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burg
Posts: 14
Joined: Oct 2008

I just had a CT scan. It read a 4mm nodule on my right lung. Follow up in 6 mo. to a year. Is that normal to have to wait that long? I don't have any insurance, are they pushing me off because of that. My mother, my aunt, and my uncle all died of lung cancer in 2000. I thought lung cancer was very aggresseive and can be treated if caught at an early stage. And is a nodule the start of lung cancer?

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

First, that node could be any number of things, including scarring from previous bronchitis, pneumonia, whatever.

Second, docs need to watch a 'node' to see if it is growing or not (see the above). They are actually trying avoid unnecessary surgery for you.

Third, the 'node' may be to small to biopsy at this point. Mine was, at one point. So they let it get a little bigger (if it is going to) before going after it. I doubt, seriously, that it has to do with insurance.

Fourth, not all lung cancer is aggressive. Small cell lung cancer is aggressive, but non-small cell is not.

Hang in there! You are frightened, and have every right to be. If you smoke, quit now. If you do not exercise, start now. Get a head start on beating it, if it turns out to be cancer.

I would say, at this point, that they are not brushing you off, but waiting for some further developments, if, in fact, there are going to be any.

Take care and best wishes,

Joe

burg
Posts: 14
Joined: Oct 2008

Thanks a million. I feel much better. The only reason my doctor recommended a ct scan in the first place is because I'm scared of getting lung cancer. I first watched my aunt die at age 60 in Feb. of 2000 after a 6 mo. battle. My mother was diagnosed in March. My uncle died in July after a 2 month battle. Myself and 3 sisters cared for my mother the last 6 mo. she was 56. She passed away Aug. 2000. I'm 47. I have 3 daughters, includ. a set of identical twins. On moters day of last year one of the twins Justine, gave birth to identical twin boys the odds are 1 in 10,000. My oldest daughter is on her 11th year in school to become a doctor. She is also trained on the hyperbaric chamber and works in a clinic that specializes in that. I have heard that some say this can cure cancer but not proven. Have you heard that? Its a chamber you enter and breathe pure oxygen. It is proven good for alot of lung ailments. Shaon my daughter her gpa is 3.89. Gotta go for now but again thank you Cindy

cabbott
Posts: 1046
Joined: Aug 2006

Thanks for sharing. Joe gave you some great advice. I have 2 different kinds of cancer: breast and lung. The breast cancer came first. My local doctor wanted to operate quickly after diagnosis. When I went for a second opinion, they said they liked to operate within a 30 day span after a definitive biopsy for cancer. They pointed out that the fastest most aggressive known breast cancers rarely doubled in less than 28 days. That's how they decided 30 days was an okay limit. After reading about it, I found they were right about the doubling time and relaxed long enough to make a good decision for me about what kind of operation I wanted. Then along came the lung cancer 4 years later. The xray done to find out if I had pneumonia showed a spot on my right lung. Given my history, they followed the xray with a CAT scan and considered the possibility that the breast cancer had moved to my lung. They said that lots of things might have caused the nodule. It could have been scar tissue from having pneumonia decades earlier. It could have been a lung disease other than cancer. It wasn't big and the spot wasn't an obvious cancer, so they decided to wait 3 months and then do another CAT scan. CAT scans give the doctor a 3-D look at the nodule. This is much better than the flat 2-D picture given by the Xray. Cancers are usually irregular in shape. But CAT scans take "slices" of pictures, so really small nodules and small changes in nodules don't always show up until the nodule gets big enough. That's why they needed to wait. My sister (a family practioner doctor), said that the 3 month wait was usual. The radiologist said on his report the second time around, that he thought maybe the nodule had grown, but he wasn't sure. When lung cancer is caught early, removing the entire lobe has a good chance of being curative. In case you didn't know, your left lung has 2 lobes and the right one has 3 lobes. The surgeon can remove 1 lobe and leave the rest of the lung functioning just fine. However, it is major, major surgery and not something to attempt if you don't really need it. Unlike breast cancer where a biopsy is relatively easy to do, lung cancer is dang difficult to biopsy. Nobody can tell for sure if you have lung cancer until they see the cells under a microscope. The researchers in some areas are working on a "spit" test that can tell if you have proteins that indicate you have lung cancer, but the test is not yet available except in research settings as far as I know. Your tiny spot is very small (mine was about 1 cm and they called it tiny). So they have to wait and see if it grows. Even then , it could be TB or a fungus or any number of other things. Until the doctors see it under the microscope, it isn't cancer for sure. Even then, as my doctor found out, it may need further testing to find out what kind of cancer it is. They backed out of my first operation after finding out that it was cancer but they thought it was breast cancer. Later that week they had to call me sheepishly to tell me it really was lung cancer. That meant another operation for me...but that's my story.

Getting back to you and your story: take time now to get in the best health you can manage. IF you have to have an operation, you will want the best lung function anyone your age can manage so that the operation will not handicap you. Lungs eventually recover lots of their initial ability after parts are removed, but the doctors will not remove more than they estimate you can live without. Pardon my grammar, but what that means is that even if the cancer is showing in the entire lung and you need the whole thing removed, the surgeon won't do the operation if the remaining tissue won't keep you functioning after the operation. All you would get is chemo. Chemo helps, but it is not as good as surgery. So get your lungs in shape. Eat lots of fruits, veggies, and whole grains without getting overweight or underweight. Exercise as you can (walking is good) until you can keep it going for 30 minutes to an hour a day. Having fun doing a sport like tennis or basketball counts. Get a good night's sleep every night. I'm not a smoker, but many folks with lung cancer are. My doctor says that those of us with a genetic suseptibility to cancer often smoke, so I may have gotten cancer even earlier if I had that habit. It is not anyone's fault if they get lung cancer. Cancer is a disease not a punishment! Still, stop smoking if you do smoke for sure. Smoking delays healing and sometimes prevents it entirely. Many doctors won't do tricky surgery on smokers. Of course smoking also reduces your lung capacity. I wouldn't have wanted to deal with a smoker's cough after either of my lung surgeries. OUCH! The worst that will happen if you take good care of yourself and DON'T have cancer is that you will be in great shape. And if you might have cancer and have to have an operation, you will have more options.

You do have options when it comes to lung surgery. They may or may not be available in your community, but now is a great time to explore your options. Almost all general surgeons know how to remove a lung or part of one. However, they leave a 10+ inch incision and sometimes have to remove a rib or two when they go in. There is another operation called a VATS procedure. VATS stands for video-assisted thoracic surgery. It is like laproscopy. Both surgeries have the same results as far as survival and reoccurance. However, it will take a year or two to feel "back to normal" after a regular operation. The VATS procedure leaves three very small incisions that you could mostly cover with bandaides and after a few weeks you will feel pretty normal. I had a VATS procedure done at a teaching hospital for my biopsy. While I was wiped for the first couple of days in the hospital, by the end of 10 days I was able to walk and jog around the high school track. My second procedure was a modified VATS that left an incision about 4 inches plus two one inchers for the camera and tools. Having the bigger incision and anesthesia twice in a month took longer to recover from (about 3 months till I was back walking on a treadmill. But recover I did. I hope that your test in the future does not show cancer. They would probably put you on a monitoring schedule if that happened (like a CAT scan or Xray every 6 months for a couple of years). Please write back if you have more questions and concerns. Best of luck!

C. Abbott

burg
Posts: 14
Joined: Oct 2008

So how large does this nodule have to be before I should be concerned? It is 4mm now. Is this how lung cancer starts, a nodule? Or do alot of people have nodules that are not cancerous? My doctor just kind of pushed me off when I started asking questions, he is always in such a hurry. He treated me like don't waste my time, its not big enough YET! That day the nurse told me 4mm was about 3 inches. I now know that is not true.

cabbott
Posts: 1046
Joined: Aug 2006

Cancer starts as one lousy cell that got its pattern wrong when it divided. Usually the body recognizes when this happens. From what I've read, it actually happens alot. When the body's immune system picks up a mixed up cell, it destroys it and that's the end of that. When the cell escapes detection, it may or may not have the ability to divide. If it doesn't divide, it isn't cancer and it doesn't really cause any harm. Cells are too small to see you know, so one messed up cell is no trouble at all. But when a cell is messed up and it divides itself, it starts growing. One thing about cancer cells is that they don't stop growing when they reach a certain size. They just keep doubling. Regular cells stop when the proper size of whatever they are is reached. But cancer cells keep dividing without stopping. They also invade nearby tissues. That can stop healthy tissue from working correctly. Worst of all, these messed up cells can break off and plant themselves in other places and start dividing there. And there they go messing up even more stuff. That's why cancer is such a problem.

There is no way at all to tell if a spot is cancer or not until the cells are seen under a microscope. Sometimes a good CAT scan or PET scan can pick up hints that suggest that something is or isn't cancer, but there is no proof until it is examined under the scope. A tiny 4 mm nodule (nodule just means a 3 dimensional spot) is too small to stop your lung from working. It is probably too small to be picked up well by a CAT scan either. If it doubles in 6 months (and it might not even if it is lung cancer) it will only be 8 mm. Some lung cancers take almost 2 years to double. Mine takes a long time, which is why I will have to keep seeing the surgeon for about 8 years before he is confident I can go back to my regular doctor. Other kinds of lung cancer have shorter doubling periods. But I doubt that 6 months will be too long of a wait. It will not further endanger your life. If the nodule has already developed the ability to spread waiting won't make things worse. Hurrying won't make things better. Having an unnecessary lung biopsy would be hard on your body and with such a small spot the surgeon might not be able to find it. A one centimeter spot is less than half an inch. Yours is much tinier than that. Get a ruler and check it out. The surgeon will use his fingers to find the nodule to make sure he has the right tissue to look at under the microscope if in fact the nodule grows and they think it might be cancer. I have a spot showing on the CAT scan that was never found during the operation. Was it cancer? Will it grow? Well, it hasn't yet and I'm doing pretty okay after 2 years of waiting.Things may change on my next scan. Then again they might not. That may be worrisome, but it is what it is. The doctors really won't take any chances with your life or my life when they know they might get sued up one side and down the other if they don't follow their guidelines. They are following the gold standard of treatment guidelines by waiting. The hard part is that there is no assurance that everything is okay. I deal with that by deciding it is not cancer until the path report is finished. Then there is no need to worry because it is what it is. There is just the decision making needed to deal with the problem. Good luck finding your own way to deal with the uncertainty. It is not easy. But right now you do not have cancer. You just have a worisome nodule that they really need to monitor closely. Make sure you make your appointment for followup on time. But try not to agonize in the meantime.

catcon49's picture
catcon49
Posts: 388
Joined: Aug 2008

For me they found a nodule, it was 1.3 x 1.2 cm. It was cancerous. they did a biopsy, but the radiologist was worried about doing one because it was so small. He told me they won't even do a biopsy if it is small than 1 cm. My family physician stayed on top of things ordering all the testing he also sent me for a pet scan. The nodule lit up again they said the same thing about size. that If the nodule is small it may not lite up. I had cancer Stage 1a.

burg
Posts: 14
Joined: Oct 2008

My doctor just ordered me a cat scan because I'm so worried about cancer. The 4 mm nodule showed up. How did yours show up ct, xray? Whats the difference between a cat scan, pet scan? You mention your doctor stayed on top of things and ordered all the testing. Should I be getting other testing? So how long ago did you find this out? And what are they doing or did? Is it treatable? I'm sorry about all the questions? I just don't want to wait too long and I want to be informed about everything. So are you saying mine will have to be at least 1 cm? If it changes at all. And when some people say they found a spot on their lung and when they went back in 6 mo. for a follow up the spot was gone.
So are these SPOTS really nodules? Can mine just BE GONE in 6 mo.? Thanks Cindy

cabbott
Posts: 1046
Joined: Aug 2006

As I understand it, during a PET scan they can give you a sugar solution that is radioactive. Cancer loves calories and really goes for sugar, so it absorbs more of it than normal tissue. (The cancer goes for sugar because it is very actively dividing, so it needs energy to grow). After a short period has passed, they can "scan " your body and discover where the hot spots are and determine how likely those spots are to be cancer tissues. A CAT scan is like a series of xrays done at once that can be manipulated by computer to give a 3-D picture of the tissues in your body. Some soft tissues and all hard tissues show up on CAT scans. Sometimes the way a growth looks on a CAT scan lets the radiologist suspect cancer (irregular shape(s) that seem to be invading surrounding tissue are ominous while regular shapes that are rounded and clearly defined are not likely to be cancer). Please remember that only seeing it under a microscope proves it is cancer. These tests just give an idea of where it is and how it is behaving on these tests. I had a PET/CAT scan done after two CAT scans and an xray were showing a nodule that maybe had grown. The radiologist wasn't totally sure, but asked for it to be checked out further. The PET/CAT scan showed both where the nodule was and where the hot spot was. It was still iffy, but they decided to biopsy anyhow. It turned out I had a slow growing cancer. Slow growing cancers do not absorb as much sugar as aggressive ones.

Nodules can be many things besides cancer. Sometimes they grow and need to be biopsied. Sometimes they don't and aren't hurting anything. TB, fungi, pneumonia, and even parasites of various sorts can cause spots on the lungs. Some things other than cancer need to be monitored and possibly treated. So go back for monitoring as the doctor suggests, but don't panic. It may be nothing. You don't want unnecessary chest surgery.

burg
Posts: 14
Joined: Oct 2008

You are such an asset to this site!!! You answer almost everyones questions, and in terms we understand. I have learned ALOT from all of you. THANK YOU GOOD LUCK and GOD BLESS Cindy

MadelynJoe's picture
MadelynJoe
Posts: 96
Joined: Sep 2003

Dear Burg

I am a 3 1/2 year nonsmall cell lung cancer survivor. If I were you, I would not wait 6 months for further evaluation. Since you are uninsured, call a social worker at your local hospital or an oncology clinic and they can help you find the proper care. Many times, foundations associated with oncology practices will offer free care for the ininsured. Several drug companies offer free chemo drugs for patients that are uninsured or unable to afford the drugs. My tumor was only 2.8 cm on my initial CAT scan but it turned out to be cancer. Please don't wait - make that phone call today. Please let me know what happens. I will hold you in my prayers.

Best regards,

Madelyn

burg
Posts: 14
Joined: Oct 2008

Thanks for the advice!!!! I will contact someone this week. When I asked my doctor about having to wait 6 months to a year, he said it was too small right now. It is (or was)
4mm at that time. And he didn't think it was anything to worry about. He said alot of people have these and they are nothing. And of course the fact that I don't have insurance. Thats why I went on line. Is 4mm REALLY too small, or should I stand my ground and insist on something being done??? And if yes WHAT?

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

Be sure as you read other suggestions, even though well intended, that you are keeping your math straight. A centimeter (cm) is 1/100th of a meter, while a millimeter is 1/1000th of a meter. So if someone says they have a 4cm node, that means it is 10 times as large as yours!

In any event, if you do not have faith in your current doctor, you should probably find one that you can trust. Only then will you be able, hopefully, to allay some of your fears.

I say again that my oncologist, and my ENT surgeon, both of whom I had worked with previously (for tongue and neck cancer in '05) I trusted, and trust, implicitly. So when Onco Man said let's wait and see if it grows, I trusted him completely, even though it seems odd that you would ever WANT to wait on cancer. The truth is, it really is hard for them to even find a node when it is so small, and, I've been told, quite difficulty to get any valid results from a biopsy. Even when they DID biopsy mine, it was too small to tell if it was new or metastatic, an important distinction, believe me. They did determine it was malignant, however.

I guess I'm saying that unless you have reason to doubt your doc, go with his/her call.

Best wishes.

Tale care,

Joe

burg
Posts: 14
Joined: Oct 2008

Thank You Very MUCH! I really do feel much better now. Again Thanks Cindy

catcon49's picture
catcon49
Posts: 388
Joined: Aug 2008

Thanks for helping to clear up what I said Soccerfreak. I didn't want to get anyone worked up just to differenciate the size thing. yours is very small and I maybe nothing but I would definitely want it followed.

sheilake
Posts: 4
Joined: Oct 2008

By now you have probably had a CAT scan to see if your 4mm nodule has grown. I hope you found a Dr. you trusted. I appreciate your sense of concern. I had a 4mm nodule that the Dr. said I should follow up on in a year. I did and it had turned into an inoperable 6CM X 5CM orange-sized tumor in my right lung (stage IV adenocarcinoma lung cancer). They told me that it couldn't be "cured." I refused chemo because they only promised two to four extra weeks. The good news is that I am now taking Tarceva - a targeted pill by Genentech. The tumor has shrunk to 1/5 of its original size in just a month without the horrible side effects of chemo. So trust your intuition - with all the lung cancer in your family keep pushing for closer monitoring. I wish I had done so. You have so many more choices with Stage I lung cancer.

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