multiple nodules in breast cancer survivor

[CPACAT]

I am a 6 year breast cancer survivor. (Age 55)  An incidental finding during a test from a recent hospital stay led to a full lung CT. Result is there are 6 nodular densities (both lungs) ranging in size from 3mm to 5mm - radiology report says they are "of uncertain orgin."

Any clue what this means? How concerned should I be that this is a recurrence of the breast cancer? What can I expect for follow up tests, etc.

Helen

[HeinrikMD]

Hi,

I think the first step is indeed to estimate if the nodules are suspicious enough to require a biopsy. The same assessment needs to be made for the lung. She would likely get a bone scan and a CT or an ultrasound for the liver, it is very atypical for breast cancer to involve the lung only, without any disease in bone. Hence, it is possible that the lung nodule is benign. Of course, if mom is a smoker - the nodule could represent lung cancer.

Explore your options and keep an open mind. Stay positive.  

[macone]

Hi there,

My mom had lobular breast cancer 15 years ago. There were some lymph nodes involved so she had a lumpectomy, chemo & radiation. She also took Tamoxifen for 5 years. She just had an mri come back with nodule showing on her right lung as well as a mammogram showing 2 nodules on her right breast. I'm freaking out. How serious does this sound to you? So far she's only seen her internist but I want her to get to an oncologist right away for a biopsy. Am I overreacting? (She's 60)

Thank you.

[HeinrikMD]

Hi,
The calcification is one of the things that are used to help estimate the likelihood that the nodules represent malignancy. It is not a fool-proof guide however, as there are cases with calcification that turn out to be malignant.

Unless you have a significant smoking history (defined as smoking a pack of cigarettes for around 10 to 20 years), lung cancer is not likely the issue. It may be more possible to get the nodules from a metastasis from the original breast cancer.  

It would be best to discuss the estimate as to how high indeed is your risk that this is cancer with your doctor. If it were a monitoring for lung cancer, looking at the size of the nodules - there are cases in which a repeat scan is recommended in 3 to 6 months. You could also explore the option of hormonal medications to see if the nodules will shrink with the treatment, there might be a problem however in terms of the scans capability of measuring small changes in size when the original masses are under 1 cm.

[CPACAT]

Just got the results of my lung CT. 8 nodules from 3mm to 6 mm  - both lungs. Report says nodules do not appear calcified. "Conclusion is that there are bilateral pulmonary nodules which are considered to be indeterminate due to their small size and lack of calcification."Do I understand correctly that lack of calcification is a negative sign that there may be a possible cancer?

Radiologist goes on to recommend a noncontrast follow up CT in 1 year "If the Patient is clinically at low risk for developing lung cancer." Am I considered to be low risk or high risk with my history of breast cancer?

Thanks in advance for your answer.

Helen

[HeinrikMD]

Hi,

You could discuss the possibility of undergoing hormonal therapy at this point. If the current plan is to observe and see if the findings in the lung are not growing - this is a valid plan. The problem though is that some patients are not  too comfortable with this since this is equated with doing nothing at all. The observation period is usually of a short interval so as to allow only a minimum period of time to detect a difference in size  - but not sufficiently long for the disease to progress to an unwieldy degree. I think it would be also be a good plan to undergo the hormones as the side effects from this treatment are not as bad as chemotherapy and are largely similar to menopausal symptoms (which you've experienced).

[CPACAT]

In answer to your questions, I did not take any chemotherapy treatments - my oncologist did not think it was necessary. No medications of any sort after the surgery and radiation treatment. I was peri-menopausal at the time of my diagnosis, which I guess adds another layer in determining treatment choices, since many of the treatments are indicated depending upon being pre or post menipausal. I was finally post menopausal about a year after my treatment.

Thanks again for your time.

Helen

[HeinrikMD]

Hi,

Your risk of recurrence would be pretty low based on the staging information that you have.

Did you take any medications like tamoxifen, arimidex, femara, or aromasin for a period of several years after lumpectomy? The estrogen receptor positivity would indicate a benefit from using the above medications. I am assuming that you were menopausal during the time of diagsosis, if you weren't- you would only be a candidate for tamoxifen, soem other drugs like goserelin/Zoladex could be offered for pre-menopausal women with breast cancer.

Discuss your available options about the next plan of action with regard to the lung findings.

[CPACAT]

Thanks for your quick response. I appreciate your time and thoughtfulness.

The radiologist should have known I had a history of cancer, but it possibly could have been overlooked in his workup.  My cancer was invasive ductal carcinoma - the staging was difficult because my axial dissection did not include any lymph nodes in the sample. The surgeon said this was most likely good news as it was unlikely the sample would have missed any anomilies. I have always felt a little uncomfortable with this fact. So, the staging was estimated at I think either 1A or 1B - the cancer was small and caught early. If I recall correctly, the chance of a recurrence was around 10% - pretty low. The cancer was off the charts high as far as estrogen receptivity. My oncologist did not recommend chemo, so I just did the lumpectomy (with a simutaneous double breast reduction) and radiation for treatment.

Helen

[HeinrikMD]

Hi,
Its hard to say if the radiologist was aware that you had a history of breast cancer, when the reading was written, it is also possible that the features are equivocal to say whether it looks malignant or not.

It would be important of course to find out if the nodules represent recurrent cancer. Breast cancer generally doesn't favor metastasis to the lungs without involving bone or liver, hence I think your doctor would likely be performing some blood tests and some additional scans which may target the liver and the bones to estimate indeed if the disease is present and how extensive it is.

There are some centers that perform biopsies to make sure - I'm not sure if this philosophy is practiced where you consult. Others would perform repeat scans to check if the nodules are growing. Some patients are not too keen on this because they believe that it is delaying action. The plan however, is scientifically sound - if the nodules are not causing any symptoms - watchful waiting is a valid option.

Of course, it is possible that the nodules are benign. Incidental findings in the lung have been observed for a long time in studies evaluating lung cancer screening. It is estimated that up to half of the normal population may harbor some of these incidental masses.

Stay positive. Stick to a healthy smoke-free lifestyle.

Would you recall the stage of breast cancer 6 years ago? did you undergo a mastectomy or a lumpectomy? did you receive chemo and hormones (tamoxifen) afterwards?