Multiple lung nodules: Might they be noncancerous? What next?

Posted by felix536 @felix536, Aug 17, 2021

I have 3 lung nodules measuring 4mm, 6mm and 14 mm in three different lobes. Have had ct scans showing no change in 6 months and have another scan scheduled in three months per my pulmonologist. Should I get a second opinion from an Oncologist or wait it out? What are the chances of this being noncancerous?

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@vic83

Your concern is understandable. My mother died at age 58 from lung cancer and my cousin on my mother's side at 54 of the same. You mentioned "My family physician wants to take a watch and see approach". Is that a Family Medicine or Internal Medicine doctor? If so, and your insurance allows you, seek out a Specialist (Pulmonologist). Check their background and look for one that treats lung nodules and/or lung cancer because not all of them do. Have you read the radiologist's report? Those reports can contain recommendations on follow up. I had an abnormal chest x-ray at urgent care and the report recommended a CT scan. I made an appointment directly with Pulmonologist and skipped my primary care provider- the CT scan report recommended PET scan. I did have lung cancer. My only symptom was recent shortness of breath which could also be attributed to a heart issue. I always look for a specialist for specific health issues. Medicine is a large subject, and it is important to see the knowledgeable experienced doctor with the right training.

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Thank you! It was my primary Dr. I’m going to ask her to refer me to a pulmonologist. But you know how mayo is..it will probably be months before I can get in. And the report stated wait 3 mos and do another ct scan..but that person doesn’t know my family history! So frustrating.

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Thank you so much for the information. I truly appreciate it. I had CT for my heart..I had high cholesterol.
You stated a statistic of 95%, but that is not for nodules over 10mm. Unfortunately its much lower percentage. Everything I have read and as you stated, it should be biopsied or have a PET scan but for some reason my physicians want to wait. Even with my family history. 🤔 So if the national standard is to have the tests why are they so hesitant??

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@aahlrichs

I hope I’m in the correct area to ask this question..during a recent CT scan a 13mm nodule on my lung was found. I’ve had two close family members die of lung cancer. My family physician wants to take a watch and see approach but everything I read says “over 10mm should have PET scan or biopsied”. And that if it is malignant it can grow fast during the “watch and see” time frame. I’m curious if I have legitimate concerns??
My information at this point has only come from doctors, who see many benign cases a day, and insurance companies. The nurses and doctors at this point have all treated it like it’s not a big deal and pushed me off.
I’d really appreciate any advice. Thank you for reading. 😊

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Your concern is understandable. My mother died at age 58 from lung cancer and my cousin on my mother's side at 54 of the same. You mentioned "My family physician wants to take a watch and see approach". Is that a Family Medicine or Internal Medicine doctor? If so, and your insurance allows you, seek out a Specialist (Pulmonologist). Check their background and look for one that treats lung nodules and/or lung cancer because not all of them do. Have you read the radiologist's report? Those reports can contain recommendations on follow up. I had an abnormal chest x-ray at urgent care and the report recommended a CT scan. I made an appointment directly with Pulmonologist and skipped my primary care provider- the CT scan report recommended PET scan. I did have lung cancer. My only symptom was recent shortness of breath which could also be attributed to a heart issue. I always look for a specialist for specific health issues. Medicine is a large subject, and it is important to see the knowledgeable experienced doctor with the right training.

REPLY
@aahlrichs

I hope I’m in the correct area to ask this question..during a recent CT scan a 13mm nodule on my lung was found. I’ve had two close family members die of lung cancer. My family physician wants to take a watch and see approach but everything I read says “over 10mm should have PET scan or biopsied”. And that if it is malignant it can grow fast during the “watch and see” time frame. I’m curious if I have legitimate concerns??
My information at this point has only come from doctors, who see many benign cases a day, and insurance companies. The nurses and doctors at this point have all treated it like it’s not a big deal and pushed me off.
I’d really appreciate any advice. Thank you for reading. 😊

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Welcome, @aahlrichs. I can understand that you're concerned. Being told that you have a 13mm lung nodule is worrisome and you have a family experience with lung cancer. Most lung nodules (95%) aren't cancerous. Read more here: https://www.mayoclinic.org/diseases-conditions/lung-cancer/expert-answers/lung-nodules/faq-20058445

I moved your question to this existing discussion where @felix536 was asking similar questions as you are today:
- Multiple lung nodules: Might they be noncancerous? What next? https://connect.mayoclinic.org/discussion/multiple-lung-nodules/

I did this so you can read the previous helpful posts and connect easily with other members like @merpreb @sueinmn @vic83 @marye2 and others.

Often, active surveillance is the first step and a new CT scan ordered in 3 to 6 months to see if it is growing. Sometimes, with nodules over 12mm further testing such as a PET scan or biopsy will be ordered.

@aahlrichs, may I ask why the CT scan was ordered that found the nodule? Nodules rarely cause symptoms. Were you having symptoms or was the CT scan for something else?

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I hope I’m in the correct area to ask this question..during a recent CT scan a 13mm nodule on my lung was found. I’ve had two close family members die of lung cancer. My family physician wants to take a watch and see approach but everything I read says “over 10mm should have PET scan or biopsied”. And that if it is malignant it can grow fast during the “watch and see” time frame. I’m curious if I have legitimate concerns??
My information at this point has only come from doctors, who see many benign cases a day, and insurance companies. The nurses and doctors at this point have all treated it like it’s not a big deal and pushed me off.
I’d really appreciate any advice. Thank you for reading. 😊

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@felix536

The nodule hasnt't grown in 11 months and the Petscan did not light up, however there was some breathing interference with the test so not entirely reliable. When faced with the options of waiting even longer, wedge or needle biopsy, I am choosing needle. How small was your nodule that they thought it to be too small to biopsy?

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Mine was ground glass, with lacey edges and is relatively small (1 cm) so they said they could not biopsy. Waiting.

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Good no solidity. Keep an eye on it and will hope that it stays stable. Hoping the best for you. Has anyone ever had "hazy opacities in lung base that could represent sequela of needle biopsy"? This showed up on a chest x-ray eleven days after the needle biopsy.

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@felix536

Had a needle biopsy of 12mm nodule and came back positive for Invasive Adenocarcinoma, this is after watching and waiting for 11 mths. This was done at UCLA and surgery will be done there also. The nodule had not grown but was showing signs of hardening, which indicates cancer. The 4mm is unchanged and will be watched and the 6mm unchanged as well and there is a possibility that its a lymph node and not a nodule, they aren't sure. My options all along have been watch and wait, needle biopsy or surgical biopsy.
Surgery on March 8th and then follow up scans. Hoping for a wedge and not a full lobectomy. I hope this information may be helpful to others. Best to all!

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This sounds like where I am right now! My lesion was all ground glass with no solidity so I am waiting 6 more months! No biopsy will be done as I can only have SBRT (radiation) at this point because I can't lose too much more lung tissue.

I wish you well on March 8th. Do you have any preparations that you have to do or stop any medications?

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@merpreb

Felix- How are you holding up? What was the breathing interference with the test?

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Had a needle biopsy of 12mm nodule and came back positive for Invasive Adenocarcinoma, this is after watching and waiting for 11 mths. This was done at UCLA and surgery will be done there also. The nodule had not grown but was showing signs of hardening, which indicates cancer. The 4mm is unchanged and will be watched and the 6mm unchanged as well and there is a possibility that its a lymph node and not a nodule, they aren't sure. My options all along have been watch and wait, needle biopsy or surgical biopsy.
Surgery on March 8th and then follow up scans. Hoping for a wedge and not a full lobectomy. I hope this information may be helpful to others. Best to all!

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@colleenyoung

@dongshiming, you ask "Can I request a particular provider?" I can answer how it works at Mayo Clinic.
Appointment specialists are specially trained to match you with the provider or group that's the best fit for your diagnosis and medical history. But you may wonder if you can request a specialist that you've read about or who's been recommended by a friend or colleague. Mayo Clinic can't honor all requests, but we try to when possible.

You can read more on this page of Frequently Asked Questions https://www.mayoclinic.org/appointments/faq

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Yes, the Mayo appointment specialists are very good. I first called when I saw I had an unusual chest x-ray. They told me they were scheduling 3 months out but encouraged me to set up a patient account which I did. I had CT and PET scans done at my primary care provider clinic, and Mayo said to have actual scans sent and someone would get back to me within 48 hours. I was called the next morning. I made sure my PCP sent the actual scans immediately!

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