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Old 05-13-2005, 04:35 PM   #1
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Nodule in Lung

Hi everyone! What a sad reason to join a new board.

Yesterday I had a chest x-ray and a CT scan of my chest and abdomen because I have been experiencing swelling above my collar bones and the doctor wanted to rule out lymphoma and Cushing's Disease.

The x-ray was clear - however, the office called earlier today to say that the CT scan revealed that there was a 8 mm "nodule" in the "medial aspect of right middle lobe" of my lungs.

They said that in 3 months I will have a repeat scan. I thought, ok, fine, I am great, this is good! Then I typed in "lung nodule" on ***** search and everything that came up had to do with cancer.

The more research I have done the more scared I feel. I see things about a "5-year survival rate" ... as well as other reasons for a solitary lung nodule which are non-cancerous.

I was a moderate smoker for 4 years (age 16 to 20) then on and off for the remaining 11 years (I am 31 now) .. more off than on, more socially than daily. My father smoked while I was young.

I am unhappy! I went in for one reason and came out with another.

Monica

Last edited by signing; 05-13-2005 at 04:36 PM.

 
Old 05-13-2005, 05:43 PM   #2
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Re: Nodule in Lung

Hello Signing Baby,

I am so sorry that you are going through a difficult time. I just wanted to share my husbands experience. Several years ago he was having a lot of shortness of breath and a great amount of fatigue. He went to the dr. for a physical and they did a routine chest xray. That showed something they wanted to see further so he had a CT scan. The CT scan showed several nodules. So, he was sent to a pulmonologist. They did a test called a PET scan which revealed that he has an autoimmune disease called sarcoidosis. He has things in his lungs called granulomas. It also showed two nodules. He had a mediastynoscopy on the nodule in his lung and it just confirmed the sarcoidosis - it was benign. They did not biopsy the one near his heart because the procedure to get there is dangerous. So he had CT scans every 6 months and now every year. The nodule has not changed at all and that is a good thing. His sarcoidosis is also under control thanks to a few rounds of prednisone. It might help you to see a pulmonologist if you have not done so. Good luck to you and let us know how you are. Bern

 
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Old 05-13-2005, 07:20 PM   #3
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Re: Nodule in Lung

First, the best and MOST IMPORTANT thing for you to do RIGHT NOW is to stop smoking. It is a killer all the way around. I know it's very hard to stop but if you only could know how many patients suffer from the variety of ailments that they do because of smoking, you would quit this very day!

There are many, many reasons for lung nodules as well as several types. The CT is a great method of showing the anatomic relations of a lung nodule and yours was evidently decided by the radiologist to be non-worrisome for cancer, this far. Also, it is small. Nodules over 2.5 cm have a higher probability to be a cancer.

You should get a copy of your Chest CT report so you can read the impression yourself. The CT would show the absence or presence of calcifications in the nodule - when calcification is present, the lung nodule is most often benign (non-cancerous). Because the radiologist is informing your doctor that your nodule is not worrisome at this point, your doctor is taking the proper precaution by ordering a follow up CT in 3 months, which will show changes or not. If changes are noted, you will then be referred to a pulmonologist to determine whether or not a thoracoscopy with biopsy is needed.

I know that 3 months is a long wait for you but if changes are noted at that time, your treatment at that time will offer the same prognosis as if you had anything done right now (if that eases your mind at all). If you are uncomfortable with your doctor's current decision, you have every right to be referred to a pulmonologist now to ease your mind, but I personally believe (from experience) that your doctor has you on the right route and that any pulmonologist would give you this same recommendation. As long as your nodule remains stable, you can expect to have another Chest CT in another 3 months after the upcoming one, and then every 6 months for a year and then one every year after that. Without a previous x-ray or CT for comparison, this is a watch and wait situation at this point. The best favor to yourself is to stop smoking today.

 
Old 05-13-2005, 07:54 PM   #4
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Re: Nodule in Lung

Oh, I no longer smoke at all, and haven't for quite some time. I just meant that I did off and on since I quit full-time. I have recently had asthma problems and couldn't even if I wanted to. I should have made myself more clear initially! I didn't want to give the impression that I still smoke, but didn't want it to appear that I didn't at all. It was more of a 1 pack per three months kind of a habit as opposed to 2 packs per week.

Thanks for your information. It was very helpful. I just hate to wait if it is something more serious, know what I mean? My aunt died of lung cancer and the fact that there is "something" in my lung is upsetting.

Monica

Last edited by signing; 05-13-2005 at 07:59 PM.

 
Old 05-14-2005, 05:58 AM   #5
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Re: Nodule in Lung

Monica- I know what you mean, I don't blame you one bit! I would be very upset if I was walking around knowing I had a lung nodule also! Know this though: Your nodule must appear very contained and stable or they would be doing further testing immediately due to liability. If the appearance of your nodule is truly as they believe it is, then 3 months is safe. Keep in mind though that due to the fact that you have even been a previous smoker, you are at a higher risk for Lung CA. This is also compounded by the fact that you have a family history of Lung CA (If your aunt is on your familial side, of course) These factors are all the more reason for you to not only ask for every report done (start your own file at home!) but to watch your follow up dates. Medical clinics usually enter into their computer systems what are known as "recalls". These are lists of things that need to be ordered for patients and this recall list is printed out each month. That is how they know when to call you. It can happen where recalls are entered improperly or there is a computer malfunction or back up error where recalls are even lost altogether and if the patient didn't remember to call, they don't get proper follow up. Mark a day on your calendar 3 months from now, as a reminder to call your doctor's office to remind THEM that you are ready to have your CT ordered. Have you had bloodwork also? I would have hoped they ordered that as well. I know it's crappy for me to tell you to try not to worry but you are really in a safe zone at this point. Just help them help you by keeping track of the time when you need your follow up.

 
Old 05-14-2005, 07:14 AM   #6
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Re: Nodule in Lung

Hi Monica,

Dang! Same thing happened to me! I went in for a ct-scan for enlarged lymph nodes and they found a 5 mm nodule in my lung. I am 42, and a pack-a-day smoker. The doctor did give me a copy of the ct-scan report and the language in it was interesting.

Here's what mine said: ..."somewhat vague 5mm nodule.... calcified granuloma....thought to be a small focal area of pleural fibrotic change at the left major fissure. There would appear to be very mild interstitial disease diffusely suggestive of minor to mild interstitial pulmonary fibrosis."

At this point I'm not worried about cancer because my oncologist ran some cancer bloodwork tests that came back negative (suspected lymphoma). He did recommend another ct-scan in 3 months to see if the nodule has changed. I'm not in a hurry to have the scan done earlier because if it is GOING to change, I want to give it enough time to change. Now the interstitial lung disease is a scary thing. I'm gonna wait and see what the 3-month follow up shows.

Someone had posted a reply to a post I had made regarding my ct-scan and they had a similar experience. They had 2 ct-scans 3 months apart. One reading indicated a nodule and a second scan indicated a plural thickening. I think it all has to do with the interpretation by the ct-scan doctor. Then your medical doctor has to do the tests to see if it is cancer or something else.

Sweetie, I would say, please don't get your panties in a knot. I'm trying not to myself! However, I am gonna follow up and get that 3 month scan. In the meantime I have to get my "stenosis of the subclavian vein" checked out. That showed up on the scan. I was referred to a cardiologist because I have a normal EKG, normal cholesterol, etc. Going there Monday. Fun, fun, fun.

Well, I wish ya luck. Three months will be up before you know it!
~zeez

 
Old 05-14-2005, 09:04 AM   #7
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Re: Nodule in Lung

smithn: Thank you SO much for your answer. You are so sensible - I'm afraid that I'm the opposite ... also I went into a bit of a freak-out mode when I realized what she had said.

I had a lot of blood work that all came back "normal" - CBC with differential, TSH, T4, sed rate, and cortisol and another one that has to do with the pituitary (the last two have to do with Cushing's).

I didn't know I could request my reports - do you think they will fax them to me? Or do I have to pick them up in person? I would love to look over them and start my own "me" file.

My aunt was my dad's sister and a lifelong smoker (as all of his other sisters!).

Thanks again! I look forward to getting my reports.


Monica

 
Old 05-14-2005, 09:07 AM   #8
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Re: Nodule in Lung

zeez: Thanks for posting - although I'm not glad you are going through a similar thing, it does help to know I'm not completely alone. What blood work did you have? My mom who is a nurse said that if I did have cancer it wouldn't necessarily show up in the blood work I had drawn.

I think you are right on the 3 month wait - it does make sense the way you put it.


Monica

 
Old 05-14-2005, 01:42 PM   #9
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Re: Nodule in Lung

Quote:
Originally Posted by signingbaby
smithn: Thank you SO much for your answer. You are so sensible - I'm afraid that I'm the opposite ... also I went into a bit of a freak-out mode when I realized what she had said.

I had a lot of blood work that all came back "normal" - CBC with differential, TSH, T4, sed rate, and cortisol and another one that has to do with the pituitary (the last two have to do with Cushing's).

I didn't know I could request my reports - do you think they will fax them to me? Or do I have to pick them up in person? I would love to look over them and start my own "me" file.

My aunt was my dad's sister and a lifelong smoker (as all of his other sisters!).

Thanks again! I look forward to getting my reports.


Monica

I work with a lung surgeon (imagine that!)

You can request your reports either in person or via fax. They will most likely have you sign a records release due to the pain the in rear HIPAA guidelines every medical office must follow. Just sign it, send it back to them and you should be able to get any record you want. Tell them you want ALL of them. Not only is it good for you to have them for your own sake, but to keep them on hand as good medical history for others in your family or your own children some day.

 
Old 05-14-2005, 05:27 PM   #10
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Re: Nodule in Lung

Hey there Monica,

There are several reasons that I am not worried that it is not cancer. The way the ct-scan doctor read the scan did not indicate cancer but interstitial lung disease. It also said to "correlate clinally", which I take to mean as have a doctor follow up with a true diagnosis.

The tests the oncologist ran were CBC, ESR (sedimentation rate), and a p and c. The P&C is a test they run to determine the overall health of a person. I think they ran that on my because, ummm, I'm quite lean. My CBC (which I have had 3 in the last couple of months) was normalish, as were all the others. White blood count is what I would be concerned about, which mine were normalish. The only things out of range on my tests were a slightly low sodium, slightly high AST, all of which I attribute to working out a lot. The only thing that struck me as really odd was my ESR - sed rate test. Supposedly it is higher in older females. I'm 42 and mine was 2 on a scale of 0-20. Which also does NOT indicate cancer or blood disorders.

If I were you, I would request a TB test. When I was going through the scare of enlarged lymph nodes, I kept coming across enlarged node above the collarbone being indicative of tb. I know that may be a whacked out suggestion, but you could have been exposed somewhere in public...., who knows.

If there is anything I can help you with, I'd be glad to. I just wish I could give ya my email or something. I'll keep this thread "subscribed".

Good luck sweetie!
~zeez

 
Old 05-19-2005, 02:14 PM   #11
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Re: Nodule in Lung

Hi everyone! I went to my doctor's office to request copies of my recent medical records and they said that not only would it take 4-6 WEEKS but it would cost $17 plus 40 cents per page. I was inflamed! I said a not-nice word and left. Later I called to speak to the nurse (not mentioning that I had already been there) and started asking many questions about my CT scan, and she actually volunteered to send a copy of the report to my home.

Here is what it says about the nodule:

"There is an 8-mm nodule in the medial aspect of the right middle lobe, which is not seen on chest x-ray as it is overlapping hilum and mediastinum on the 2 views. The Hounsfield units average 128.7. With the administration of contrast, it is uncertain whether this represents an enhancing nodule or a calcified granuloma. Would consider followup noncontrast CT scan in 3 montsh for further evaluation."

First of all, what does contrast (I had intravenous contrast as well as barium) have to do with being able to see a nodule in my lung clearly? And second, if they can't tell what it is due to the contrast, why not order a noncontrast CT immediately? Is it because it's so "small"?

Thanks,
Monica

 
Old 05-19-2005, 05:39 PM   #12
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Re: Nodule in Lung

Quote:
Originally Posted by signingbaby
Hi everyone! I went to my doctor's office to request copies of my recent medical records and they said that not only would it take 4-6 WEEKS but it would cost $17 plus 40 cents per page. I was inflamed! I said a not-nice word and left. Later I called to speak to the nurse (not mentioning that I had already been there) and started asking many questions about my CT scan, and she actually volunteered to send a copy of the report to my home.

Here is what it says about the nodule:

"There is an 8-mm nodule in the medial aspect of the right middle lobe, which is not seen on chest x-ray as it is overlapping hilum and mediastinum on the 2 views. The Hounsfield units average 128.7. With the administration of contrast, it is uncertain whether this represents an enhancing nodule or a calcified granuloma. Would consider followup noncontrast CT scan in 3 montsh for further evaluation."

First of all, what does contrast (I had intravenous contrast as well as barium) have to do with being able to see a nodule in my lung clearly? And second, if they can't tell what it is due to the contrast, why not order a noncontrast CT immediately? Is it because it's so "small"?

Thanks,
Monica
Contrast is used to make specific organs, blood vessels and/or tissue types "stand out" to better show the presence of disease or injury. CT contrast highlights specific areas in an image or "dyes" it. It is the ideal method of choice when you have previous films for comparison or if a person has already been diagnosed with a lung cancer and they want to evaluate the tissues to see if it has metastasized, or spread. In your case, your doctor has no previous films for comparison and the radiologist isn't completely sure whether this is a calcification or something more. Because of the uncertainty and the size of your nodule and the fact that it does have some calcification features, it is best to follow up in 3 months with a non-contrast CT because non-contrast CT's show calcification patterns better. Doing a study sooner than 3 months wouldn't allow enough time for this nodule to change enough to better diagnose it.

You can expect that if on follow up CT the nodule has changed, they will refer you for a biopsy. If it appears more calcified, then they will continue to watch it.

What you could do is this: Call your radiology department and tell them that you would like another radiologist in the department to read your films so you can get a second opinion on this. Or, you can ask for an "outside" opinion and ask that your films be sent to another radiologist at another reputable hospital altogether. You will be charged for this but if I were you, I would do this just for better piece of mind. Two heads are better than one and I'm all for second opinions on most every medical matter.

 
Old 05-19-2005, 05:59 PM   #13
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Re: Nodule in Lung

Quote:
Originally Posted by smithn
Because of the uncertainty and the size of your nodule and the fact that it does have some calcification features, it is best to follow up in 3 months with a non-contrast CT because non-contrast CT's show calcification patterns better. Doing a study sooner than 3 months wouldn't allow enough time for this nodule to change enough to better diagnose it.
Where did it say that it has calcification features? I'm not questioning you - I just simply don't see it!

Thanks for the information on the contrast, I appreciate that.


Monica

 
Old 05-20-2005, 04:20 AM   #14
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Re: Nodule in Lung

That's what the radiologist is thinking. If your nodule did not have calcific features to it, he would rule out calcified granuloma completely - he wouldn't have even used that word in his report. If he thought it was more of a neoplastic nature, his suggestions for follow up would be different and more aggressive.

Last edited by smithn; 05-20-2005 at 04:21 AM. Reason: made additional comment

 
Old 05-20-2005, 12:08 PM   #15
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Re: Nodule in Lung

Oh great, that does make me feel a little better, and is more encouraging (do you agree?).

Thanks again!! You are so helpful.

 
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