It seems this spot has been around for 15 years and it is now about 1.7 by 2.0 cm. Do you remember how large it was 15 years ago? It seems to be slow growing. The SUV of 2.6 is low which makes sense for a slow growing spot. Usually 2.5 SUV is the cut off for suspecting cancer in a lung nodule. I am not sure about the node SUVs they talk about.

I had lung cancer 23 years ago which a huge 10-12 cm tumor on my right lung. I had a thoracotomy and they removed 2/3 of my right lung. Very painful. Very scary. I was only 46 so I was strong and recovered well.

All was OK for the next 21 years, then two years ago I had a new spot in my left lung with 4.4 SUV. We were pretty sure it was cancer. They were able to biopsy it to confirm. It was the same kind of lung cancer I had before. No way I was having another thoracotomy plus I didn't have much lung tissue to spare after the first surgery. So I had this tumor zapped with 2 days of SBRT radiation treatment. After the SBRT treatment, it took about a year for the cancer tumor to go away. It is now gone.

About 9 months ago they found a new spot on the remainder of my right lung. I have a CT scan every three months to check it. It can't be biopsied without risk of lung collapse. It had a 2.7 SUV. It has stayed about 1cm for the last 9 months although if they show the last 3 ct scans right next to each other and we squint our eyes it seems to be growing very slowly.

So what to do about a slow growing spot with a low SUV like this? Because I am about 70 and because I have shortness of breath already from previous surgeries, we have opted to keep watching this spot. There is a chance that I won't need to treat it. I am hoping that it will peacefully co-exist with me for the rest of my life. On the other hand, should it start growing again then I will need to treat it with more SBRT or an ablation technique. Even though it has a low SUV, it most likely is the same cancer I've had for the last 23 years.

If I were younger or had more lung tissue then I'm sure they'd treat my newest spot immediately. Not sure what your age or physical situation is. The two nodes that lit up on your PET seem to be concerning too. I don't have any nodal involvement showing on my PETs.

So it is hard to know what to do. I can tell you that instead of a thoracotomy like I had 23 years ago (major scar and pain and risky surgery), they often can now do something called VATs which is laparoscopic surgery leaving smaller scars and less recovery time. Also supposed to be less painful.