My thoughts aren’t likely to be that useful (sorry!), but here goes:
While I agree that the rise in CEA is concerning (though yours has been at least somewhat elevated for years, and this rise over 10 is recent (I’d want to rule out alternatives, like infection (including COVID, which can be asymptomatic)), the larger node is very small, and PET/CT is less diagnostically effective at that size. Also, to me the SUV + lack of observed growth (though I don’t know the history, namely, how it got to 5mm), at least may cast some doubt on the conclusion that it’s a met. See, e.g., this study, which uses 1.4 SUV as the cut off for 6-8mm nodules (but note also the low diagnostic value). https://jnm.snmjournals.org/content/49/ ... t_1/112P.4
Also, does your oncologist think it looks like a met? The CEA may or may not indicate recurrence somewhere, but you would want at least a good sense that these particular nodes/nodules are bad before removing them, I would think.
You say “[you] know it’s a met.” Am I missing something above? To me, it looks unclear. Of course, I’m
not a doctor, and I don’t have full information, so my view should certainly be taken with a grain of salt. Just offering questions, really.
In a case like this, one or very possibly two oncological and surgical opinions may well be a good idea. Thus, I’d be interested in my oncologist’s view on what this data suggests (if anything), and what options exist for diagnosis and therapy. With respect to metasectomy: are either/both nodes/nodules amenable to an easy wedge, or would a more extensive procedure (segmentectomy or lobectomy—taking more healthy tissue) be required? Would a surgeon even be able to reliably locate these (there are advanced techniques if not sub-pleural, but smaller than 5mm gets very tough, I think). Would ablation of some sort preserve more lung? Given the size of these nodes/nodules, would you get enough material for genetic testing if they are removed and do turn out to be metastatic disease? Finally, is there a risk to waiting for more clarity (here I’ve seen diverse opinions)?
Those are my thoughts. Again, really just a lot of questions for your doctors (and potentially second opinion docs). It might be good to update your signature as well, as it does not reflect the new info.