy a viable option?

I've read that nodules that grow to over 1 cm are basically a huge concern ... am I right?

Dr West

Though I can't tell if it's very feasible for a biopsy without seeing images, it sounds like a location likely amenable to a biopsy. Yes, we'd generally hope and expect to see a questionable lesion resolving or at least remaining stable with antibiotics and steroids, and yes, it's concerning to see a lesion growing. The risk of it being cancer is greater the larger the lesion is, so >1 cm is of some real concern.

Perhaps your surgeon can better explain why he's not concerned. I can't explain why your situation wouldn't merit further workup.

-Dr. West


I'm sure Dr. West will reply later today but I just wanted to say that I think you are asking some good questions here that would be fair to ask your onc.
Many of the doctors on the site have suggested that they don't favor a generic list of questions. Everyone is a unique case that requires specific needs/questions. In 2 weeks you'll have a good list. I take a pad and pen with my list of questions to the appointments and take notes.
Janine fm

Dr West

I'm really not a fan of laundry lists of questions, and there are many other places that routinely offer these. I'm happy to try to address more defined questions, but I just can't be complete about very open-ended queries like "what side effects could happen?", "what questions should I ask?", etc.

-Dr. West