Onco's opinion

[hany]

Hi, I met my mom's onco today to get his opinion on the 4 lung nodules (7mm, 4mm, 2mm, 2mm). all other tests are normal inc. CEA 1.1.
He told me that he cannot actually say if these are met because its too small, also PET scan may not have an accurate result. so he just correlate the history and other tests of my mom to his opinion. he told me that since my mom's dx is stage 1 (rectal), the probability of recurrence and metastasis is 5-10%. so what he recommend is to have another scan after 4months which is on december.
My question is, do i need to have a 2nd opinion or we will just follow his reco?
thank you.

[SweetC80]

I think generally speaking a second opinion is always a good idea. We've had another doctor review my mother's records at a couple of points throughout this process to confirm diagnoses and treatment suggestions. I wish you and your mom the best results.

[susie0915]

I have a 4mm lung nodule that is being watched. Oncologist doesn't think it's a met, but is too small to biopsy or do pet scan. I do have inflammation and scarring in the lungs so she thinks it's related to that. I had a repeat scan 3 mths later and there was no change. Cancer nodules tend to grow fast can double in 4 months so no change or shrinking is good. I will be having another scan in October and hopefully no change or reduction will be the result. It cannot hurt to get a second opinion but I think your doctor is following protocol. Good Luck

[GrouseMan]

Best you can do I think right now is just keep an eye on them. My wife when initially diagnosed Stage IVb had something in her lungs that initially they thought was mets. But during the entire 4 years if her journey - these never changed in size or otherwise indicated that they were actually tumors. it was abdominal mets that actually did her in after fighting continuously for 4 straight years almost always on chemo. As always a second opinion is a good idea, but I think based on what you have said that its likely any oncologist will take a wait and see stance.

Regards,

GrouseMan

[Volfan]

I'm stage 4 with liver mets. I do have two spots on my lungs that are about the same size as your moms. Oncologist and colorectal surgeon both think the lung deal is just scar tissue probably from smoking.
My second scan after the liver mets shrunk there was no change in the lung nodules or whatever they are called. The lung deal isn't even brought up anymore.

[NHMike]

I spoke to a former manager today and his wife had a spot on a lung and the doctors pointed it out. They did a needle biopsy and analysis was inconclusive. They put her on watch and wait and a scan a few months later showed it to be shrinking. Last winter was a really bad cold and flu season and she had pneumonia and it might have been remnants of a lung infection. At any rate, they went out to celebrate.

[rp1954]

His offer of a next scan sounds like a good start to me but I'd investigate additional precautions since there is a possibility that you're actually dealing with an early stage IV, rather than the normal stats of recurrence for stage I RC.

Since you haven't had chemo or radiation, your bloodwork should be more stable and sensitive than most patients who have had neoadjuvant or adjuvant chemo/radiation. I'd expand the markers assayed and monitor at 2 month intervals, or less for the first year or so. At some point, a VATS biopsy or a bronchoscopy might be a better biopsy option if there's suspicion.

Likewise, there are mild immune and anti-inflammatory/cytokine routines that may be somewhat helpful in the meantime but are outside standard oncology. The anti-inflammatory aspects can improve bloodwork sensitivity too.

From an individual view, nailing down the difference between the two diagnoses is more important to us personally, than to "them". If this were a stage 4, early detection and surgical treatment has the highest chance of cure.

[hany]

Thanks for all your feedback... really helped me a lot. My mom had colds on the day she had her ct scan, im not sure if its one of the possible reasons of her nodules. I also asked the opinion of her surgeon and he told me that if there was no lymph node, then its probably not metastasis and he is referring me to a pulmonologist. then the radiologist told me that pet scan could not accurately identify if these are mets because there are infections like TB that also lit up in PET scan.
another question is, are the opinions of the surgeon and radiologist considered a 2nd opinion or it should be an onco also?

[NHMike]

I think of a second opinion as the second opinion of the team. I have a local oncologist and radiologist but I got second opinions from an oncologist and radiologist at Dana Farber. My surgeon is from Dana Farber/Brighams and Womens so I didn't feel that I needed a second opinion there. I think that the opinions of the radiologist and surgeon have greater weight as that's more of what they deal with I think. The oncologist deals more with the chemo from what I can tell.

When I met with the DFCI folks, I was most impressed with the surgeon. The radiologist and oncologist agreed with the local guys on the course of treatment which is fairly standard stuff. The surgeon told me a lot of things that I didn't know and understood the nuances of what she might have to work with. So hopefully it's a pulmonary issue and not cancer.