Cancer?

chest ct scan show 1.2cm x 1.3 cm soft tissue nodule, in lower right lung. Scheduled for Pet scan thursday.  Is this cancerous? Doctor said 50/50 plus add some for my years of smoking. What else could it be? anybody

[HeinrikMD]

Hi,

The odds of a lung nodule being malignant has a very wide range, the numbers may fall along 10 to 70%, other reports estimate it at 30-40%.

Size is one indicator, those that are less than 1.5 cm tend to be lower risk. Other features would be the shape, the smoothness of the borders, the presence or absence of calcium.

The smoking history raises the risk for cancer, if the smoking history was non-existent, based on size alone, the biopsy may be deferred in favor of observation.

Aside from malignant nodules (cancer), there are benign nodules. These may arise from prior infections or slow growing infections. Others may simply be normal tissue erratically growing within the lung, causing no more than an indiscernible reduction in lung capacity. Still others may be due to abnormal deposits (like amyloid) with the body reacting against it, effectively containing the injured area.

[catcon49]

I just got a copy of my ct scan report. there are a bunch of things on it. any of them of concern? splenic cyst.  indeterminat nodule in the left adrenal gland My CA 125 in 2002 was 9 In 2008 8.5.  they gave me a CEA my range was 6.5  my test score 8. Anything to worry about with these.

[HeinrikMD]

Hi,

The blood tests you mentioned are not really able to diagnose diseases on their own, but are generally more useful to monitor for recurrences for those patients with known disease. Occasionally, they may be helpful if the results are very high, but this is not so in your case.
The adrenal gland has a high propensity for having benign cysts, so the reading of indeterminate is not surprising.
The next step in this case may be to simply observe and repeat the scans in a few months or to have a PET scan done. The merits of either method whether one approach is indeed superior depends largely on the estimated risks of each individual case (put another way, there is no single diagnostic algorithm to address each patient). Discuss the next steps with your doctor and raise your anxieties then come up with an acceptable plan for you. Stay positive.

[catcon49]

PET scan is scheduled for tomorrow.   I am also BRCA I positive. I worry about the effects of all these test on that.

[HeinrikMD]

Hi,

I understand the theoretical risk of the radiation on the breast, and your predisposition to cancer.

The BrCA status is more likely the biggest risk. The repeated scans would not double the risk conferred by the BrCA status, but would likely increase it to as much as 1.6x. For example, if you are more than 60 years old, you would be 15x more likely to get breast cancer than the average woman due to the BrCA status. If you have repeated scans, the risk could be as much as 24x. If we assume the average woman has a risk of 1 in a 1000 or 0.001, your risk changes from 0.015 to 0.024.

The more critical radiation involves radiation as therapy such as for patients with lymphoma. In this case, the risk can increase 5.2x. So your risk would change from 0.015 to 0.078.

These are all estimates of course, not fearless predictions. The important thing is to stay the course, ask questions, if it doesn’t make any sense to you, you are unlikely to benefit from all the work-up.

Stay positive.

[catcon49]

I went for PET Scan thursday, both drs. on vacation so no one would give results to me. Saturday, I received a 2 phone calls 1 from hospital number one from drs office. I missed both of the calls. I returned the calls no one was there. Hospital couldn't trace what number it was called from. Drs office said no one was in. Is it odd that the dr would call me on saturday while he was on vacation? I didn't even have the test done at the hospital so I figured both calls were from him.  Would they call on Saturday with bad news?

[catcon49]

PET scan results came back today. lung was 2.7. what does that mean? Thyroid was 4.3. Dr wants me to continue with biopsy of lung and ultra sound on thyroid. does this sound right?

[HeinrikMD]

Hi,

Calls from the office may mean several things. It may simply be a reminder about the fact that your doctors are not available that day, a schedule when the PET results were available, an attempt to re-schedule your visit.

At any rate, the task of waiting isn’t easy on anyone. Bad news is best discussed face to face not over the phone. I always feel that anxiety over the unknown is helped best, by learning, and I think that is what you are trying to do here.

Stay positive.

[catcon49]

What about the suv  lung 2.7 thyroid 4.

[HeinrikMD]

Hi,

The SUV is a measure of how strong the signal is against the background. The strength of the PET is that among patients with cancer, practically all of them would be labeled as PET positive. A common cut-off for positivity would be 2.5 for lung and 2.0 for thyroid.
While cancers are seen as positive on the PET, benign lesions may also appear as positive on the PET 40% of the time. This is why the diagnosis would still require a biopsy.
Discuss the findings with your doctor. Other tests could be used to visualize the thyroid as well, to check if the finding on the PET also has a suspicious lesion that may need a biopsy.
Stay positive.

[catcon49]

does pet scan successfully pick up any lympnode activity? Also I thought the staging of cancer was done by pathologist right after biopsy. is that correct.

[HeinrikMD]

Hi,

There is a clinical staging and a pathologic staging. The clinical staging would look at the results of scans as well as the findings on physical examination, in order to decide whether particular suspicious areas may already have disease.

Pathologic staging would involve the pathologist reading though all areas that were sampled or removed. This would be definitive.

Biopsies are not without risks. Generally, it is acceptable to perform clinical staging for as long as a biopsy confirms the presence of cancer.

The PET scan would tend to get all nodes with malignant invasion. The problem is that it actually measures metabolic intake, and hence some benign nodes may also look malignant because of the uptake. Some centers use the PET to select which nodes to sample/biopsy prior to performing a curative surgery.

[catcon49]

The Pet Scan says no lympnod activity.  Biopsy report just says malignant. Would the radiologist be able to tell if smaller lymphnodes were cancerous also? Dr. said this is slow growing how slow growing? days weeks months. Pulmonologist says t-1. but is that his call?

[HeinrikMD]

Hi,

The Pet scan’s limit would not be a question of size of the node investigated, but rather the difference between the activity of the node and the activity of the surrounding anatomical structures. Hence, if there is an infection that is still in the healing phase, this may show similar to a cancer. If there is inflammation of the lung itself, then the PET may not be able to discern between the node and the lung itself.

On a practical sense, the PET would actually be more useful if the report shows nothing, since no further testing would be needed. If the PET is positive, sampling of the nodes would still be recommended if it would change the selection of treatment. The malignancy in the biopsy is no less malignant because the PET was negative.

[catcon49]

What could the thyroid be ultra sound said complex cyst. Could this be thyroid cancer that metastisized to lung or lung cancer that met to the thyroid or just 2 primary cancers. Dr.s are a little stumped. I was seen at Uof Penn They said lung surgery first then deal with thyroid. Any ideas about this

[catcon49]

Thyroid pathology report came back as characteristic of a goiter.

[HeinrikMD]

Hi,

The thyroid gland is not a usual site where lung cancer would metastasize. During the planning for diseases in the lung, imaging studies would occasionally demonstrate something in the thyroid gland (it is estimated that up to half of adults may have some nodules in the thyroid).
The depiction of a complex mass in the thyroid would likely trigger the need for a biopsy, I’m glad that it only demonstrated goiter. At this point, I think it makes enough sense to go for the surgery in the lung. My best to you.

[catcon49]

What is the recovery for VATS? They are going to take the lower right lobe.

[catcon49]

If you have to have lung cancer is there a place in the lung that is better? Upper lobe lower lobe?

[HeinrikMD]

Hi,

Your questions are pretty difficult to answer as they would vary on the individual case (partly personality and lifestyle plays a role as well, it seems that the more active people tend to do better… some writers on this post range from a fireman to office workers and they seem to experience some shortness of breath long after the surgery, but the fireman seems to adjust much better), so it would be better to discuss them with your surgeon. In general, patients are expected to have reasonably returned to baseline functionality by a month after surgery. For VATS, this may take a shorter period of time. The removal of whether upper or lower lobe doesn’t really make a clear difference in terms of cancer outcomes. What is more critical is how much would be removed as this would affect lung capacity afterwards, it also generally means more extensive cancer, and the more lung removed, the higher may be the early mortality after surgery. For some patients with severe emphysema, removal of the upper lobe may improve the symptoms of emphysema and hence in such a situation, the upper lobe would be the “better place” for the cancer (of course no place is the best place). Let me reiterate that the approach is really individualized, and you would have an entire team deciding this, not just the surgeon. Stay positive.