Imaging in Lung Cancer
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Wonder if someone can translate this to English. Like our doctor but her accent is difficult to understand and I think she doesn't like to tell us negative things. From the PET: There is a small cavitary focus within the left apex with pleural thickening and soft tissue density. In the posterior aspect of the left apex, there is a soft tissue density meausring apx. 2.3 centimeters. This demonstrates marked hypermetabolism with standard uptake values up to 15 (mediastinal blood pool 1.5). Ther eis a second 5 millimeter density along the medial aspect of the cavitation in the left apex. This is noted medially and posteriorly and also demonstrates hypermetabolism with standard uptake value at 5. This may represent posturgical change, however, residiual on recurrent tumor cannot be exluded. There is also a small pleural-based density in the posterior aspect of the upper hemithorax, measuring (copy but I think it says) 12 x 7 millimeters, this is hypermetabolic and has standard uptake values of 9. There's more but these were, I think, the areas of concern. The comments were well, some of this could be scar tissue, surgical related, or emphysema but it could be cancer. Can anyone clarify a bit - I prefer to know what we're dealing with here.
The imaging results are only part of the story. First, a report is only a summary of what is actually seen, and it can be very helpful for the doctors who know the situation to actually look at the images: you can get more information than a summary report will provide. Meanwhile, the context of what's going on is critical: is this a setting of prior surgery for known disease? A question of a new diagnosis of lung cancer? Any significant risk for infection or inflammation?
It's fair to say that when the PET scan shows several areas of increased metabolism (abnormal uptake on the scan) in someone with a known history or high risk of cancer, we're concerned that this may represent active cancer. At the same time, you can absolutely see increased uptake after surgery from normal post-treatment inflammation or from an infection, which wouldn't be welcome, but it's almost always better than recurrent cancer.
You can't actually diagnose cancer from a PET scan, even though the PET scan can raise or lower your level of concern. If there is any doubt about the diagnosis based on the overall scenario and the imaging, a biopsy is the way we can say something more conclusive.
Online discussions of scan results are actually a poor substitute for input from someone more directly involved. I think it would be appropriate to press for more information about what these results mean. Even if the oncologist involved may be uncomfortable talking about possibly negative results, a good discussion is part of the job and can't be sidestepped.
It means that there is a nodule in the back of the right lung, toward the center part of the chest, that is abnormal. It doesn't mean that it is cancer vs. some benign nodule, because it can't tell -- only a biopsy can really do that. But it does suggest that there is something that merits at least being followed and perhaps worked up more actively than that. A doctor reviewing the results could provide more context.
It's a little nodule on the lining around the lung and chest wall. This could be just a benign little area of scar tissue, or it might represent an area of cancer. The overall context of whether there are other areas of benign findings or known cancer in the chest could raise or lower the level of suspicion, as could the result of a PET scan (if it's got high metabolic activity on PET scan, that suggests a cancer; if it's got low or no metabolic activity, cancer is very unlikely). In the end, though, only a biopsy can truly clarify what it represents, though we wouldn't necessarily pursue that if we have enough clues from other variables.
Please help. Can you explain what the following report means? "...there are numerous sub centimeter mediastinal nodes as well as a relatively flat precarinal node measuring 1.7 cm, slightly larger then on previous study. There is a 9-mm opacity in the lingual again seen, unchanged. No other nodules are identified and there are no infiltrates." my dad got a ct chest scan a year ago and The doctor said that he found an "iIl-defined opacity in the medial aspect of the left lung base and also in the inferior aspect of the left hemidiaphragm" Ever since then he told my dad to get ct chest scan every 3 months so they can watch more closely what is happening. The report above is from the last scan. The doctor said that he doesn't know what it is. My dad is scared -every 3 months going to the doctor to find out if he has lung cancer or not. I asked the doctor if there are other tests that he could perform on my dad and he said "no we just got to wait."
Seeing enlarging lymph nodes and/or lung nodules on a chest CT makes us concerned about the possibility that a person has lung cancer or another medical issue that could benefit from treatment. If the progression is convincing, we often do a biopsy or consider a PET scan, which looks for increased metabolic activity in the areas that are suspicious. If you see higher than normal metabolic uptake in a nodule or enlarged lymph node, that raises our concern for cancer. But the only definitive way to really get an answer is from a biopsy.
Hello,What are the opinions of your experts on the use of low dose CT scans as a strategy for early detection of lung cancer?
An annual low dose chest CT is the evidence-based screening approach for lung cancer that has been proven to improve survival in higher risk people. The screening population is defined as those with a smoking history of at least 30 pack-years (the product of average number of packs smoked per day x number of years smoking), continues to smoke or has quit in the last 15 years, and is age 55-74 and otherwise fit enough to pursue the treatment for a detected early stage lung cancer (generally surgery).
Though screening programs haven't yet been widely implemented, the data really support it, and because we need to balance the value against the risk from the screening test, a low dose screening chest CT is the scan of choice.
My husband (49) had a CT scan done at the local VA in, I think, April of this year. The dr. (I use that term loosley because I think what he has done is unprofessional in my opinion) looked at the scan for only a few minutes, my husband asked if it was cancer & the dr. said Yes. This is a general dr. who is not a specialist -- the scan showed 2 small abnorbalties. My husband has been 'freaking' over this ever since then... In my opinion I don't believe that the dr. should have told him it was definitly cancer without doing any other testing -- blood work, biopsy, specialist, etc.! Since then there has been several other 'questionable' happenings that has taken place at the VA regarding the way my husband has been treated that he will now Not go back to any VA again. He is a veteran who served for 14+ years in the service & was in Operation Desert Storm in the '90's! My question is this: Where can he go to get another scan (we do not have insurance) done in the Kansas City area? Also, is this normal procedure for a dr. to tell his patient that he definitly has cancer when there is no biopsy, etc done?Thank you in advance
I'm sorry I can't answer your question about where to go, since that's really a practical question that can be best addressed by someone in the area, and I'm about 1400 miles away. I don't know the lay of the land there, but the local university usually has a wide range of specialists and should be charged with seeing people throughout the community.
I agree with your point that it isn't chemo unless a biopsy proves it to be that. Seeing new lung nodules is always a concern, but it really depends on the characteristics of both the nodules and the person they're found in how likely they are to be cancer. We know from screening studies looking for lung cancer that small, ambiguous lung nodules are VERY common, and most often they're benign. The larger a nodule is, and the more of a smoking history a person has, the higher the risk that a nodule is actually a cancer. Nevertheless, even in people with very worrisome scans and a history that highlights a high risk of cancer, all experienced doctors have encountered patients in whom they were all but convinced a cancer was present, but it turned out to actually be infection or inflammation. Consequently, you're right to want to have biopsy confirmation of what you're actually dealing with before making any declarations or starting treatment plans.
Chiropractor saw what he describes as a pancoast tumor. Are these invasive tumors and what is a prognosis for these tumors?
This is some introductory information on Pancoast tumors:
Though these posts are 6 years old, neither the treatment nor our general understanding have changed appreciably in that interval.
However, I would be very wary about drawing any conclusions before a proper workup that includes a biopsy and full staging has been done.
In your clinical judgment does this situation warrant a VATS instead of a biopsy? 1.8 centimeter mixed nodule found incidentally, no respiratory symptoms, 51 year old woman in excellent health, 35 pack year smoking hx and 2nd hand smoke exposure throughout childhood, nodule has spiculated edges, 2 CT scans 1 month apart showed no change. I'm a single parent with a 13 year old. I need to live!
I'm sorry, but it's illegal for me to provide a medical recommendation for someone who isn't my patient. While I want to help, it's very clear that providing an individualized recommendation for someone of what they should do for their particular situation constitutes medical advice.
I am a radiation therapist. On a routine cxr my mom was said to have a mass in her lt lung done 1-9-14. Her prev cxr 10-11-13 makes no mention of this. She had multiple complications with a biv-icd (lead perforation and blood around heart, lead change, infected pocket, removal and replament of icd-pacemaker not biventricular within a few weeks in May 2013 and had pneumonia with plueral effusion. They were checking on the plueral effusion again with this cxr and found the mass. I know usually something this fast appearing would indicate infection. My worry is oat cell cancer or neuroendocrine or metastatic disease (read following please). Is there information regarding tumors that would progress this quickly. She is to have a CTA in a few days. She is 55. Smoker since 14 about half a pack a day. HPV positive history of partial vaginectomy/vulvectomy Sept 2012 with bilateral inguinal lymph node removal (1 microscopically positive out of 9 rt side. 0 out of 7 on lt side. Nov 2012 re-excision vagial/vulvar area to obtain clear margins that were not achieved prior. Laser ablation Oct 2013 of vaginal cuff for dysplasia.
I consider the interpretability of a chest x-ray to be extremely minimal, in this setting primarily only useful for highlighting the need for a real imaging study that will provide some actual detailed information.
I agree that the new finding in a short interval is highly consistent with infection or inflammation rather than cancer, but you're right that lung cancer, especially small cell, can progress out of nowhere pretty rapidly.
It may be helpful, if there is going to be an interval between imaging studies, to start an antibiotic and see if that possibly leads to any apparent improvement. Obviously, cancer isn't going to shrink with antibiotics, so that's a reassuring finding if you see it.
How long does it take standard chemo to work (carbo and taxol)? I had 2 treatments in 6 weeks and the cancer continued to grow. My doctor recently switched me to Xalkori a chemo pill 2 weeks ago. Today I had my CT scan,but don't know the results yet.
We usually assess response to chemotherapy or a targeted therapy like XAKLORI (crizotinib) after about 6-8 weeks. You don't tend to see a dramatic response to chemo in less time than that -- at least 3-4 weeks, in most cases. In contrast, you can SOMETIMES see a significant response to a targeted therapy (if you have the right biomarker) within days or under 2-3 weeks, but we generally don't presume that to be the case and typically re-scan after 6-8 weeks to assess response to a targeted therapy as well.
Husband had upper right lobectomy for stage 2a adenocarcinoma in 2012. Apparent success but being having Ongoing investigations for significant abdominal pain. On ct enlarged lymph nodes showed has had ultrasound guided lymph node biopsy for supraclavicular node but when we went for results it said no lymph tissue found, why would this be, the radiologist said she could see the node and it looked enlarged? They are going to repeat, but is there any point?
It's possible that the biopsy missed the lymph node or that the enlarged area that was presumed to be a lymph node actually wasn't one. His doctor may be able to provide more insight based on the specifics of the imaging and the biopsy report.
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