I had my third post-TX PET/CT on 20 Aug. Was chest PET Negative but had some ringing around my tounge due to an aphthous ulcer (painful). That PET was followed up by Head & Neck MRI and Physical of Head and Neck and then followed by a Chest CT on 18th of Sept.

The Chest CT shows three nodules, a 9MM top of right, 3 to 4 MM bottom of right and a 3to 4MM top of left. I had three 3-4MM spots back on my first two PET/CTs that have cleared. Pulmonologist ordered another PET/CT for the 29th of Sept. He wants to biopsy one of my three nodules. Largest is 9MM but is the most difficult to biopsy.

Anyone have lung nodule issues? RAD/ONC isn't concerned, Pulmonology is concerned.

Hi Bill...welcome to OCF. I see you have posted before but this is the first I have seen so welcome:)

I have lung nodules also. My pulmanary doc is not too worried but wants to keep an eye on me because it's not unusual from what I understand, for head and neck cancer to go in that direction. It's stressful enough and it looks like you have already gone through a lot. Sorry this another issue to deal with.

When are they doing the biopsy? Looks like they are only doing one? Is that going to be the 9mm one? I have only heard of the needle biopsy for lungs..is that what they will be doing?

The large nodule is in a spot that cannot be biopsied by needle. My RAD/ONC Dr. wants to wait, he feels that we should watch for a bit before going in. He fears that surgery is the only way to get at the 9mm nodule, bronchoscopy is out too.

Hopefully the PET rings negative tomorrow. The recovery was going so well. I am confident that the nodules are benign.

Thx

Bill,

I had spots that cleared themselves before my first post Tx year ended and no one ever mentioned the word nodule. I know how much stress those spots caused my wife and I and I hope your situation resolves itself quickly.

When I was first diagnosed 5 years ago they discovered at least one lung nodule. They have done follow up tests - at first every 6 months now yearly and they/it (not sure if more than one) have not changed so far, so they are not concerned.

FYI.

Donna

Second PET which was a more detailed/accurate report came back as showing activity. The tumor board met and want me to discuss possible surgery to go in and get the 9mm by my heart. They have not grown in almost 2 months, but they are still concerned. Not sure what is the best route to take....Any suggestions?

Lung nodules are not necessarily unusual findings, particularly as you get older. I had one of those low dose CT whole body scans about 6 months before I was diagnosed with my SCC, and it showed a few small nodules. CT scans at 6, 12 and 24 months were done to insure no growth, and then I was discharged from the pulmonologist. They did not grow, and in a couple of cases disappeared. The never lit up on PET.

As a general rule (numerous exceptions of course), but the existence of multiple nodules at one time is more indicative of old inflammatory residue than of malignancy, particularly when you are monitored regularly. Pulmonology would not be doing their job if they did not follow up, but I would not stress over it.

You said that in the last PET they showed activity. Could you please post what SUV value they equate with each nodule. This number is very telling. You are one of many, as you can see, that has pulmonary nodules develop some period after treatment. With this disease notorious of spinning mets to the lungs, people have to be careful. Pulmonary guys call it ALL out, your oncology team is more accustomed to seeing these kinds of things, and knows that there is a difference between a lung extension of the disease and nodules.

Another common finding in those of us that have this happen are hot nodes in the mediastium near your heart and lungs. These are almost always lung lobe inflammation related to silent aspiration (accompanied by surrounding nodes trying to clean things up and getting hot on the scans.) This always raises your blood pressure and sounds dire, and most of the time is not. In me it has been a chronic find as the aspiration is a chronic worsening issue over the years, and aspiration pneumonia has put me in the hospital more than once. There are few that want to biopsy these things since they are in the middle of lots of huge blood vessels. It can be done by only a couple of people in the US that I would personally be comfortable with personally doing it. It is done by CT guided needle and if it nicks something it shouldn't in the process, it is an immediate crack your chest to stop the bleeding. Not a procedure for the faint of heart or someone outside of a major institution that has done lots of them. A woman doc at MSKCC is considered the best in the US for doing these if the are absolutely necessary.

That is precisely why those in the know watch and wait on some of these things. Experience is the difference between a major CCC and a smaller institution that sees them less often. Having said that, it always scares the crap out of me, but I am getting more used to things going bump in the night..... after ten years of it.

I'll get the values today and post this evening. Thanks for looking.

Hi Bill,

Brian certainly is a great person with a lot of knowledge. If it were me and they wanted to do surgery. I would do it...no reason to not in my opinion. Good luck and I will keep checking here to see how you are doing and what you decide to do.