Small lung nodule growing in Ewing's Sarcoma survivor

On September 1, 2007, my daughter was diagnosed with non-metastatic Ewing's Sarcoma in the soft tissue in the chest wall. There were also two small (2mm) nodules in the lungs near the site of the tumor. The nodules were on the pulmonary wall, not deep in the lungs. One was removed and biopsied and shown to be benign (I believe the term was regressive tissue). The other was not removed.

Over the course of treatment, the nodule in the lung did not shrink, which her oncologist indicated today was a good sign. It has, however, grown from 2mm to 4mm in the three months since treatment ended. He still indicates he feels it is benign, but the growth is a sign for concern. He suggests, rather than remove and biopsy, we should have another CT in a month.

Considering Ewing's is a rather aggresive (aggressive) cancer and lung metastasis is not a good sign, my wife wants the tumor removed and biopsied.

My question is two-fold.

1. What should we look for in this tumor that might indicate it is malignant or benign?
2. Would you suggest waiting or having it removed? Would you feel the same if it were your child.

[Fernando Roque, MD]

Hi.  While serial CT scans may suggest a tumor's behavior (a rapidly or progressively growing nodule suggests a malignant rather than a benign lesion), only a biopsy can definitely diagnose if that nodule is indeed malignant.  I can understand your doctor's reluctance to have that nodule removed.  It's still small enough (less than 1 centimeter) to be labeled as "not suspicious enough to warrant further investigation".  However, since the nodule is near the pulmonary wall and is more accessible,  I would suggest proceeding with the biopsy for everyone's peace of mind.  You definitely don't have to wait to have it removed.