Malignant neoplasm

[bing1487]

My father has been having lung problems...According to the CT scan report: C.T. images reveal a mixed attenuation, heterogeneously enhancing mass measuring 8cmx9.4 cm.x8.1 cm in the posterior segment of the right upper lobe extending to the apical segment. Its borders are irregular and lobulated. It has a fairly large non-enhancing hypodense focus at its, core, likely due to necrosis. Right upper lobe pulmonary mass with obstructive pneumonia, as described above likely neoplastic. Research tells me that the words "irregular" and "necrosis" hint that its cancer...We're about to schedule a biopsy..He's been having problems with his knees and the right side of his body (arms, hands, shoulders...) Your responses will be greatly appreciated...

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
A biopsy is certainly indicated for your father. He has a large mass in his right lung with radiological characteristics suspicious of cancer.
A CT guided FNAC or a biopsy is a relatively simple and near-painless procedure, and will help clinch the diagnosis.  It is likely that the mass (located on the upper part of his right lung) is compressing nerves supplying the right shoulder, arm, and hand. Doctors call this the Pancoast Syndrome.
A PET scan and a bone scan too may be useful for staging the disease. Is he a current or a former smoker? If he smokes, he must stop immediately.
Pl post additional queries if you need more details.
All the best, and God Bless!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Any new nodule picked up on CT thorax should be followed up with repeat imaging. So you could wait for 3 months as advised. Or you could get additional tests now to determine the nature of this lesion.
A PET would indicate presence or absence of metabolic activity within the nodule. An active nodule may be because of neoplasm or infection.  
An FNAC (if technically feasible) should provide the answer in most cases.
All the best, and God Bless!

[jmurphy317]

Hi iam a59 yr old female with a 36 yr hx of smoking i joined the elcap study 2yrs ago a nodule was found 3x3mm in r upper lobe, second year a nodule was reported in the LLL 5x4mm. the study has ended but i was advised to follow through and have additional ct of chest also have mild copd, have seen pulm md good pft, no meds just had repeat ct old nodule stable but in the left lower lobenew0.9x0.6cmirregular opacity is nonspecific may reresent infection,or neoplasm. advise repeat ct in 3 months.this was i a surprize for me i haven't been sick. ps i gave up smoking 4 +yrs ago

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The symptoms you mentioned are often caused by advanced disease and bony involvement by the cancer cells.
You must try and schedule the tests as quickly as possible. Early treatment will help relieve his symptoms and improve his quality of life significantly.
Be strong.

[bing1487]

He was a heavy smoker for decades....I heard that symptoms of bone pain, joint swelling, shoulder and back pain (which he already has) are attributed to advanced stages of lung cancer..Could this be true? Since tests and results would most likely take days if not weeks...We would like a heads up...Thanks for your time Dr. Saini..God Bless!