PET scan for single pulmonary nodule

[Lorelei66]

I just had a PET scan for a single pulmonary nodule (8mm). I have recently had a bunch of tests (after a single case of internal bleeding/melena, which remains a mystery) to rule out many things (Gastro-endoscopy, colonoscopy, echo & CT scans of abdomen, 2 chest x-rays, chest CT scan, and mammogram), and all they've found so far is a (supposedly benign 4cm dermoid) cyst in my ovary, and the SPN. The doctors say the spot is very small, and they can't gaurantee that its benign - thus the PET scan. I am 38, never smoked a single cigarette in my life, and am otherwise fit and in perfect health. I did have pneumonia 5 years ago, but the doctors can't say that its related. The seriousness of this test really has me worried. Could you give me any idea what the possibilities test results might be? Is there any diagnosis besides benign tumor or lung cancer? The doctors also mentioned a concern that it could be a secondary tumor, but could I have metastisized cancer without even having any symptoms?! Any information you could give would be much appreciated!

Nancy

[National Jewish]

I assume that your doctors have compared your recent chest x-ray with chest x-rays you’ve had in the past to determine if the nodule was present at an earlier time.  The most common cause of a single pulmonary nodule (SPN) in young, healthy people is granuloma.  This is a small cluster of inflammation that is not cancer.  After a lung infection, like the pneumonia that you had 5 years ago, the inflammation could have cleared away and left this scar behind.



Your doctors are right about the size of the nodule.  By conventional standards, this 8 mm nodule is small.  In a 38 year old healthy, non-smoker, the odds in favor of it not being cancer are quite high.  Both the CT scan and the PET scan can suggest, but cannot tell for sure that this SPN is or is not cancer.



Most studies specify the approach to such a nodule in a healthy individual.  The melena may or may not be an indication of less than completely good health and this adds another dimension to concern about the nodule.  You could have metastasized cancer without even having any symptoms.



If the nodule is present in the periphery of your lung, it might lend itself to removal by video-assisted thoracic surgery (VATS).  During this surgery a scope with a small video camera at one end of a flexible tube is placed through a small incision between the ribs into the chest.  If, after a careful review of the PET scan and all other data, one or more of your doctors recommend removal of the nodule, you should give very serious consideration to their advice.



Good luck.  The odds are in your favor.

[EROS]

The big problem with PET scans is that in alot of cases they show benign nodules which require further follow up and investigation.



Eros.

[Lorelei66]

But isn't a benign nodule OK????? I understand that the best-case scenario is that this (benign) nodule will need to be watched for two years. But aren't the chances good that it will remain benign (if it even is benign - I'm still waiting for the PET scan results....)

[HappyNeige]

PET is good if the spot is bigger (usually > 10 mm).  In your case, having a negative PET may not mean much because the spot is quite small.  One thing you may want to ask your doctor about (and this may have something to do with your internal bleeding as well.) is the possibility that the spot is an AVM (arteriovenous malformation).  AVMs can occur in the lung (as a spot), in the stomach or intestine or in the liver.  And these things bleed quite often.  Pulmonary angiogram is a good way to find out if the spot in your lung is an AVM.  But ask your doctor first about how likely he/she thinks this might be AVM.  (BTW, AVM will show up as negative on the PET scan.)



Good luck,

HappyNeige...

[Lorelei66]

Thank you for your response. Fortunately my treatment moved so quickly that your answer came long after the fact. The PET scan showed no activity in the lungs. We will monitor the spot with chest x-rays (or CT scans?) for the next year or so.... I have also just had my laparoscopy (which prompted the frightening chest x-ray in the first place), and instead of the expected ovarian cyst they found a (seemingly harmless) fibroid on the outside of my uterus! So at the moment I appear healthy - I just need to follow-up to make sure things stay that way!



Reading through the forum archives was very helpful to me in dealing with this sudden crisis - it hepled lessen the fear a bit and I learned a lot - thanks!

[Lorelei66]

Thanks for your response - I've never heard of this. The internal bleed was a one-time occurence, 4 1/2 months ago - never happened again (the theory is that my sometimes excessive use of Ibuprofin for headaches caused a tiny ulcer/tear in my stomach that was healing/healed by the time I was tested - I haven't used Ibuprofin since!). Is that still possibly an AVM If I only bleed one time? My doctors (internist and gyno) seemed only concerned with malignancy, and since they couldn't find a primary cancer (not for lack of trying, believe me), AND because I had pneumonia in my left lung 5 years ago, they seemed content with the negative PET results, but will follow it up for 2 years.



I really appreciate this new info, though. I'll keep it in mind if any concerns arise again.