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Large GGO. What to do?
May 2021 (five days post double mastectomy and three months post COVID) I was readmitted to the hospital for tachycardia. A CT scan showed slightly spiculated ground glass opacity (GGO) measuring 3.0 x 2.0 x 4.2 centimeters (NOT millimeters). No solid components. Right upper lobe. By all standards, this is huge.
“Differential considerations include a focus of atypical infectious/inflammatory process. Other considerations include chronic interstitial lung changes and neoplastic process.”
Follow-up scans:
9/14/2021
3.1 x 2.1 x ?? (third dimension was not listed). There was also an 8mm GGO found in the lower left lobe. This was not mentioned in the first scan but this scan states it is unchanged.
“Stable ground-glass opacities, as above. The differential diagnosis remains unchanged and includes infection, scarring, or a lepidic neoplasm.”
6/8/2022
3.1 X 2.0 X 4.0 This time there was also a calcified granuloma noted in the right upper lobe. For the 4cm lesion:
“There is a linear focus extending from this lesion to the chest wall, the appearance most typical of atelectasis or scar and without change.”
7/3/2023
3.1 X 1.9 X ? cm. The impression was that the “CT chest is stable”. The larger GGO is stable compared to 5/2021 and the lower left GGO is “relatively stable” at 8.3 mm. The radiologist also noticed a micronodule 1-2 mm on the lower right side. This was never mentioned before. He recommends a 1 year follow up for the upper right and lower left “as well as the scattered nodules in the right lung”. What?? I’m doomed! Scattered nodules?
Stupidly, I have more recently started asking Dr. Google about these lesions. I am now frightened to death.
The radiologists reference the “Fleischner Society guidelines for managing incidental pulmonary nodules” probably because this was incidentally found. I am very confused because these guidelines are for nodules in patients that don’t have a primary cancer because “patients with known malignancy… an incidentally-detected pulmonary nodule is more likely to be cancer-related than in the general population”.
At my last follow up appointment, I asked the pulmonologist if we might be worried that it is related to breast cancer. He stated that is why we are doing scans. In the past I have asked about doing a biopsy and the pulmonologist stated that lung nodules are hard to find to do a biopsy. But now I see that mine is HUGE and since they don’t want to do biopsies on anything smaller than 8 mm, I have ample nodule for them to find. My IDC (breast cancer) was located in my right breast and it went very close to my chest wall and they had to remove some muscle to make sure it hadn’t gone further. Now they report a linear focus extending to the chest wall from the biggest lesion. BTW, my breast cancer was 10/2020 being DCIS (stage 0) and 1/2021 Stage pT2(sn)N1A (stage 2b, positive sentinel node of macromets and lymphovascular invasion. No radiation or chemo based on pathology.
In doing more research, a stable, large, ground glass opacity is most likely pre-cancer or slow growing cancer. I am a former smoker and right upper lobe location is where cancer likes to live.
Coincidentally, my mother had DCIS (stage 0 breast cancer) in one breast and something else in the other so decided on a mastectomy. In her pre-op x-ray, they detected something on her lung. It turned out to be BAC which is a very slow growing lung cancer. She lived with it for 15 years but eventually died from it. How much of this is inherited? Can GGO be metastasis? I am still researching
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The only positive about GGO is that if it is cancer, removing it has 100% survival rate because pure GGO usually hasn’t spread anywhere (from what I’ve read anyway). Yet.
I have not experienced any symptoms and had genetic testing done after the breast cancer fiasco which included some lung cancers, and they were all negative. I smoked almost a pack a day off/on for 20 years and quit 15 years ago, my mother had lung cancer, I had COVID – moderately bad – otherwise healthy.
Although I rather regret doing all this research, I am glad I am more educated now. I still don’t understand why this isn’t a little more concerning to the pulmonologist and why we must do all this waiting around! I have an appointment 7/7/202 to go over the scans. Boy, do I have a lot of questions! Like: why are we sitting around doing nothing?
Thoughts?
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You are in my prayers
Thank you.
I can see why you are scared - resorting to Dr Google almost always leads us down the darkest paths. And seeing the results on your portal right before a holiday gives a lot of time to worry. Many people with lung issues have GGO's that are stable for years and nothing ever develops. These are "cloudy" areas on a CT that may be remnants of an infection or previous problem, and usually develop into a nodule or cavity if they are indicative of an active disease. That said, I have numerous nodules in my lungs that are souvenirs of a bad infection, but are not cancer.
We are not doctors here on Mayo Connect, just other people with health concerns trying to find answers. But we, like the radiologist who wrote your report, do not have access to your full medical history like your docs, and also do not offer a diagnosis.
Now that the holiday is last, have you written down all the questions you want to ask the doctor on Friday? Better still, do you have someone who can come along and be a "second set of ears" and maybe make notes as the doctor answers your questions?
Please let me know what you learn.
Sue
I second Sue
- dr Google not ideal. Its always ok to talk through yoir worries/fears with primary and get 2nd opinions.
We all at times resort to google. Maybe use instead Pubmed or Scholar google ? https://scholar.google.com/
It also helps like Sue have said to write down all your questions and bring a friend or a loved one to your appt with pulm. Most of times if inconclusive what needs to be done now, there are subsequent CTs (ask how often and schedule these) and what symotoms to watch out for that would warrant to reach back to pulm md earlier rather then scheduled routine check ups
Wishing my best this Fri appt.
Try to stay calm, ask questions, come up with the plan with pulm md. Trust your gut feelings, ask for 2nd opinion if you feel like by the end of appt you need another input
Lena
Thank you both for your kind and calming words.
I should clarify that I don't go willy-nilly to Dr. Google. I researched what the radiologists referenced in their reports (Fleishner's 2017 and A White Paper of the ACR incidental findings committee JACR 2021) and have read some studies in Google Scholar and Pub Med. I do appreciate message boards too since that is real life. I believe in being educated about these things. I have already been down this road with breast cancer so have some experience with panicking vs. being smartly informed.
I guess my concern is that I have ALL the risk factors for this being cancer and I wonder why the pulmonologist isn't more concerned beyond recommending yearly CT scans. I do understand that cancer can be present like this forever and never spread, but it seems GGO is more of the slow growing types. GET IT OUT! Or at least check to see what it is.
I do appreciate your suggestions though. I do need to ask about symptoms that warrant a call to the pulmonologist instead of my PCP. Great idea! And I do think when you arrive with your questions on paper, they take you more seriously and speak to you like an adult.
This was helpful! Thank you again!
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3 ReactionsIf anyone is still following this, I had my follow-up appointment withe the pulmonologist. I received the same information again. Since nothing is growing or spreading, they determine that it is safe to stay in there. The radiologist suggested another 1 year follow up, but the pulmonologist stated that since I had breast cancer, I will probably have a CT every year, when usually they stop after 3-5 years.
I am to contact them if I have symptoms that are not acute like a cold or pneumonia, but linger for a long time. Due to my feelings of shortness of breath on mild inclines that I walk on every day, I am going to have a baseline breathing test.
That's it! I do feel better that I don't have to have a biopsy right now and I can go on vacation and enjoy another year without worrying about it. I really worked myself into a tizzy about having that CT scan because your life can change in one moment. That was my fear.
Thank you again for your calming words. I am settled with the fact that I can relax for a year.
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6 ReactionsGood for you to have found some peace with your life and are looking forward to enjoying the year!
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1 Reaction@carolof3, Thats great news! Wishing you well and hoping that this next year is everything you want it to be. Live life, it's so special!
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1 ReactionWell done you! Yes I have been a silent follower. You had excellent advise from others, and so glad this helped you.
It is perfectly okay to feel overwhelmed at times as we navigate through these journeys. Getting excellent advice and gaining a plan of thought follow up is key to peace of mind.
You have researched well. Knowledge is power.
Take best care of yourself, and enjoy life knowing you have a medically solid plan of care in place.
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3 ReactionsBeing informed is important...that is what they mean when they tell you to be your own advocate in healthcare. Dr Google should be to find information from CREDIBLE resources...like well-known research institutions. I read those radiologist reports, then googled all the terms and acted to get myself immediate quality treatment for lung cancer.
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