12 mm Spiculated Nodule upper right lobe

I had a similar situation in November 2021. I had an abnormal chest x-ray followed by a CT scan that indicated ground glass part solid nodule in the right upper lobe which was "concerning for scarring, cancer or both". I did a PET scan one week later which indicated two nodules (different lungs) with significant uptick . The PET scan also indicated that there was no evidence of any other cancer in my body so no metastasis. CT scan and PET scan provide different information.
My local Pulmonologist wanted to do a needle biopsy, but their radiologist said he was not comfortable doing it-too risky. I sent my scans to Mayo and was called by the Mayo Pulmonologist. Mayo knew what I had and proposed VAT surgery. The Mayo surgeon said 80% chance it was cancer. Mayo was implementing a program to do bronchoscopy biopsy and surgical removal in one sitting. I did that and in fact it was cancer (stage 1b). I had a wedge resection of right upper lobe. They told me one night in the hospital so I figured it could not be too bad. I stayed two nights - I was 80 and weak from lack of food. Otherwise, it was easy surgery, and I was driving my car one week later. I stopped all pain medication within four days of surgery.

The removal of my left tumor was an easier recovery than the removal of my right tumor. The doctor had to go in further because of location and Recovery for me was several weeks.

Because of the size and chance of malignancy, I would have it removed!

Well first I should mention I’m older than dirt. So if you’re young then you can expect a more vigorous response I would think.

I had a nodule in the left lower
Lobe that my pulmonologist and I had been watching for four years.
It grew only about 1 mm a year and the PET scan wasn’t impressive - it barely reacted. So we kept watching and in April 2023 the CT showed it had grown 5mm from 9 to 14 in that year. The doc said there was only a 25% chance it was malignant but he would biopsy it in surgery and if it was malignant, he would remove the whole lobe. ‘Get it out’ is the gold standard. I did ok but 9 mos later I still have shortness of Breath and rib/ diaphragm pain when I take a deep breath. Frustrating. But we persevere.

So sorry to hear that you had to go through this. I appreciate you sharing your experience in here to help others. I'm so glad that I found this group. If you don't mind me asking, how long did it take you after the surgery to feel like yourself again?

Yea but that 1” threshold just doesn’t hold true. It was true for you - but it’s not a universal Truth. Bigger Is frequently more indicative of malignancy. But not always.

Lung cancer is a gut punch whether you are stage one or stage four. When we were younger this was an automatic death sentence. It's hard to imagine otherwise it's so ingrained.

The reason your doctor thinks the PET scan won't reveal much is because it images metabolic activity. GGOs are not terribly metabolically active. And they are slow to experience apoptosis (cell death) so they don't shed pieces of the dead cell into the bloodstream so liquid biopsies are not useful either. I tried,

Please know that I am grateful that this was caught so early. Patient advocates have been pushing hard to find a way to detect these early. Your early diagnosis, no matter how incidentally it was found, represents a kind of victory.

Hi @jannam, Welcome to Connect. I saw your profile (thanks for adding that). I was also diagnosed in 2020 with metastases to the liver and lymph nodes. I'm glad that you are doing well and are treatment free. Wishing you many more years in that same mode!

@joannamountain24, It's ok to be scared, this is scary stuff! I liked to live in denial too, it's a comfortable place to be, but sometimes our bodies have other plans for us. None of this is easy, but we get through it with the support of others.

@joannamountain24, Welcome to Mayo Connect, I'm glad that you found us. I can appreciate you taking time to access the situation and to process what this all means and what the surgery might entail. It sounds like it's now time for action, and a PET is a great next step. The PET will show a level of 'uptake' in nodules and any other areas that may be metabolically active. Cancer, infections, and inflammation can all be active, but cancer is usually most active and will generally have a higher uptake number than other causes. (Here is some additional info: https://www.mayoclinic.org/tests-procedures/pet-scan/about/pac-20385078)
Surgery is always a big step, but if this is cancer and it hasn't spread, surgery is likely your best option for long term survival. If you are able to get input from more than a surgeon, a pulmonologist or an oncologist, it may help you to access the options. Let us know how the PET scan goes, and if you have other questions.