pulmonary nodules and ggo's non hyperrmetabolic, lymph nodes are hypermetabolic? - 1253279

Fri, 02/01/2013 - 08:30

A 1.5 cm pulmonary nodule was incidentally found on a chest xray.Followed up with recommended CT Scan and PET Scan. The findings after scans was that the single RLL pulmonary nodule was non hypermetabolic, They also found LLL ill defined nodular ggo 15x11mm, RUL nodular ggo 7mm, RUL nodule 3mm, The nodules were non hypermetabolic and the ggo's were non hypermetabolic and the LLL ggo has the appearance of aednocarcinoma in situ which can be pet negative. They found in chest the right hilar(max suv 4.2) and subcarinal lymph noes (max suv 3.9). Nodal tissue sample recommended. Bronchoscopy done...Specimen source FNA Ebus Right Hilum Lymh Node diagnosis was Non-diagnostic mainly blood present without lymphoid tissue and Specimen source FNA Pre Trachea Lymh Node, Negative for malignancy: benign lymph node tissue and brochial epithelium. Generally Good News and agreed to follow up with scan. 4 months later followed up with CT scan, basically no changes and the lymph nodes are still enlarged.Options to continue follow up scans in 3 to 4 months and next time use contrast with the CT or do PET. continue screenins for 2 to 6 years. Or get second opinion and be referred to a hematologist, I elected to continue screenings. My husband thinks I should have another PET now because he is concerned that it is puzzling that the lymph nodes are still enlarged and wants to know if they are hypermetabolic? What options do you think are best? I have no real symptoms except shoulder/underarm pain and night sweats which i am not sure are normal symptoms of a 51 year old female. I have no cough or breathing problems. Thanks in advance for a response!

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catdander

Hi 1putt, I'm very sorry you're going through this. It's actually one of the most difficult periods anyone even those who eventually get a cancer dx goes through. So don't beat yourself or your husband up for being over vigilant or scared or worried. It's normal and it's reasonable. You need to make sure you're getting the care you believe in.

We aren't able to say what is best to do. That needs to be left to you and the doctors taking care of you.

If you're not satisfied or comfortable with waiting or that waiting is the right thing to do a second opinion is always a good move. If nothing else it will agree with what you already have been told or it may find something that is treatable. In any case 2 heads are always better than one.

You're symptoms aren't really 'not real'. Most people don't have symptoms until it is late stage, that's why lung cancer isn't found earlier, too often there just aren't symptoms.
A 51 year old woman can certainly have night sweats, in my case at 50, 53, I have night sweats, day sweats caused by menopause. It is my understanding night sweats associated with cancer are the type that can cause you to have to change the sheets the next day.

With all that said, I'll contact a doctor to comment on your post. You should hear back within a day. I hope all is and stays well.

Janine
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Dr West

This overall picture is very typical for what we often see when someone is ultimately diagnosed with bronchioloalveolar carcinoma (BAC), now with the terminology being changed to lepidic-predominant adenocarcinoma, but it could also just be inflammatory or infectious stuff, especially with the enlarged nodes, which isn't typical for BAC. I'm not very reassured that this is absolutely nothing just because a biopsy came back negative, since false negative biopsies are common, but with a repeat scan done and no progression, this makes it very likely that it's either not cancer or something that is technically called a cancer but arguably doesn't deserve to be called that.

As someone who sees about as much of this as anyone (I'm writing the chapter on multifocal BAC for one of the definitive textbooks on lung cancer), I am pretty convinced that we do a great disservice by over-treating many things that are really exceptionally slow-growing, as I describe more in this post:

http://cancergrace.org/lung/2013/01/20/mf-bac-algorithm/

Though I'm not convinced this is [i]nothing[/i], I do think that anything that is truly threatening in the next few years should grow over a four month interval (it may possibly be a greater issue on a very chronic basis, but I'd say the same thing if you were diagnosed with high cholesterol, which probably wouldn't cause anyone to be deathly afraid of the diagnosis). I would also say that it's pretty close to unfathomable that you'd get any more useful information from another PET scan when the CT showed no real change.

As I mention in the algorithm, I think regular follow-up is appropriate. I don't say that there is no risk involved over time, but this risk of intervening may well be greater than the risk of just being vigilant about following things over time.

Good luck.

-Dr. West