Stage 1 metastasis?

[seacoast_nh]

Hi,

A year and a half ago I was diagnosed with Stage 1 kidney cancer. I
had a 5 cm tumor in my left kidney and had a nephrectomy in May 2007.
I have had two CT scans since both clear. I went in for my third scan
this past Monday and the Dr called with some potentially bad results.

They found 6 white spots on my lungs, 3 in one, 3 in the other, the
largest of which is 1cm in width. Needless to say as I play the
waiting game now I am trying to keep positive but I am getting that
sinking feeling.

I am 39, have three young children and other than this annoying
nonsense, I am healthy. I bike, hike, walk, etc with no lung issues to
speak of.

About a month ago I got a chest cold from one of my kids and had a
bout of bronchitis, went to the Dr, had a chest X ray and it came out
all clear. Also, I just had a complete blood workup done and everything is normal except for a slightly elevated SGPT.

My question to is: Is it possible for early stage 1 RCC to
come back so aggressively in the lungs? I thought that would be highly
unlikely. On the positive side, I am hoping that these spots are
scarring from the bronchitis or something minor, but I don't really
know at this point.

I am frustrated because none of the doctors I have spoken with has
actually seen the scans, only the radiology report. I have no idea
what these nodules look like nor do I know if the doctors think they
are metastatic.

My next move is to meet with a thoracic surgeon who is supposed to
perform a biopsy, but anything invasive is annoying since I am on
bloodthinners. I would have thought that a PET scan would have been
the next step, but I guess not.

I meet with the biopsy surgeon next week and the procedure is probably
going to take place the week after. I am at Brigham and Women's / Dana
Farber so I know I am in good hands, its just that I want more
definitive answers and opinions than I am getting.

Here is some text from the CT report:

There are multiple bilateral pulmonary nodules which are new when
compared to the prior study of August 6, 2007. Within the right
upper lobe abutting the major fissure is a 0.2 cm nodule. Within
the right lower lobe, posterior basilar segment is a 0.5 cm
nodule. Within the right middle lobe abutting the pleura is a
0.8 cm nodule. In the lingula 0.5 cm. Lateral basilar segment
left lower lobe 0.4 cm, and left upper lobe 1.2 cm.

The visualized portions of the liver, gallbladder, spleen,
pancreas, adrenal glands and upper pole of the right kidney is
unremarkable. There surgical clips in the left renal fossa.

IMPRESSION:
1. Interval development of multiple bilateral pulmonary nodules
in this patient with a history of renal cell carcinoma. Metastatic
disease must be considered until proven otherwise.

Pretty unspecific if you ask me, other than "we need to cover our
bases since this guy had cancer" -- I just want more detail on those
nodules, which I think I can get.

I can't focus on anything else in my life at the moment.

Thank you!

[turtle221]

Hi.  I am sorry this is happening to you.  I just wanted to say that you should insist that someone else read the films from your scan. I know this is a totally different situation, but I recently was told that I had a suspicious ovarian cyst on a film that was read only by a radiologist.  I freaked out for months while I waited for another ultrasound and it turned out I was told that the person who read the films made a mistake.  They were actulally looking at a normal, healthy vein, not a cyst with suspicious blood flow.  I know its very hard, but try to think positive.  It could just be scarring from your recent chest infection.  I will pray for you.  Good luck.

[Dennis MD]

Hi.
Do you have a family history of kidney cancer?  Do you know the histologic type of your renal cell carcinoma?  There are aggressive variants of RCC like the type 2 papillary RCC.  
I agree with the previous post.  The lung nodules could be secondary to the bout of lung infection you had.  However, given the history of cancer, any nodule found on a diagnostic examination can be considered malignant unless proven otherwise.  I agree with your decision to have the CT scan plates reviewed and the lung nodules biopsied.  By this, you will have a more definite diagnosis and appropriate management can be started.          
Take care.