cavitated nodule

I have had numerous ct scans following lung nodules for the past 5 years and 4 ct scans,years, ago a cavitated nodule showed up on my scan,in upper right lung, along with some growth. It is now almost 3cm(,2.9cm) and most recently the report said the medial wall is thickened. Can someone explain the difference in cavitated and not cavitated and what is the differing outcome of one over the other if any?

[riley180]

Hi.
Before I answer your question, let me say something about cancer screening.
Most people see the obvious benefits of screening – which means catching the disease earlier and getting improvements in overall outcomes. What most people do not see are the harms of screening – which would be anxieties over indeterminate or intermediate results and false positive reports on the scan which on biopsy turn out to be benign. Another problem is a lack of uniformity in reporting. A study published in 2004 (Acad Radiol. 2004 Feb;11(2):233-7) describe non-uniformity of reporting among radiologists, which weakens any recommendation. In fact, screening using CT scans for lung cancer is not currently recommended. More experience will be needed before the testing will improve.
Your case though is NOT for screening but for surveillance, and hence you likely stand to benefit because the nodule is already there, however, I felt a word on screening was important to raise the point that CT as a tool still needs work to discern when to perform any biopsy (this is the real question which you are not asking: should I get a biopsy with these findings?)
Going back to the question. There is some data that the probability of survival when cavitation is present is markedly shorter. The cavitation tends to be associated with a squamous variety of cancer because it grows along the lining (the squamous cells form the lining where air exchanges in the lung) and tends to form holes (cavitation) as opposed to other varieties of cancer which form more solid areas. There are causes of cavitation that may not be cancer, such as tuberculosis in which scarring tends to produce areas where air doesn’t exchange well (imagine them as large holes as opposed to small holes that is normal lung). In a small review of 72 patients with lung cancer, (Radiology. 2005 Oct;237(1):342-7), the survival probability of those with cavitation was less than 40 months, compared in those without cavitation, which was around 80 months. The figures come from a review of patients and was not really designed to estimate how large the difference of survival would be, so the real survival based on these estimates would not be possible to extrapolate. It must be emphasized that the review consisted of all stage 1 cancers. Hence, the absence of cavitation indicates an adenocarcinoma – with that size the prognosis is known to be good. If the cancer was larger, comparing cavitation (squamous) vs no cavitation (adenocarcinoma) would likely produce inverse results: the squamous may do better because of the higher propensity of adenocarcinoma to metastasize. Further, there is conflicting evidence that in the presence of cavitations in a place where TB is common, this means that the nodule is more likely benign (Korean J Intern Med. 2001 Dec;16(4):236-41).
Its best you discuss matters with your doctor. The institution most likely has its criteria when to intervene (when to do the biopsy), and these are likely not based on the cavitations only, but incorporate the growth rate as well. Evaluate as well your risk factors for TB and sarcoidosis, as the radiologist may read the CT differently when a strong suspicion for either cannot be discounted.
My best to you.

[marm218]

Thank you for your VERY informative response!  I actually did have a TB test a few years ago when this first showed up but the results were negative. I have Rheumatoid arthritis so sarcoidosis may be a possibility at this point but I was a smoker for 30+ years and only recently quit 4 years ago so that will no doubt be considered. I have other nodules that have not gone through growth changes as this one did so I suspect this one may be different. I also had a PET scan 4+ years ago when nodules showed up on my first ct scan. It was clear. I understand PET is the test of choice for cancer but  my RA could effect the test results couldnt it? I really dont have any symptoms of cancer ,especially weight loss,but I do get some shortness of breath which concerns me. I have a family history of lung cancer too so as you can imagine I am leaning that way. I tend to grab a bull by the horns and go from there so I am trying to learn as much as I can now so I can make informative decisions should the need arise. Thank you again!

[riley180]

Hi.
On the RA and the PET :
You are correct that the RA may interfere with the PET. The tracer for PET is a radioactive sugar – and anywhere where there is inflammation in which cells are actively causing destruction, cells are multiplying, etc  will show up on the PET.  However, the areas that RA involves are generally the joints so there would be some clue as to the location of the signal enhanced areas.
There is a new tracer under development in which a radioactive thymidine (a component of DNA) will be used – this would be more specific for cells multiplying (which would more likely mean cancer) rather than cells merely active requiring an increased amount of sugar/energy.

On family history and lung cancer:
There isn’t much data on specific lung cancer families – this is likely because it would be hard to eliminate the effect of smoking, as second hand smoke is bad, and children of smokers tend to become smokers as well. At the most perhaps, the family history tends to make family members more aware, and I think you have the right attitude. The opposite extreme is to take the route of denial and fatalism and ignore whatever comes until the symptoms get too nasty to be denied.

Try to stay positive and bear in mind that the goal here is to catch the disease in the earliest stage where treatment options have the largest impact.