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CT and Lung Nodules

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I cannot find my previous thread, but this is my newest CT scan. So far I have had them in November, January, April, and today. I had a PET in November that lit up on a couple of spots in my left lung and three level 2 cervical nodes. Currently on a watch and see. Anyone have some information on this newest scan? Not familiar with some of the wording, and possibly what your MO said the last scan my MO say metastatic cancer does not appear as many nodules, only one nodule

 No pathologically enlarged cervical lymph nodes are demonstrated. A left posterior triangle node measures 7 mm and appears slightly larger than on more recent examinations. There are couple of subcentimeter right-sided thyroid nodules. A small area of sclerosis within the mandible near the midline remains unchanged. Several of the previously described nodular pulmonary opacities remain unchanged. There is a new 2-3 mm noncalcified nodule within the left upper lobe (image 66). A new 4 mm subpleural nodule is located anteriorly within the left upper lobe (image 95). A new 2 mm nodule is observed far inferiorly within the lingula (image 180). A left lower lobe nodular opacity near the lung base abutting the lower margin of the major fissure remains unchanged. A previously identified subcentimeter nodule posteriorly in the left upper lobe is no longer observed. An additional tiny subpleural nodule in the left upper lobe laterally has resolved in the interval. There are no confluent areas of airspace disease or significant volume loss. The central airways are patent. No pleural fluid is identified. The heart and great vessels appear unremarkable. A nodular soft tissue density within the anterior mediastinum remains unchanged. There is no pathologic hilar or mediastinal or axillary adenopathy. Within the visualized portion of the upper abdomen, there is fatty infiltration of the liver. No acute osseous abnormality demonstrated. IMPRESSION: The majority of the previously demonstrated pulmonary nodules remain stable. There has been decrease in size of a couple of the left upper lobe nodules and appearance of a couple of new left-sided nodules. Again, the findings could represent infectious or inflammatory etiology with metastatic disease not excludable. Additional short-term follow-up is warranted.

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  • maggie15
    maggie15 Member Posts: 1,075
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    bookworm14, The original thread seems to have been lost in the update so thanks for starting it up again. As I recall this seems to be a similar pattern to your last CT: some nodules stable, some smaller/gone and a couple of new small ones. Depending on the radiologist different things get mentioned. I don't think your previous CTs mentioned the small dense area of jawbone or the area of fatty liver (unrelated to the lungs.) One of my CTs mentioned coronary artery calcification so my PCP started me on a statin; I have had borderline high LDL for a while so that prompted her to do something.

    I'm not too sure what your MO is referring to (one vs. many nodules being mets or not.) I was under the impression that lung mets could be single or multiple. My pulmonologist did tell me that a nodule > 1 cm could just as likely be a met or lung cancer (and malignant nodules are more likely to be large) so a biopsy would probably be done in that case. It looks like your surveillance will continue. Do you have an upcoming appointment with your MO or the pulmonologist?

    After my last CT I got a call from the pulmonologist's NP before I got home telling me I had infiltrates in my right lung and had to go back on oral prednisone. I hadn't felt any different so I guess the scan discovered the exacerbation before it got going. I've tapered off to inhaled steroids and won't know if any additional damage was done until the next CT (6 months) but I don't feel any worse. The radiologist's report noted my previous nodules have remained stable but I have two small new ones in my left lung. I'm a bit disappointed since all the scarring and nodules had been confined to my right lung but my pulmonologist feels pretty certain everything is caused by inflammation. He follows the scan protocol, though.

    @margecandoit , What were the results of your chest CT at the end of April? Good, I hope.

  • moderators
    moderators Posts: 8,285
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    Hi @bookworm14, we're sorry you're back here and worrying. We wanted to let you know all of your previous threads are available by clicking My Discussions in the Quick Links menu on the right of your screen (or at the bottom of the screen on mobile/tablet). Here is a direct link to your threads:
    https://community.breastcancer.org/en/profile/discussions/bookworm14

    We hope this helps!

    —The Mods

  • cookie54
    cookie54 Member Posts: 748
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    Hey bookworm, Glad you came back to update us. To me reading this report nodules that have disappeared are not lung mets, mets just don't resolve without treatment. Also they don't decrease in size. If I remember correctly you are not currently on treatment? Are these new tiny nodules inflammatory, possibly. Have they ever discussed treating with antibiotics or steroids in the interim if these are infectious? I'm curious if infectious would they respond to treatment?

    Ugh the nodule game is absolutely sooo annoying! However I think this is an optimistic report being nothing has really increased in size. I'm sorry that you are being tortured by this, we all totally understand! I think I may have said this before but if cancerous it's very slow growing which is a positive. If course I we are all rooting for benign!

  • bookworm14
    bookworm14 Member Posts: 102
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    maggie15

    Keeping hopeful that your scans stay stable or get better. Hopefully, they can do something for the infiltrates? Not too familiar with those.

    I just had my meeting with the MO and he is not worried about the enlarged lymph node and also thinks it is inflammation, but it not putting me on anything for it.

    I am due to go see a Pulmonary Doctor at Tulane Medical that does lung biopsies so my MO said let him handle the nodules and if it does come back as cancerous then he will take over. My understanding is that this doctor is the best in the region for this.

    cookie54,

    I was rather happy about that one area not changing since that was the one the original Pulmonary doctor was worried about. There was another nodule she did not like the look of, but I will not see her until the 14th and as I mentioned to maggie15, I go see the higher up Pulmonary doctor at Tulane the day after.

    I was a little more worried about the lymph node, but my MO says nothing to worry over.

    I asked my MO today to maybe see if there was something I needed to do since lymph nodes are swelling, lighting up on PET and lung nodules, but he said no. Nothing to do.

    I will ask the Pulmonary doctors to see what they say since my MO is pretty much handing me off to them.

    Here's hoping for continued good news and health for you all.

  • cookie54
    cookie54 Member Posts: 748
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    Ok sounds like a good plan, keep us posted. Best Wishes🤞

  • margecandoit
    margecandoit Member Posts: 150
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    Maggie and bookworm. I am glad to see this. I couldn’t find the old threat to report back. My lung nodule is still the same but I feel like it seems large and that dr google say anything over 10 mm should be biopsied, mine is 15 mm. I also did not feel real confident with who read my CT scan. I had a mild fatty liver 3 months ago that they didn’t report and I have 2 uterine fibroids that they didn’t report. I also have a 3 cm lump in my breast that they think is fat necrosis. That they didn’t report. Maybe I am just crazy but that all seem like they should have put that on there.


    bookworm- I am glad your stable but it does seem awful confusing.

    Maggie- I am sorry you have to go back on meds but I hope it helps.

  • maggie15
    maggie15 Member Posts: 1,075
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    bookworm - I'm glad you are going to see an expert pulmonologist for another opinion. It's frustrating (but not unusual when it comes to lung nodules) when you can't get an explanation for what shows up on the CT. Let us know what the expert thinks.

    My cancer doctors turned me over to the ILD pulmonologist as far as any lung issues go, saying to send me back for treatment if mets were ever found. I have a great deal of confidence in my pulmonologist who thinks my lung problems are probably due to inflammation (the infiltrates were from my RIPF and treated with steroids) and feels that developing radiation induced lung cancer would be just as likely as mets in my situation. My hope is that my left lung remains clear and functioning.

    Marge - Radiologists mention only some of the things that they see unless they are related to the reason for the CT or seem serious enough to need medical attention. Sometimes I hear about bone islands, costochondral calcification or coronary artery calcification. I always hear about my deviated trachea (from a collapsed lobe) since my airway is only about 50% open and large thyroid nodules since they could be malignant (but have already been determined to be benign by biopsy.)

    I'm glad your nodule is stable. Size >1 cm is a contributing reason for a biopsy but the edges (smooth or jagged), the appearance (solid, ground glass or mixed) and increase in size are also taken into consideration.

  • bookworm14
    bookworm14 Member Posts: 102
    edited June 2023
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    Thanks cookie54!

    margecandoit,

    I have quite a few things show up on CT scans that were there in previous scans that were never mentioned. It can be a bit frustrating with that, but as Maggie15 said, they usually on focus on what the particular CT is for at that time

    Maggie15,

    The pulmonologist they sent me to is at Tulane Medical center and is supposed to be one of the best doctors to perform the bronchoscopy (they decided my risk was too high to not biopsy) and able to get to some tough places. He is going to take several samples and send off for cancer, infection, and inflammation along with some more tests to figure out what is going. I have good feeling about him and his staff. My scope with be either the 6th or 21st of July. Waiting on the exact date. It sucks that the treatment to help cure one cancer has the possibility of creating more cancer. This crap is just so twisted. Looks like I may be in the same boat with you with surveillance for awhile. I hope that the steroids help and we keep up with cleanish scans!

  • maggie15
    maggie15 Member Posts: 1,075
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    bookworm - I'm glad the expert pulmonologist will be performing a bronchoscopy and biopsying some of the suspicious nodules. You have been getting ambivalent answers for a long time. It's hard to treat a problem when you have no idea what is causing it. You may have a sore throat afterwards but it will be worth it to get results and/or reassurance. Having confidence in the doctor is so important for peace of mind. Let us know how the procedure goes.

    Breast cancer treatment is portrayed in the media as a walk in the park with wonderful results, maybe because it is easier to raise money by having a cheery public appearance. Survival rates have improved over the years but many of the new treatments have new adverse side effects and not everyone gets good results. When we sign those permission to treat forms we never imagine that we are going to be one of the unlucky ones who experience the serious SEs or a recurrence. Since cancer is life threatening the toxic treatments are usually worth it, but there is no knowing how you are going to come out of it. Scanxiety is real but I prefer to have someone checking for problems before they get out of hand.

  • cookie54
    cookie54 Member Posts: 748
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    bookworm, That is great news, so glad you will have an answer soon! Glad you like him and his staff ,agree with maggie confidence in you doc is a necessity.

    Ha maggie don't get me started with the rah rah cheery breast cancer crap lol! The public has no clue what this is like. We would all be cured if pink ribbons, walks and tshirts were the cure. Wouldn't that be a dream, instead here I sit Stage IV with 5 percent of funds for Stage IV research. Disgraceful!

    Well positive vibes your way bookworm for benign results.🤞

  • margecandoit
    margecandoit Member Posts: 150
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    Bookworm- so glad to hear you will hopefully get some answer soon and the Dr. come with a good résumé. Thanks for letting me know that it normal for them not to catch everything but it still frustrating and doesn’t give me confidence in who is reading it. How do you know the shape of your nodule. Will they tell you if it’s not round?
    I am with you on all the rah rah let’s go breast cancer research. Did the race and cheers with my mom and it did t help her. Though here I am 16 years after she passed and begins g my fight. I think I have more treatment options be women are still getting it. Sorry for my rant.

  • brutersmom
    brutersmom Member Posts: 924
    edited June 2023
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    Hi all. I saw this in another group and I have shared it a few places. I can relate. I here the term warrior thrown around a lot. When I hear it I feel like they are talking to someone else. Perhaps some of you will relate. Oh and I hate those commercials with all those happy people advertising meds,but that is a story for anther day.

    https://www.adn.com/opinions/2023/06/09/opinion-dont-call-me-a-brave-warrior/?fbclid=IwAR2Y6zgkOPlMG_6UlchFjAru6FrX_tAd9ZSIJ73lTzHfqeY2hZUMTCswx9w

  • cookie54
    cookie54 Member Posts: 748
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    brutersmom I am sooooo with you on this! I recently was involved i for my opinion for a chemo commercial, well that was invigorating lol. It felt good to let them know how it really feels. I wasn't sure if they were listening but but by the third revision I felt like they finally got it right! They were so off base with the reality of living with breast cancer. We'll see when it airs…..

    Yes and I love that article, defiantly describes what I feel, glad you shared it.

  • gailmary
    gailmary Member Posts: 449
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    Warrior? Me?. I didnt think so,but ok. Bookworm. Best of luck when you finally get those results. It is nerve wracking. Cookies, I hope I'll be able to see the commercial. Glad to hear you were able to give some input.

    Seems nobody "gets it" unless they dealt with it before. Feeling some frustration that people in my life ask so casually. They don't have a clue. Even if I answered honestly I doubt I'd get any time from them to talk about it.

    It seems I've had a number of nodules for some time that aren't growing. A good 2 years. Doctor has been thrilled that just faslodex has them under control. I've been very anxious about it with increased coughing. Scans are Wednesday. Probably most anxious about what meds are next. I hoped he'd just want to add Ibrance back. Will i need a biopsy? Ugh. My aches and pains are minor except now my mouth won't open fully. Hoping scans clearly show Its just tmj arthritis. Always something.

    Really bummed I can't loose myself in the garden. We still have leftover smoke here and Air quality index is dangerous, so I'm quilting if I can focus.

    Gailmary

  • cookie54
    cookie54 Member Posts: 748
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    @gailmary Two years of nodule stability is great! Good luck with your scans, I hear tmj I hear can be painful. Sending positive vibes for stability.

  • maggie15
    maggie15 Member Posts: 1,075
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    @gailmary , Best wishes for stable scans. TMJ is a real pain. I have arthritis in my right joint and after PT didn't help a steroid injection did.

  • brutersmom
    brutersmom Member Posts: 924
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    Gailmary. I hope your scans are good. And I hope that the weather soon gets rid of the smoke. The smoke has moved out of our area and has been replaced with general smog and pollen.

  • cindyny
    cindyny Member Posts: 1,229
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    Hi ladies, I’m just searching posts on lung nodules and this came up.

    I had a CT for a lump under my tongue after a tooth extraction. It turned out to be a cyst. But incidental findings were nodules in my lungs and thyroid. Had a chest CT w contrast and an US of thyroid.

    Lungs - both nodules in apex of lung; 5 mm right; 6 mm left - this one is irregular shaped. I met w the chief of thoracic surgery who seemed very through. I’m having a repeat CT at the end of November, 3 months out from first one. But he did mention VATS, taking a wedge from the tip of my lung. Used the same “clear margins” language from my BC reexcision.

    Thyroid is getting another US right before my endocrinologist PA meets with me to discuss it; 9/27. Radiologist report from the first one stated 3 separate modules; w 1 needing a fine needle aspiration.

    I started hypofractionated rads on 12/26/2017. I remember fear of scatter but mostly to my heart (left breast at 12:00). Either I’ve forgotten, quite possible, or it wasn’t emphasized about lungs and thyroid. Maybe it has nothing to do with the rads but my gut says otherwise.

  • cookie54
    cookie54 Member Posts: 748
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    Hey @cindyny Sorry to hear you are dealing with nodules as I'm sure as you read here majority wind up being benign .Small nodules can be inflammatory or could have been there for a while. I'm not sure how frequently you are scanned? However always need follow-up to prove stability over a 2 year period to prove benign. There are many different ways to get a tissue biopsy depending on size and location. Most scenarios they like it to be at least 8mm to get a quality tissue sample.

    I had a VATS wedge resection for a nodule that reached 8mm + over about a year as i was not obtainable by CT or bronchoscopy. The wait and see approach is really frustrating but necessary to ensure it truly is suspicious and warrants some type of tissue sampling.

    I also had an incidental thyroid nodule that popped up on a PET and many of these are benign also. However it turned out to be Papillary Thyroid Cancer( very treatable and typically not agressive). Thyroid nodules are very common and yours very well might have been there for sometime . There is a known association between thyroid cancer and breast cancer and vice versa so understandable to get an FNA to be sure.

    So as you said follow your gut to get some peace of mind with this. Endless scenarios as to why both of these nodules appeared but you are absolutely following the right path on this. My hope is that these have been these are are benign and you will put this to rest and move on! Sending strength and good vibes your way as you wait. I know it's hard but remain aware but positive until proven otherwise. Best wishes.

  • maggie15
    maggie15 Member Posts: 1,075
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    Hi @cindyny , I'm sorry you have to join the lung nodule surveillance group. Radiation may be the cause of both the nodules and the thyroid issue but there are other possibilities including infection and inflammation. You could send copies of the CTs to your RO and ask if those areas were in the rads/scatter field. I ended up with progressive RIPF (radiation induced pulmonary fibrosis) and a recurrent thyroid issue (possibly but probably not caused by scatter from nodal radiation.)

    Have you had any symptoms? Severe coughing, SOB, weight loss and O2 sats in the 80's on exertion led to a CT which showed RIPF. My RO referred me to an ILD specialty pulmonologist for management (no cure.) Oral steroids and oxygen slowed the spread. I now use inhaled steroids for the cough and to hopefully prevent the scarring from moving to my good left lung. I have 3 nodules in each lung. The two that have grown are in my fibrotic right middle/upper lobes so my pulmonologist thinks inflammation is driving that. I have HRCTs every 6 months to keep an eye on things.

    Five years ago I had a near total thyroidectomy for a large benign goiter compressing my trachea. The surgeon left a 1 cm strip of the uninvolved left lobe to preserve two parathyroid glands and hopefully keep me euthyroid (it did.) Now the left lobe has grown to 7cm and the right to 2cm. I had two T4 nodules biopsied (benign) and am under thyroid US surveillance watching tracheal deviation. While re-excision would be the solution it goes against my RIPF orders (no respiratory infections, no intubation, no drugs with ILD SEs) so I am waiting until my breathing is compromised.

    Cookie54 has given you excellent advice. Her personal experience and professional knowledge of medical imaging have helped many of us. A thyroid biopsy is easy and if anything is found treatment is not too bad. VATS is a tougher procedure so I would get a pulmonology opinion on the probability of mets/lung cancer if the nodes get up towards 1cm. The waiting can be worrisome but chances are excellent all is well. Hopefully your nodules will remain stable or disappear. Come back and report on scans here; it's good to have the support.

  • cindyny
    cindyny Member Posts: 1,229
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    Thank you ladies! My endocrinologist appointment is Wednesday. I’m hoping to know more after that.

  • margecandoit
    margecandoit Member Posts: 150
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    Hey ladies I am back again. This lung stuff is really frustrating. I had a pet scan 2 weeks ago and it was for the one lung nodule that we be watching and having some back pain. When I got the report back the one lung nodule was mildly lit up and has reduce in size from 1.5 cm to 1.1 and the dr said that’s basically the same and not worried and there was also more that lit up that wasn’t there last CT but he didn’t want to say that for sure cause this was compared to my last pet scan and so he going to send it off to be compared. It also said my breast lit up mildly and thinks it cause of my surgery but that was almost a year ago on that breast and I had surgery 2 months ago on my right breast that didn’t lit up at all. So he agree to do a biopsy on my lung nodule and have a call into my breast surgeon ugh!! Any insight would be greatly appreciated and thanks for listening to my rant.

  • maggie15
    maggie15 Member Posts: 1,075
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    Hi margecandoit, Lung nodules are certainly frustrating. They can be difficult to biopsy so doctors are much more prone to guess what is causing them. The decrease in size of the nodule is a good sign but it is still there. Surgery a year ago sounds like a sketchy reason for causing inflammation but it could be due to radiation which continues to cause SEs long after it is done.

    A biopsy is the only way to get a definitive answer. Hopefully the nodule can be reached by needle or bronchoscopy. My slowly increasing nodules would have to be biopsied by VATS which is invasive and could reactivate my RIPF so I’m going with my pulmonologist’s educated guess of inflammation which makes sense in my case. Hopefully you’ll get good news. At least you’ll get an answer.

  • margecandoit
    margecandoit Member Posts: 150
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    Thanks for answering me!! I was thinking it getting smaller was a good thing. Then when I was talking to my oncologist he said I was on the first line for stage 4. So then today it popped in my mind what if it’s getting smaller cause I am still doing some sorta treatment. I don’t know hard to not stop thinking and keep the fear away.

    Didnt think that they might not be able to biopsy it. Ugh

  • cindyny
    cindyny Member Posts: 1,229
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    Marge & Maggie, my worrisome nodule is in the apex and also would require VATS. I’m wondering, kind of thinking out loud, should I request a PET scan if my next CT on 11/27 shows the nodule has grown? Vs agreeing to a VATS wedge removal. (6mm irregular nodule)

    Marge I’m hoping yours can be biopsied without VATS.

    Tuesday is the fine needle biopsy on my thyroid.

  • maggie15
    maggie15 Member Posts: 1,075
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    Hi Cindy, If your CT shows nodule growth you should probably consult a pulmonologist about next steps. They usually don’t biopsy until the nodule is larger than 1 cm. VATS requires several days hospitalization but it is way easier than an open biopsy. I hope your thyroid biopsy goes well. Let us know what they find.

    Marge, I understand your oncologist’s thinking. Maybe it’s the Verzenio or maybe the nodule is just shrinking on its own. Hopefully it can be reached by needle or bronchoscope.

  • cookie54
    cookie54 Member Posts: 748
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    @margecandoit Ugh I know this is all so frustrating but either way a biopsy is the best bet to get confirmation. It's best to get a pulmonary doc involved if you don't have one already. As others have said depending on location will determine how the biopsy is performed. I know you would rather not have a wedge resection but as you know it's important to know what your dealing with. I had to have a VATS wedge resection and had it on a Friday and was home by Sunday afternoon. Yes it was a bit uncomfortable as it does require a chest tube for drainage that is removed before you leave the hospital. The sample is pretty small so the volume loss of the lung was only 2 percent for me.

    I wish you all the best with your decision, we are all here to support you. Hugs.

  • cookie54
    cookie54 Member Posts: 748
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    @cindyny Hi In regards to if you should get a PET if your nodule increased in size on your CT some small nodules are not always well analyzed by PET. CT surveillance is the go to study because even if it grows and enhances on PET you always need a biopsy to see what your dealing with. It can't be assumed that if it's cancer in your lung that it's the same breast cancer.

    Good luck with the thyroid biopsy, sending positive vibes for benign.

  • margecandoit
    margecandoit Member Posts: 150
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    i heard back from my breast surgeon and she said that it was lighting up from having radiation and that can take a year to heal. So that’s why my right breast didn’t light up from my surgery 2 months ago.

    How do you know if your nodule is in a hard place. This is what mine is saying.

    A 1.1 cm nodular opacity at right middle lobe on image 81 shows low-level FDG uptake with

    max SUV 1.3. Few small subpleural linear nodular opacities anterior left mid to lower

    lung have max SUV 1.4

    Do you find out that it a had area when they get in there to do it?

  • cookie54
    cookie54 Member Posts: 748
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    @margecandoit Glad you got a explanation for the breast enhancement. The way they know how and if they can get to it is looking at your scan. Depending on the size and location of the nodule will determine what method they think is best to use to get a good tissue biopsy. For example when you are having a CT guided biopsy a needle is inserted thru the outer skin to the chest wall/ lung/nodule. The needle is only so long to reach and be able to grab enough tissue to get a conclusive pathology result. When you consult with a pulmonologist he can decide if he thinks he can get a sample by bronchoscopy. A scope goes down your airway and they see if there is a pathway off the main branch out to the lung that can reach your nodule to get a sample. They should be able to look at your scan and determine if they think it's possible.

    For me my largest nodule was in my lower lobe and they couldn't get a sample either by CT or Bronchoscopy so I had the VATS wedge resection. As you can see every case is different. You and your doctors will have to decide the risk vs the measure to see what the best scenario is for you. Hope that helped explain.