Question about LC Staging - 1252932

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Question about LC Staging - 1252932

I am a 45 year old female with a 30 year smoking history, and recently found out I have multiple bilateral pulmonary nodules...a total of five, the largest about 4mm. Since they are too small for PET or biopsy, the plan is to re-scan in a few months to check for any changes.

I had been led to believe that because these nodules are so small, even if they did turn out to be LC they would probably be early stage. Then yesterday I read something that implied that, regardless of their size, because they are in BOTH lungs any malignancy would be considered M1a and make me an automatic Stage IV. Is that true?? And is the prognosis the same for all Stage IV, even if the malignancies are very small? One would think it would be easier to treat/shrink/cure subcentimeter nodules than multiple centimeter masses. I find this confusing (and rather frightening) and would like more information.....

Reply To: Question about LC Staging

jadetroll, Hello and welcome to Grace. I can imagine how frightening it is to be in your position.
The first thing I'd like to say is most everyone with your smoking history has lung nodules like you've describe and aren't cancer.
The standard of care for unknown nodules less than a cm is to watch them for a while (scan every 3 to 6 months) until your doctor is comfortable that they are staying put.

Your conundrum is one that will happen more often as more people are scanned with the newest highest resolution machines. Smaller and smaller nodules will be found...then watched, that end up being benign.

As for staging you're right. Once lung cancer has moved from the original lung it did so through the lymph or blood system. That means there are cancer cells in the blood that can't be detected but will eventually grow in other places. FYI, the only way, for now, to detect lung cancer is through visual scanning.

If you would like to search the site there is an extensive library on Grace. You can access it by the tabs above by clicking general or specific cancer info.
If you do a search you may need to log off first but it is well worth it.

There are several post just like yours that have been addressed by doctors here (again you may need to log off if your using IE browser)

All best and extremely hopeful for the most hopeful post I've seen all week :)
forum moderator

Reply To: Question about LC Staging

So separate nodules are considered "connected"....and if one is malignant, all are considered part of that cancer? Is it not possible to have one or two be malignant and the others benign??

And are your chances any better if you are dealing with very small malignancies rather than large ones?

I guess it's obvious, I am rather frantically looking for a way out of a Stage IV dx....nothing frightens me more.....

Dr West
Reply To: Question about LC Staging

Having just written a book chapter on multifocal (advanced, metastatic) bronchioloalveolar carcinoma, I would emphasize that there can be extreme variability in the behavior of cancers that may technically be called stage IV lung cancer. Many times, scattered tiny lung nodules are absolutely nothing. Sometimes they grow quickly, and that needs to be treated with systemic therapy and can have a pretty limited prognosis, though more and more people have a detectable "driver mutation" that can be treated very effectively with oral therapy for many months or even years at a time.

But there's a 3rd category of very indolent disease that might technically be called a cancer but behaves like a chronic disease. Frankly, you won't find much valuable information written about it, since many physicians wildly over-treat it -- doing surgeries, chemo, radiation, etc. -- frantically treating it with anything they can find. In fact, plenty of these patients actually have a cancer that is going to grow extremely slowly over years to even beyond a decade, maybe several decades, but if you give a treatment, you can show patients are alive years later, write a paper about how well they're doing, and presume you're doing a wonderful job. However, many people with a slow-growing cancer will do extremely well even if you do nothing and may be doing well despite rather than the interventions.

Here's a post I just wrote on the subject:

So my key points:

1) This may or may not be cancer

2) Even if it is cancer, if it's stage IV, don't presume that the numbers you might hear and read apply. There is an enormous variability in how individual people do.

3) If there is very little progression, you would likely do well to find someone with some expertise in lung cancer to help provide guidance. And if it appears slow-growing, fight the urge to over-treat it.

-Dr. West

Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: Question about LC Staging

Dear Jadetroll:

When you are very new to this process, it is indeed scary. All the terms are like trying to learn another language. It will be two years in April, that I got the same diagnosis that you describe. It took me a year to settle down and be relieved of constantly thinking about it. I have the 3rd option that Dr. West describes and at first had scans every 3 months. Now, when I have the next scan in April it will be 6 months. So far, it has proven to be indolent. I recommend the following that has worked for me.

1. Find the website. ( you already have found the best resource for all I formation. )

2. Find a doctor that is completely open to listening to your concerns and research on this website.

3. Have your dr (oncologist) communicate with Dr. West. He is the best resource for BAC.

4. Do not jump into any therapy without checking with Dr West. ( I even went to Seattle to confer). Before I found Dr West, I was heading to a thoracic surgeon!!!!!!

5. If you have a hard time relaxing, take yoga or some kind of meditation and relaxation classes.

6. Good luck and I hope we are both enjoying a productive life many years from now.