I have had my LL lobectomy last Sept. for NSCLC, T2N0M0. The first post-operative CT in 12/13 shows a 1cm nodule in a right lobe, where a pre-operative CT 3 month earlier didn't show the slightest abnomality. A new CT in 02/14 shows a growth of the nodule towards 1.2cm.
The doctor suggests further probe, and I am waiting for the precise decision. Meanwhile, the CT findings leave me quite perplex.
From the way it appears from nothing within 3 months, it is much more likely something non-malignant, like a hematoma. But how a hematoma continue to grow several months after the surgery?
If it is cancer, it is probably a new primary. But then the history of the growth is more like logarithmic than exponential! Do we see many cancer examples of this kind?
Or maybe the body's wound healing reaction to the surgery has provoked an accelerated growth of an existing dormant microscopic nodule. But that's still incredibly fast for a cancer, as the wound healing mostly ended after only one month.
Reply # - February 17, 2014, 08:00 AM
Reply To: New nodule post-lobectomy
Hi azuredu,
The problem with trying to determine what a nodule represents, without a biopsy, is that there is a large element of guesswork involved. One factor that should not be given much weight is the difference of 2 mm from the December to the February CT. That small a change, although it seems like a large percentage difference, is not really significant. Though CTs are high resolution, a millimeter or two is a very small amount and can be the result of using two different CT machines, or how the images "slice" (the scans consist of a series of images taken from slightly different angles and it is easy to add or subtract a millimeter or two depending on where the "cut" falls). Dr. West describes this in detail here: http://cancergrace.org/lung/2011/08/09/limits-of-ct-scanning/
JimC
Forum moderator
Reply # - February 17, 2014, 09:07 PM
Reply To: New nodule post-lobectomy
I'm afraid my leading concern would be that this is recurrence. I would be surprised to see a benign cause leading to a new nodule that was then growing months after surgery. While a new cancer would be a possibility and what I would hope for (as a separate stage I lung cancer has a better prognosis than a recurrent cancer), seeing a nodule occur immediately and then growing just after surgery would lead me to suspect this is a recurrence/multifocality of the same cancer process.
Good luck. I hope you'll tell us more as the work up continues.
-Dr. West