1. < Lung Cancer

New to Site: SUV max scores for lung nodules and lymph nodes?

Posted by lbucky @lbucky, Sep 6 6:18pm

Husband, 59 yrs old, felt off from a long-lasting summer sinus infection, about a month ago, got a heart/lung CT scan. Shocked to discover he has 2 lung nodules in upper right and 1 lower left, all just over 1 cm. The lower left lung nodule is spiculated. Because hubby is sensitive to allergies, occasional asthma attacks, and that recent sinus infection (with drainage and coughing), pulmonologist said the right lung nodules might just be inflammation, and to wait a month for inflammation to recede, then get a PET scan.

Hubby recovered from the sinus infection, now feels fine, no breathing symptoms or discomfort. Got the PET scan last week, all nodules do have mild hypermetabolic activity, SUV max scores of 2.7-2.9. But also, several enlarged thoracic lymph nodes (1.1-1.5cm), with SUV max of 6.1, 7.3 right paratracheal, 8.0 left hilar. Is this lymph node situation indicative of likely malignancy metastasis? I am just reading the report and looking up the terminology, etc. and this is what I am seeing.

We see pulmonologist again in a few days to discuss PET scan results, biopsy possibilities, etc. We are trying not to freak out like we did when we first got the CT scan results (ok, I am def. freaking out inside, just not in front of him), but this seems bad, no? Nodules with hypermetabolic activity in both lungs, lymph node activity on both sides, what are we likely facing here? [I would love get some insight as to what questions to ask the Dr., also maybe to hear a story from someone with similar scan results who is doing fine.]

Interested in more discussions like this? Go to the Lung Cancer Support Group.

Mentor
Lisa, Volunteer Mentor | @lls8000 | Sep 25 1:29pm
In reply to @lbucky "Update: got biopsies last Friday, getting results Tuesday. Samples were taken from left nodule ( which..." + (show)
@lbucky

Update: got biopsies last Friday, getting results Tuesday. Samples were taken from left nodule ( which is smaller than originally thought, .8mm not 1.2), left hilar lymph, a couple from right paratracheal lymph nodes, and some saline lavage fluid. Still waiting, been waiting to find out what he has since end of August when we first got the news. Any advice on what to remember to ask if we have to discuss treatment? I like the discussion about health goals. Also, we are ready to go to Minnesota for treatment/2nd opinion, how does that work with our local doctors? We already send all imaging and reports to Mayo for his file up there.

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@lbucky, Here is a start for what questions you may want to ask:
- What stage is the cancer?
- What are the treatment options?
- Have the specimens be sent for biomarker testing
- What else do I need to know?
- What is the next step?
- If surgery is recommended, what type of post-surgical support will be expected?

REPLY
lbucky | @lbucky | Sep 26 12:08am

Update to the update: biopsy results: NO cancer. Unbelievable. We were absolutely expecting bad news, so once again are having out of body experience. The granulomas were caused by a fungus, histoplasmosis. That July illness was likely when his immune system was fighting off the fungal infection. Since he has no symptoms now, he needs no further treatment, just follow up scans in 6 months. We were both kind of numb, we have been under such tremendous stress for over 2 months since finding nodules in July (think I said August in earlier post.) I know people say not to get on the internet and I guess this is why (although the support I found on this site was a lifeline). But of course I’m the contingency planner in the family and wanted to know what we were likely facing. Every term I looked up (like spiculated nodule), every test statistic value (SUV), everything, indicated malignancy. We fully expected to finish the biopsy consult and call up Mayo to book him in. “Relief” feels like too small a word. Thank you so much to everyone here for your support.

REPLY
lbucky | @lbucky | Sep 26 11:51am
In reply to @flusshund "Lisa, I attended the World Conference on Lung Cancer at the beginning of this month and..." + (show)
@flusshund

Lisa, I attended the World Conference on Lung Cancer at the beginning of this month and learned the best question to ask your doctor about upcoming treatment. Like all good questions, it starts by asking yourself a question: What are your treatment goals?

A person with a 12-year-old daughter and a 10-year-old son might strongly desire to see them graduate high school. Such a person could decide to ask their doctor to kill this thing inside as thoroughly and quickly as possible; side effects be damned!

At the other extreme, a 78-year-old patient who learns that aggressive treatment would mean they have to move out of their home and into a retirement home might decide to seek the most comfortable treatment that allows them to remain in their home.

First, you and your husband should decide on your treatment goals. Express these goals to your doctor and ask what his or her plan is to help you achieve them. Hopefully, that's the beginning of a productive conversation.

I sincerely wish you and your husband all the best. I was first diagnosed when I was 58. I'm still working full-time, helping NASA return people to the moon, and doing a lot of yard work after our recent stormy weather! And be sure to take care of yourself. Being the caregiver is also tough.

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Matthew, thanks for responding, glad to hear your story, and I hope you are well. I’m not sure how to post an update so all can see, so I will say here that we got biopsy results and it is not cancer (once again, stunned by unexpected news). It was a fungal infection that he has apparently recovered from, nodules are residual granulomas. No treatment needed, just a follow up scan in 6 months. So appreciate your support, thank you for sharing your story.

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1 reply
lbucky | @lbucky | Sep 26 12:04pm
In reply to @lls8000 "@lbucky, patients can self-refer to Mayo Clinic or have their physician make the referral. You can..." + (show)
@lls8000

@lbucky, patients can self-refer to Mayo Clinic or have their physician make the referral. You can find out more here: http://mayocl.in/1mtmR63
Many Mayo Clinic patients go to Mayo for complex and serious illness, while maintaining a relationship with a local non-Mayo physician. So, there are many options on how that can work. I've done a little bit of both.
I'm assuming that you have received results of the biopsies by now. How are you both handling the news?

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Unbelievably, we got biopsy results and it is not cancer (once again, stunned by unexpected news). It was a fungal infection that he has apparently recovered from, nodules are residual granulomas. No treatment needed, just a follow up scan in 6 months. So appreciate your concern and support.

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1 reply
Mentor
Lisa, Volunteer Mentor | @lls8000 | Sep 26 12:50pm
In reply to @lbucky "Unbelievably, we got biopsy results and it is not cancer (once again, stunned by unexpected news)...." + (show)
@lbucky

Unbelievably, we got biopsy results and it is not cancer (once again, stunned by unexpected news). It was a fungal infection that he has apparently recovered from, nodules are residual granulomas. No treatment needed, just a follow up scan in 6 months. So appreciate your concern and support.

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@lbucky, Wow, that's fantastic news! I'm happy for you both, what a huge relief, I'm sure.
I had a nodule early this year, which we originally thought was cancer progression, but it turned out to be histoplasmosis. They treated mine for a few months, but I'm not sure the meds really had an impact. The nodule still shows on my 3-month scans, it's stable, and not bothering me.
Thanks for sharing the good news with us!

REPLY
Matthew K | @flusshund | Sep 26 3:10pm
In reply to @lbucky "Matthew, thanks for responding, glad to hear your story, and I hope you are well. I’m..." + (show)
@lbucky

Matthew, thanks for responding, glad to hear your story, and I hope you are well. I’m not sure how to post an update so all can see, so I will say here that we got biopsy results and it is not cancer (once again, stunned by unexpected news). It was a fungal infection that he has apparently recovered from, nodules are residual granulomas. No treatment needed, just a follow up scan in 6 months. So appreciate your support, thank you for sharing your story.

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@lbucky, you figured it out! We can all see this and your next reply. Great news! That's why I recommend NOT consulting Dr. Google. It's a great way to scare yourself silly. I know. I did it after my first PET scan.

Your husband's results are also why expanding lung cancer screening is a more complicated issue than it would seem. While we all want to detect lung cancer as early as possible, the fact is that if we dramatically increased screening, we'd also increase false positives and cause a lot of expensive and invasive testing. At the World Conference, I attended a session that made the case for more screening and a session that recommended against it. And these are the best oncologists and oncology nurses in the world.

It's always important to remember that the doctors are conducting a test because they don't know. As you've seen, it can always turn out to be something else, even when the Internet makes the word "spiculated" sound scary.

I'm glad your husband has already recovered from his fungal infection and for the fact that you're not both facing a cancer diagnosis!

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