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Thread: Lung Nodule; should I be worried

  1. #1
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    Lung Nodule; should I be worried

    I am a 38 year old male, non-smoker. During a physical last week, my chest x-ray showed something unknown. My GP, told me not to be worried (he stressed this several times) but told me that he was going to have me get a CT scan, because he didn't want to ignore it. I had the CT scan done on Friday the same week, and the following Tuesday (today) I received a call from a nurse at my GP's office saying that the CT scan showed that I have a nodule in my upper left lung. They are sending me to a lung specialist this Thursday. I probed the nurse for answers like, does the GP's original statement not to worry still stand, did the radiologist say if it looked cancerous, etc. She said I didn't need to worry, and that the GP was sending me to the specialist because he didn't want to ignore it; and that the specialist would work with me to decide what needs to be done. I got the impression that the nurse was not allowed to make any comments on what she thought it might be. I also got the feeling that the GP was sending me to a specialist because he didn't feel comfortable making the call.

    Despite my GP originally telling me not to worry, I am. I've been searching the Internet, but most of what I have found has only told me that I haven't been asking the right questions. From the statement that the nurse made, it appears to be just one nodule. But I don't know what size it is; I don't know the shape, or consistency; I don't know if it has smooth edges, if it's calcified or not.

    I've read that it can be scarring. I had Pneumonia once in 1998. I have had a history of Bronchitis (usually once or twice a year in the spring and/or fall) since then. I typically see a different doctor when diagnosed with Bronchitis, and she usually has a chest x-ray done as part of the diagnosis. If an unknown or a nodule has been present in those x-rays, she has never said anything. The most recent of those x-rays was last December or January. This fact has me worried that this nodule went from nothing to something in just 6 months.

    My last bout of Bronchitis (diagnosed last December or January) took almost two months to fully go away. The symptoms recently came back (and are still here) about a month ago. I haven't been to the doctor about it because this is allergy season, and I usually get these symptoms during allergy season. However, the recent Bronchitis and allergies have had a wheezing symptom that I don't remember having before.

    I have none of the other symptoms that I've read about others having. No pain in the shoulders or back, etc.

    As for a family history. My grandmother died of pancreatic cancer in her 60's. She was a heavy smoker. My mother on the same side, was a non-smoker, and was diagnosed and died of pancreatic cancer in her 60's. Despite this, my mother's doctor said that her kind of cancer was not hereditary, and I shouldn't worry. When I pointed out that her mother died of the same thing at the same age, he said it was a coincidence, and that if I did develop the same kind of cancer, I wouldn't need to watch for it until I was in my 60's.

    Again, I'm 38, and most of what I read says if you're under 35, that it's less than 1% chance that a lung nodule is cancer, and that if you're over 50 that increases to a 50% chance. I assume that my chances are going to be closer to the under 35 category.

    I guess my questions are, should I be worried at this point? And what questions should I ask the lung specialist at my appointment?

    Any information or experiences would be appreciated. Thanks.

    Steve

  2. #2
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    Hi smpratt77

    I think (don't take me at my word) that the biggest a nodule can be is 3 centimeters. Technically, bigger than 3 centimeters is a mass. If it is a nodule, then you are lucky that it was caught as a nodule. I think it's unlikely that you have the dreaded c word but IF you do (unlikely) then thank God it was caught at such an early stage. Many, many people on this forum (including my dad) would kill to be in your position (just a nodule and not a mass). Try to take things easy, even in an absolute worst case scenario you are in a "best case scenario" because it was caught early. However, be proactive about your care and push the doctors to figure out what it is.

    God bless.

  3. #3
    Top User mike.b's Avatar
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    Yes, don't panic. It's likely nothing but you should follow through with the pulmonologist. He will give you a pulmonary function test and look closely at your CT scan. He may just want to rescan in 3 months. If it is suspicious he may order a PET scan or biopsy.

    If you are super impatient you can request a copy of the radiologist's report. At the bottom it should have a summary of his findings.

    It took me a month to get an appointment with a pulmonologist. I hope your's goes quicker.

    mike
    At the time - 46 yo male, non-smoker
    Sept 2012 - DX - One tumor NSCLC Squamous Cell Right Upper Lung
    Oct 2012 - TX - Treatment similar to Pancoast Tumor - Pre-operation radiation and chemo (5.5 weeks of IGRT and 3 cycles of Cisplatin and Etoposide)
    Dec 2012 - Surgery - Remove RUL, Surgical Pathology Report Adenocarcinoma T2N0M0
    Now - Wait, watch, & pray

  4. #4
    Top User emilyloveslime's Avatar
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    Hi Steve,

    Sorry you have to be here, but by no means do those scans mean that you have cancer! Nodules are small, which is good. If they did a CT scan and all you have is that nodule, that is *still* good. It can be scarring, infection, many other things than cancer that light up on the CT scan. It isn't cancer until they biopsy it and confirm the pathology of the cells.

    If by chance it is, then you have definitely caught it early, which is very good. I know it must be scary to think about it and it is completely natural to worry, but Ziggy is right: symptoms of lung cancer usually don't show up until it's too late, so if you do have lung cancer you really are in the best situation you can be. Be sure to thank your GP for being so diligent. I think you are in good hands

    Speaking of which, your GP is doing the right thing by sending you to someone else. He is "just" a GP; he isn't qualified to read those scans. The nurse didn't tell you anything because right now everything is inconclusive and she doesn't even know either.

    Also, the statistics you're quoting are just that: numbers and nothing else. I know it's hard to ignore all the information online, but Dr. Google will just make you more worried, so I'd just recommend staying away from the computer. People defy statistics all the time: my boyfriend was 24 when he was diagnosed with cancer (wayyyy younger than the average individual) but has also been around for almost 2 years after his diagnosis, which is wayyyy over the average for stage IV.

    Next steps: when's your meeting with the specialist? This part is actually the worst part: just waiting. It helps to bring a notebook to jot questions down when you have them and try to get a binder and ask for copies of your scans and scan reports so you'll have them for yourself. My estimation is that if the nodule is *very* small, they won't be able to biopsy it yet and they will have you come back in 3 months to see if it's gotten bigger. If it is big enough for a biopsy, obviously they will go ahead and do that.

    Good luck with everything and keep us updated!

    Emily
    Boyfriend, 25, dx'ed Stage IV NSCLC 6/29/11. Malignant pleural effusion, liver/spine/lymph mets. Adenocarcinoma w/unknown primary! So confusing.

    Jul '11: 2 cycles Carboplatin/Alimta (failed)
    Oct '11: Docetaxol/ramucirumab/Xgeva/Neulasta
    Dec '12: Liver met growth
    Jan '13: 10+ brain mets, 2 wks of WBR
    Mar '13: CDK 4/6 inhibitor trial (failed)
    May '13: Tested ROS1+
    June '13: Xalkori clinical trial for ROS1+
    Aug '13: Liver mets gone, lung spots gone. Doing great so far!
    Mar '14: Leptomeningeal progression. Ommaya reservoir put in for intrathecal methotrexate.
    May '14: Tolerating chemo, hoping for good news...

    Blog: http://ros1positive.wordpress.com/

  5. #5
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    Thank you all for your comments. It is very encouraging to hear. My appointment with the specialist is this Thursday; and I will report back with how it went. Thanks again.

  6. #6
    Top User emilyloveslime's Avatar
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    Great, that's super fast. Good luck!
    Boyfriend, 25, dx'ed Stage IV NSCLC 6/29/11. Malignant pleural effusion, liver/spine/lymph mets. Adenocarcinoma w/unknown primary! So confusing.

    Jul '11: 2 cycles Carboplatin/Alimta (failed)
    Oct '11: Docetaxol/ramucirumab/Xgeva/Neulasta
    Dec '12: Liver met growth
    Jan '13: 10+ brain mets, 2 wks of WBR
    Mar '13: CDK 4/6 inhibitor trial (failed)
    May '13: Tested ROS1+
    June '13: Xalkori clinical trial for ROS1+
    Aug '13: Liver mets gone, lung spots gone. Doing great so far!
    Mar '14: Leptomeningeal progression. Ommaya reservoir put in for intrathecal methotrexate.
    May '14: Tolerating chemo, hoping for good news...

    Blog: http://ros1positive.wordpress.com/

  7. #7
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    Well, I went to the Pulmonologist. He told me that with my age and not being a smoker, that it was highly unlikely that it was cancer, but he did send me to get a PET scan. The nodule is 2.6 x 2.2 centimeters; and the lymph nodes in my lungs are also slightly enlarged. And he said that his guess is that I may have had pneumonia sometime recently, and did not realize it. I did have bronchitis earlier in the year, which could have been pneumonia I suppose.

    He told me that the PET scan would not be 100%. He said if I were to look at the results on a scale from 1 to 5; 1 would be very reassuring, and we would just monitor it for a couple of years, and 5 would be very likely cancer, and that we would want to speed up response. And that a 2 or 3 would not really tell us anything.

    So I had the PET scan done, and the follow up visit was today. The results showed the 2 or 3 of not really telling us anything. He told me that it does have some increased metabolic activity, which would be consistent with his theory that it was left over from a recent infection; but that we couldn't ignore it as if it were no activity. He is going to have me do another CT in 8 weeks; which will be three months from the original. I told him that I had been worried, and he told me that what I need to worry about is driving on the interstate in the rain, or playing golf and a thunderstorm coming up; because those were more likely to be a danger to me.

    What did concern me was when I asked him, if it does end up being cancer, are we in danger by waiting 8 weeks before doing anything. His response was no; because if it is cancer, it is in the lymph nodes in my lungs as well, so we are beyond any treatment involving surgery.

    But he then continued to try to reassure me that I didn't need to worry at this point. He said that it would be more likely for me have another kind of cancer, that had spread to my lungs than to have lung cancer; and that if that were the case it would have not only shown in the PET scan (which it did not) but it would also be more likely in the lower part of my lung, and not just a solitary nodule.

    I asked about a biopsy, and he said that a needle biopsy would not be accurate if it shows benign, due to the fact that the there could be cancerous cells mixed with the non-cancerous cells. If it showed malignant, then it would be be defiantly cancer, but if it didn't, it would be inconclusive. He said we could to an open chest biopsy, that would tell us for sure, but he is not recommending that either. I take that to mean that the risk of the surgery for the biopsy is higher than the risk of it being cancer at this point.

    For those of you who have had nodules, and are going through the process of regular CT scans for comparison, is three months a typical waiting time for the first comparison?

  8. #8
    Top User emilyloveslime's Avatar
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    This is pretty typical, especially if you have a nodule. Like your onc said, it's very hard to biopsy a nodule because it is simply too small. The open chest biopsy would not be "worth it" from a surgical standpoint and would be overdoing it. And without a biopsy, there is no confirmation that it is cancer, so they can't treat it. He is doing the correct thing by waiting and monitoring the spot.

    He is also right about the "if it's cancer" part.

    Anyways, I think your onc is doing a good job and doing the right things. You seem to be in good hands, both your docs (GP and onc) seem to know what they're doing!

    For now, try to not worry (definitely easier said than done!) and enjoy the summer! Keep us updated when you get the scans!
    Boyfriend, 25, dx'ed Stage IV NSCLC 6/29/11. Malignant pleural effusion, liver/spine/lymph mets. Adenocarcinoma w/unknown primary! So confusing.

    Jul '11: 2 cycles Carboplatin/Alimta (failed)
    Oct '11: Docetaxol/ramucirumab/Xgeva/Neulasta
    Dec '12: Liver met growth
    Jan '13: 10+ brain mets, 2 wks of WBR
    Mar '13: CDK 4/6 inhibitor trial (failed)
    May '13: Tested ROS1+
    June '13: Xalkori clinical trial for ROS1+
    Aug '13: Liver mets gone, lung spots gone. Doing great so far!
    Mar '14: Leptomeningeal progression. Ommaya reservoir put in for intrathecal methotrexate.
    May '14: Tolerating chemo, hoping for good news...

    Blog: http://ros1positive.wordpress.com/

  9. #9
    Administrator Top User Didee's Avatar
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    With my blood cancer (with lumps and in remission) I have scans where lung nodules show up, have gone on the next one and others may be there. Both my Onc and GP have never been concerned and because I never went researching the net, I wasn't worried either. I see so many I have a nodule posters all over the net now and most do turn out to be benign but now because I have seen that, if I am told that there are some on a future scan I am going to wonder until maybe the next scan shows a difference. I hate that. I was so happy in my ignorance and being guided by my real life Drs,.
    Aussie, age 57
    1987 CIN 111. Cervix lasered, no further problems.

    Dx Peripheral T Cell Lymphoma stage 2B bulky, aggressive Dec/09.
    6 chop14 and Neulasta.
    Clean PET April/10, 18 rads 36gy mop up. All done May 2010
    Iffy scan Nov. 2011.
    Scan Feb 2012 .still in remission.
    Still NED Nov 2012. On to yearly bloods now.

    May/2012. U/sound, thyroid scan, FNB. Benign adenoma. A lump in otherwords, nodule if you wish to be specific.

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