LUNG NODULE

I had a eyes to thighs Pet/Ct scan in Feburary this year which said that there was no definite evidence of FDG-avid malignancy from skull base to midthigh however it said there were several nodular and ground glass opacities throughout both lung fields, not FDG-avid and recommended follow-up with CT thorax in two months to ensure resolution. I had same in June and September. September scan impression said stable bilateral groundglass opacities and semi-solid nodule in left lower lobe (1.6 X 1.4 cm.) and should consider biopsy or 6 month follow up. I met with thoracic surgeon who says he wants to take nodule out. He said biopsy is hard to get a good result. This Surgeon did fellowship at Mayo Clinic for one year but has only been at our hospital a few weeks. Anyone have any recommendations. Do you think he is being rather aggresive in the treatment as I am scared to death to have it done. He does it laposcropically but should he not be able to get to it then I have to be opened up. Do you think another Pet/ct scan is order before attempting surgery? Any input would be appreciated.

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As someone who accepted the watch and wait and ended up regretting it, I would advise a second opinion and then if it can be gotten out, get it out. If you look at my past entries, I had a nodule followed for close to two years because everyone was sure it was benign....low uptake, slow growth then boom quadrupled in size. Had it removed but six months later two positive nodes. I will always feel that if we got it out early, I would not be dealing with the nodes. Everyone is different, and I certainly think a second opinion is always important, but it seems from what I have seen, the earlier the removal the better the outcome. Good luck to you...will pray that it is indeed nothing!

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Not knowing what it is, I would be concerned....I think I would get 2nd opinion or at least try biopsy to see what it is.

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I had approximately the same size nodule on my lower left lung. My thoracic surgeon gave me the same advice as yours did. He removed it doing the VATS method (video assisted thoracic surgery) and a wedge section of my lung. It turned out to be bronchoalveolar carcinoma but since they found it so early I didn't need any chemo or radiation.
I have regular CT scans and they did find some ground glass nodules but I think they went away. I have my next CT scan in 4 weeks.
For peace of mind, maybe you should do as the above post recommended and get a second opinion. Then do some research and ask around about your original surgeon. He sounds like he's very capable and knowledgeable.
I wish you the best. Please keep us posted.
Cindy

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I had a ground glass nodule that we watched for a year with no interval change. Everyone assumed BAC. Biopsy was inconclusive. But I wanted it out, and it was a little BAC, but two thirds was adeno. I was glad it was out, since adeno is invasive, and who knows when it would start invading. The semi-solid nodule is the one that concerns me since BAC is pure ggo.

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Thank you for taking the time to answer.

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Thank you for taking the time to reply.

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Thanks for your reply.

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Thank you for your reply.

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Could you advise what "The semi-solid nodule is the one that concerns me since BAC is pure ggo" means as I am new to this and don't understand some of the short forms. Thanks so much.

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Hi Colleen, I just had a vats LUL because I had a 1 cm nodule. My thoracic surgeon also recommended surgery instead of a needle biopsy. The problem with needle biopsies, esp with nodules this small, is that the results are often inconclusive. My surgeon first did a wedge resection to remove the nodule & they did a frozen section while I was still under. Mine was malignant so he did the lobectomy. I think the thoracic surgeons prefer to do it this way because they consider the patient's age & the size of the nodule & the statistical probability of the nodule being malignant. My nodule was considered "indeterminant" by PET/CT which meant it didn't really light up, but it wasn't really negative either.
Usually the thoracic surgeon can tell by the size & location of the nodule whether they can do it using vats. My surgeon told me he has to resort to the full thoracotomy only very very rarely.
Gail
Ps ggo= ground glass opacity.

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Thank you very much for your reply. What is vats LUL and how long did it take you to get out of hospital and be back to yourself again. Was it very painful. I know I sound like a chicken but I am overwhelmed by all of this.

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I had my surgery on Aug 19th & was discharged from the hospital Aug 24th. Most vats patients aren't in even that long, but my surgeon kept me in a day or 2 longer because I live alone. They had me up & walking the next day. My pain was controlled the whole time I was in the hospital (I got IV dilaudid) so I had very little discomfort. And the only thing I take post-op is Ibuprofen (Advil).
The first few days are a little uncomfortable, but I made sure to keep taking my ibuprofen every 6 hrs.
Sleeping was somewhat challenging, only because I had to find a comfortable position. Many people find sleeping in a recliner the best, or, in bed with lots of pillows.
VATS = video assisted thoracic surgery
LUL = left upper lobectomy
I'm just now beginning to feel like my old self. I'm still off from work ( until end of Oct) because I'm on my feet & do a lot of running around on the job. If I had a sedentary job I probably could've gone back after a month or so.
You're not a chicken...it's totally normal to be overwhelmed & nervous... Who wouldn't be!!
( personally, I would've been more anxious waiting 3-6 months to re-scan the nodule which was one of my options.)
Hope this helps
Gail

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Hi Coleen, pure ggo means pure ground glass obscurity with no solid component. This is how pure BAC (bronchialveolar carcinoma) presents. Pure BAC is not considered invasive. It becomes problematic when it becomes multifocal, meaning many nodules throughout your lungs. But even multifocal BAC can remain stable for long periods of time, as can solitary BAC nodules. Pure BAC is relatively uncommon. More commonly nodules are of mixed subtype with both BAC and adenocarcinoma. Adeno is one of the most common types of invasive lung cancer, and it will usually present on a scan as a more solid nodule, although mine did not. Some think there is a continuum from BAC to invasive adeno, and the tumor becomes more concerning the more adeno there is. So, I would be curious how big the solid component is. Maybe they could try to biopsy the solid component. Violating a ggo is very difficult to get useful info from.

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Violating = biopsying according to autocorrect!

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Hi Frangipani, sounds like you're on the mend!!! Yay!
Isn't autocorrect a riot? I was typing "lobectomy" & I looked up to see that autocorrect had changed it to "Love Tony"! : )))
Gail

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Thanks again. Do you mean that the surgeon removes the nodule and if it is malignant then they do the lobectomy lapiscopically or do they have to open you up to do the lobectomy. My surgeon did not mention a lobectomy. He said that if he couldn't reach the nodule lapiscopically then they would make an incision, and I was like a deer in a headlight, and didn't even ask what size the incision would be or even where the incision is made for that matter. He sent me off the pulmonary technicial for testing and she said I did great. I have no shortness of breath or any other symptoms. This was found by accident as we all had to be checked because my brother was discovered to have pancreatic cancer. I was in Florida for the winter when all the siblings were advised to be checked so I paid to have a Pet/Ct Scan there which showed no FDG avid malignancy from skull base to midthigh and that was in Feburary, 2011, and upon returning home had a CT in June and September because of this nodule. I can't even get myself going today this has been such a shock. It is really comforting to be able to communicate with someone that knows something about all of this. I really appreciate the time you have spent to inform me.

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You're very welcome, Colleen. This is a great website, isn't it!
The VATS procedure uses usually 3 (sometimes 4) small
incisions. The largest incision I have is 2 inches long & the other 2 look to be a little over an inch long. They do the surgical biopsy &, if malignant, the lobectomy all in the same surgery & all by VATS. Again, depending on the the location of the nodule. My surgeon told me he was pretty certain he could do everything he needed to do by VATS, but if he couldn't, he would extend the incision & do a full thoracotomy.
They begin by doing a wedge resection which removes the nodule so they can do the pathology on it. If it's benign, that's all he'd do then. You get to keep your
lobe : ). I know some surgeons only do a wedge resection even if the nodule turns out to be malignant. That depends on whether a patient can tolerate the removal of a lobe... most healthy people can & you said your Pulmonary function tests were good. I believe the current trend is to do a lobectomy if a nodule turns out to be malignant, rather than just remove only the nodule by wedge resection, to up the odds against a recurrence.
But this depends on what your surgeon does & also on your particular case. I'd ask him, though, if he's considering a lobectomy.
I know all of this is a shock. But just try to take everything one step at a time so as not to feel overwhelmed.
Gail

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Colleen,

I would be sure that the Thoracic surgeon is skilled in VATS technology. Do not assume that he is.

I had a 2.7cm long andeno carcinoma discovered through this procedure. it was in my upper right lobe which he decided to remove. My only regret was that he did not check lymph nodes during the surgery. I had a second surgery to remove the effected Lymph node.

These critters slough of cells and they can start a new cancer else where in your body. Its best to get it out of your body. I walked out of the hospital the next day after my VATS surgery. And yes it was uncomfortable for a little while. Only used pain meds for a couple days and at night for a week. I also used a pillow to keep my arm off my chest. I still do that sometimes at night.

My surgery was in Jan 2011. I have some shortness of breath when running up stairs or chasing the dog. But I feel pretty good most of the time. I did have to have chemo and radiation because the cells moved into my lymph nodes.
Best wishes to you,
Julie JB

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Thank you so much for your reply. I did ask the thoracic surgeon how many VATS he had done and he said a couple of hundred. He has just finished his fellowship at the Mayo Clinic so I don't know what else you can find out because he does not have a long history in the area. I would suspect he was well trained in VATS surgery by them as they have a world renowned reputation. I suppose if I asked for someone more experienced, I would have to wait for months which means it could progress to one as large as yours and I would probably have radiation and chemo like you. I guess I just have to chose the better of two evils. I will however question him about looking a lymph nodes so thank you for bringing that to my attention. I am glad that you are feeling pretty good now and hope that you continue to recover fully.

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Hi, Colleen,

There is a technology out there that can get a good biopsy from almost anywhere in the lung called Super Dimension. Many cancer centers have it, but many more don't. A second opinion is also always a good idea. I work with the Bonnie J. Addario Lung Cancer Foundation. If you would like to speak with someone about a referral for a second opinion, the best treatment options available and questions to ask your physicians and surgeon, please direct message me.

Wish you all the best as you navigate this new world of lung cancer.

Yours,

Nicolle

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