Lung nodules and genetic testing

[Pagola44]

Hi all,
thanks so much to everyone who has always responded to me and helped me out when i've posted here, i really appreciate it ,

So an update on my self had my first CT scan and also cancer/tumour marker blood test after my surgery and 6 months of chemotherapy

The CT scan was clear except for tiny lung nodules (a few mm in size) the surgeon and oncologist was not concerned about this and said they are so small they wouldn't even be able to biopsy them and said that the CT scan just shows everything like tiny bits of dust, they also said most people have lung nodules

I'm a bit paranoid though, I am schedule to get CT scan in 12 months. What if they grow in that time? What if they are cancerous? Would it show on my CEA/blood tests?

Also- I have my genetic test results soon, originally my MSS was all stable, do you think it's unlikely i would have lynch syndrome? I'm a bit worried for the results

thanks

[beach sunrise]

Playbook answer per SOC is what you got. It's not them so of course they are not worried. I would push for 3-6 month scans and bloodwork.
What is you CEA? Any panels high or low?
I carried a lung met for 3 1/2 yrs (day 1 of dx) before it grew to 5 mm and by that time I had 3 more, One turned out to be a macrophage. I got same answer as you "most people have lung nodules. We are not worried."
I took Itraconazole, resveratrol, astragulas, fisitin, mushrooms, and vitamin E and D to keep them down. It worked for long enough to find answer to get them out.

[Pagola44]

Playbook answer per SOC is what you got. It's not them so of course they are not worried. I would push for 3-6 month scans and bloodwork.
What is you CEA? Any panels high or low?
I carried a lung met for 3 1/2 yrs (day 1 of dx) before it grew to 5 mm and by that time I had 3 more, One turned out to be a macrophage. I got same answer as you "most people have lung nodules. We are not worried."
I took Itraconazole, resveratrol, astragulas, fisitin, mushrooms, and vitamin E and D to keep them down. It worked for long enough to find answer to get them out.

Thanks for sharing beach,
That is a concerning story,

Did you happen to get a PET SCAN? I wonder if I should of pushed for a PET scan, but i'm not sure if tiny lung nodules would show as cancerous on such a scan?

At the moment my surveillance regime is blood test every 3 months and scan in 12 months. Reckon I should push for a scan in a sooner time?

I'm not sure on my CEA numbers , I should of asked for a copy of my results, but just both my oncologist and surgeon said they are normal. So i do not know the exact number.

[Rock_Robster]

You’re right that lung lesions at that size are unlikely to be PET-avid, typically need at least 5 or even 10mm for lung things to show on PET.

I don’t love waiting a year for imaging - I find that a little strange. Perhaps see if you can get them to agree for another check in 3 months - if everything is still unchanged then you might be a little more relaxed going forward.

Also this wasn’t your first CT right? Were the lung nodules visible on earlier imaging?

Lynch is unlikely for MSS (less than 1%, I believe) but ultimately comes down to the status of the 4 Lynch proteins that they should have tested and reported on?

Also definitely get copies off all your bloods/pathology history.

[beach sunrise]

My small one at dx showed up but not lit up. I have PET/CT scan every year. They didn't light up until the 3rd one, 3 1/2 yrs later. And even then only the 5 mm met lit up at 1.3 SUV. Went to Germany, had all 4 taken out and 3 were mets even though just one lit up.
I have 3 CT scan per yr (3 month schedule) then one PET/CT scan.
Yes, you should get all history from onc as you go along and review it including bloodwork.

[Pagola44]

You’re right that lung lesions at that size are unlikely to be PET-avid, typically need at least 5 or even 10mm for lung things to show on PET.

I don’t love waiting a year for imaging - I find that a little strange. Perhaps see if you can get them to agree for another check in 3 months - if everything is still unchanged then you might be a little more relaxed going forward.

Also this wasn’t your first CT right? Were the lung nodules visible on earlier imaging?

Lynch is unlikely for MSS (less than 1%, I believe) but ultimately comes down to the status of the 4 Lynch proteins that they should have tested and reported on?

Also definitely get copies off all your bloods/pathology history.

Hmm, maybe i should do a scan in 6 months? But yea i'll definitely speak to the oncologist next time i see him and see if maybe 3 months is better

This was my second CT, first one was before i had surgery/treatment, interesting point,
It was never mentioned that it was on my original scan, maybe it was and the surgeon just didn't
mention it? Also on my first scan, i didn't have the IV dye, only oral dye, so maybe that's why it didn't show .. not sure

Interesting thanks for the info about the genetic test

will do going forward thanks for the advice

[roadrunner]

Pagola44:

You got good responses from great posters here, but in my view the picture being painted is unduly negative. Background facts are vital:

First, when you get a radiological finding like this you need to understand the context: Yes, benign pulmonary nodules are very common, even arguably ubiquitous. However, they do (and should) get more attention in cancer patients. The following questions are crucial: Do you now, or did you ever, smoke (weed or tobacco)? Do/did you work in a polluted environment (e.g., construction or manufacturing)? Do/you live in a city? If you answered “yes” to any of these questions, the risk of these being mets goes way down. Also, have you had any recent respiratory infections? If yes, same result.

Second, these would be “skip mets” in your case (most CRC metastasizes first to the liver, not the lungs). That makes them unlikely to be mets as well. Even more important, you had colon cancer, not rectal cancer. Pulmonary skip mets in colon cancer are extremely uncommon, possibly rare (don’t quite recall). I will say that I don’t recall a case on the board. Note that all three people who responded to you so far had rectal cancer, not colon cancer. (It is believed that rectal cancer more often goes to the lungs because of the mechanics of blood circulation).

Next—and my memory is fuzzy but this is basically right—even in the rectal cancer context, size matters. Micronodules are very very unlikely to be malignant. I believe one study I saw put the figure at <10%. In the context of rectal cancer, which you didn’t have. So where is your risk? Probably much lower.

The background here is thus very reassuring. However, you didn’t give all the relevant facts. How many nodules are there? Where are they (bilateral or unilateral?)? Exactly what size were they? PET is not helpful under 10mm, as someone said above, and biopsy would be ill-advised (because these would be very hard to find and are very likely not metastases).

Now, on to the scans. Yes, your prior scan may decide the issue. Pulmonary metastases “double” at about 30-120 days, so stability across the two scans would pretty much end the discussion (though 2 years is the gold/conservative standard, as there are outliers). Whether you can get this information is another matter. You would likely have to convince your providers to get a radiologist to look at both (a friendly oncologist could do it, but it’s not their specialty so most are hesitant to do this (they can read scans but recognize their limitations and worry about giving wrong advice)). Getting a radiologist to look might be a tall order: It’s a significant thing from the health care/business perspective, and in this case only for your peace of mind (sadly, not a recognized health care objective in most countries). This because the result will not in any way change the care plan. Mainly because these are very unlikely to be mets and too small to do anything about anyway. But if you can get someone to check, great. Likely they were there, and are nothing. But if they’re new, see the above questions—things often pop up and disappear over intervals like yours. (Though even I would take notice if these grew/were new—not freak out, mind you, but take notice and push hard for a quicker follow-up.) CEA is not a reliable indicator here, btw. Mine was always undetectable even when I had pulmonary mets.
Note also for any evaluation of the two scans that you had chemo between them (if I recall right). You may have to factor that in, as it may have had an effect.

Finally, and this is my best advice: Do NOT go down a rabbit hole of worry here. These are very unlikely to be metastases based on what you’ve said so far. Very, very unlikely. And don’t forget that stress helps cancer. You need to try to avoid rumination and unnecessary worry. That’s your best care plan right now. Plus, it fits the facts. Exercise, get therapy if you need to. So what would I do? Well, pending answers on precise number and size, your background risks (posed above), and scan history (if you can get it), I would (1) not worry about these findings at all, they are really unlikely to be anything, and (2) try to schedule a scan at a reasonably useful interval. That depends in part on the size, since if they’re really small, observer and machine variation can eat up change for a while (Doubling is .26 times axis measurement, roughly, so a 1mm micronodule will have “doubled” at 1.26mm.). Also, if you can’t throw off the worry, an earlier scan might be better for that reason (though don’t tell your docs unless you trust them to have your back—admitting anxiety to physicians is usually a no-no, again sadly).

Bottom line: Don’t worry, your doctors aren’t BS-ing you here. These look really unlikely to be metastases. Consider the psychological benefits of a quicker scan. I can’t say exactly how quick because I don’t have all the info. Mine were done at 3-month intervals, and those took a while to confirm status. But in your case, mostly for psychological reasons, maybe 6 (or even 3 unless they’re too small for that to likely be meaningful)? So: Try to get the old scan read, then try to speed up the next scan—but mainly for peace of mind—and DON’T SWEAT THIS! Good luck.

[Green Tea]

Lung nodules and other lung "thingies"
https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=65477&p=508458#p508458

[Green Tea]

.

...I just recently been diagnosed after my colonscopy.... I had a CT scan of my chest, pelvis and abdomen and on the CT scan they said they couldn't see any spread.

... It was never mentioned that it was on my original scan, maybe it was and the surgeon just didn't mention it? Also on my first scan, i didn't have the IV dye, only oral dye, so maybe that's why it didn't show ...

If you didn't have lung nodules on your first scan but have lung nodules now, there is another possible reason to consider:

In the past 8 months there have been news reports of very bad air quality in the Melbourne area, perhaps due to brush fires or to other causes. If this was the case and you inhaled a lot of ash or black dust during the air-quality red alerts, then this might explain where benign lung nodules could come from.

This is just an alternative hypothesis for you to consider. It's just a guess.

Sources:
https://www.theaustralian.com.au/nation/melbourne-smoke-haze-air-quality-sparks-health-warnings/

https://www.3aw.com.au/whats-causing-the-haze-across-melbourne-this-morning

https://www.abc.net.au/news/2024-03-06/melbourne-southern-cross-station-air-pollution-data-revealed/103486852

[Rock_Robster]

.

...I just recently been diagnosed after my colonscopy.... I had a CT scan of my chest, pelvis and abdomen and on the CT scan they said they couldn't see any spread.

... It was never mentioned that it was on my original scan, maybe it was and the surgeon just didn't mention it? Also on my first scan, i didn't have the IV dye, only oral dye, so maybe that's why it didn't show ...

If you didn't have lung nodules on your first scan but have lung nodules now, there is another possible reason to consider:

In the past 8 months there have been news reports of very bad air quality in the Melbourne area, perhaps due to brush fires or to other causes. If this was the case and you inhaled a lot of ash or black dust during the air-quality red alerts, then this might explain where benign lung nodules could come from.

This is just an alternative hypothesis for you to consider. It's just a guess.

Sources:
https://www.theaustralian.com.au/nation/melbourne-smoke-haze-air-quality-sparks-health-warnings/

https://www.3aw.com.au/whats-causing-the-haze-across-melbourne-this-morning

https://www.abc.net.au/news/2024-03-06/melbourne-southern-cross-station-air-pollution-data-revealed/103486852

It’s not a bad guess at all. Also a past chest infection or Covid somewhere along the way can cause such artefacts.

[Pagola44]

Pagola44:

You got good responses from great posters here, but in my view the picture being painted is unduly negative. Background facts are vital:

First, when you get a radiological finding like this you need to understand the context: Yes, benign pulmonary nodules are very common, even arguably ubiquitous. However, they do (and should) get more attention in cancer patients. The following questions are crucial: Do you now, or did you ever, smoke (weed or tobacco)? Do/did you work in a polluted environment (e.g., construction or manufacturing)? Do/you live in a city? If you answered “yes” to any of these questions, the risk of these being mets goes way down. Also, have you had any recent respiratory infections? If yes, same result.

Second, these would be “skip mets” in your case (most CRC metastasizes first to the liver, not the lungs). That makes them unlikely to be mets as well. Even more important, you had colon cancer, not rectal cancer. Pulmonary skip mets in colon cancer are extremely uncommon, possibly rare (don’t quite recall). I will say that I don’t recall a case on the board. Note that all three people who responded to you so far had rectal cancer, not colon cancer. (It is believed that rectal cancer more often goes to the lungs because of the mechanics of blood circulation).

Next—and my memory is fuzzy but this is basically right—even in the rectal cancer context, size matters. Micronodules are very very unlikely to be malignant. I believe one study I saw put the figure at <10%. In the context of rectal cancer, which you didn’t have. So where is your risk? Probably much lower.

The background here is thus very reassuring. However, you didn’t give all the relevant facts. How many nodules are there? Where are they (bilateral or unilateral?)? Exactly what size were they? PET is not helpful under 10mm, as someone said above, and biopsy would be ill-advised (because these would be very hard to find and are very likely not metastases).

Now, on to the scans. Yes, your prior scan may decide the issue. Pulmonary metastases “double” at about 30-120 days, so stability across the two scans would pretty much end the discussion (though 2 years is the gold/conservative standard, as there are outliers). Whether you can get this information is another matter. You would likely have to convince your providers to get a radiologist to look at both (a friendly oncologist could do it, but it’s not their specialty so most are hesitant to do this (they can read scans but recognize their limitations and worry about giving wrong advice)). Getting a radiologist to look might be a tall order: It’s a significant thing from the health care/business perspective, and in this case only for your peace of mind (sadly, not a recognized health care objective in most countries). This because the result will not in any way change the care plan. Mainly because these are very unlikely to be mets and too small to do anything about anyway. But if you can get someone to check, great. Likely they were there, and are nothing. But if they’re new, see the above questions—things often pop up and disappear over intervals like yours. (Though even I would take notice if these grew/were new—not freak out, mind you, but take notice and push hard for a quicker follow-up.) CEA is not a reliable indicator here, btw. Mine was always undetectable even when I had pulmonary mets.
Note also for any evaluation of the two scans that you had chemo between them (if I recall right). You may have to factor that in, as it may have had an effect.

Finally, and this is my best advice: Do NOT go down a rabbit hole of worry here. These are very unlikely to be metastases based on what you’ve said so far. Very, very unlikely. And don’t forget that stress helps cancer. You need to try to avoid rumination and unnecessary worry. That’s your best care plan right now. Plus, it fits the facts. Exercise, get therapy if you need to. So what would I do? Well, pending answers on precise number and size, your background risks (posed above), and scan history (if you can get it), I would (1) not worry about these findings at all, they are really unlikely to be anything, and (2) try to schedule a scan at a reasonably useful interval. That depends in part on the size, since if they’re really small, observer and machine variation can eat up change for a while (Doubling is .26 times axis measurement, roughly, so a 1mm micronodule will have “doubled” at 1.26mm.). Also, if you can’t throw off the worry, an earlier scan might be better for that reason (though don’t tell your docs unless you trust them to have your back—admitting anxiety to physicians is usually a no-no, again sadly).

Bottom line: Don’t worry, your doctors aren’t BS-ing you here. These look really unlikely to be metastases. Consider the psychological benefits of a quicker scan. I can’t say exactly how quick because I don’t have all the info. Mine were done at 3-month intervals, and those took a while to confirm status. But in your case, mostly for psychological reasons, maybe 6 (or even 3 unless they’re too small for that to likely be meaningful)? So: Try to get the old scan read, then try to speed up the next scan—but mainly for peace of mind—and DON’T SWEAT THIS! Good luck.

Brilliant post, thanks, appreciate the information

thanks to others as well

[Green Tea]

Hi all... I have my genetic test results soon ... I'm a bit worried for the results...

Pagola44 -
Have you received the results of your genetic tests yet? What kind of tests were done, and what are the implications of your results?

Also, another question: Have you had your annual flu shot for this year? You should get it before the flu season starts. When you see your doctor you can ask about this. You might even be eligible to get the shot for free.

https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine

[Pagola44]

Hi all... I have my genetic test results soon ... I'm a bit worried for the results...

Pagola44 -
Have you received the results of your genetic tests yet? What kind of tests were done, and what are the implications of your results?

Also, another question: Have you had your annual flu shot for this year? You should get it before the flu season starts. When you see your doctor you can ask about this. You might even be eligible to get the shot for free.

https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine

My appointment for the genetic test result is late April

No i have not had the flu shot yet, is there a reason why i should ? as in is it related to colon cancer?

[Green Tea]

... No i have not had the flu shot yet, is there a reason why i should ? as in is it related to colon cancer?

Pagola44-
You can get more detailed information on the flu vaccine from your doctor when you see him later this month.

According to the announcements below, there are 7 different flu vaccines available this year, and all people aged 6 months and over are recommended to be vaccinated. Some vaccines are free -- if you qualify under the rules. For other vaccines you would have to pay yourself or have your insurance pay. You can ask your doctor which vaccine would be the best for you and when you should get the injection.

Keep in mind that the main flu season there starts around June, so you should probably try to get immunized a month or two before that.

Your next quarterly blood draw will probably be sometime in June, so you wouldn't want to come down with a bad case of flu just before you have to go in for your blood tests. That would invalidate your blood tests and require you to go back for a re-test later on.

You can also ask your doctor if you might qualify for free vaccine under one of the medical conditions indicated in the list below.

1. https://www.health.gov.au/news/2024-national-immunisation-program-influenza-vaccination-early-advice-for-health-professionals
   .
2. https://www.health.gov.au/sites/default/files/2023-11/national-immunisation-program-schedule.pdf
   .
3. https://www.health.gov.au/sites/default/files/2024-02/2024-influenza-flu-vaccination-consumer-fact-sheet_0.pdf
   
   

   People with certain medical conditions
   The influenza vaccine is free for people 6 months and over with the following conditions:
   

   • cardiac disease
   • chronic respiratory condition
   • immunocompromising condition
   • haematological disorder
   • chronic metabolic disorder
   • chronic kidney disease
   • chronic neurological condition
   • long-term aspirin therapy in children aged 5 to 10 years.

   Talk to your health professional about your medical history and eligibility.

[Pagola44]

... No i have not had the flu shot yet, is there a reason why i should ? as in is it related to colon cancer?

Pagola44-
You can get more detailed information on the flu vaccine from your doctor when you see him later this month.

According to the announcements below, there are 7 different flu vaccines available this year, and all people aged 6 months and over are recommended to be vaccinated. Some vaccines are free -- if you qualify under the rules. For other vaccines you would have to pay yourself or have your insurance pay. You can ask your doctor which vaccine would be the best for you and when you should get the injection.

Keep in mind that the main flu season there starts around June, so you should probably try to get immunized a month or two before that.

Your next quarterly blood draw will probably be sometime in June, so you wouldn't want to come down with a bad case of flu just before you have to go in for your blood tests. That would invalidate your blood tests and require you to go back for a re-test later on.

You can also ask your doctor if you might qualify for free vaccine under one of the medical conditions indicated in the list below.

1. https://www.health.gov.au/news/2024-national-immunisation-program-influenza-vaccination-early-advice-for-health-professionals
   .
2. https://www.health.gov.au/sites/default/files/2023-11/national-immunisation-program-schedule.pdf
   .
3. https://www.health.gov.au/sites/default/files/2024-02/2024-influenza-flu-vaccination-consumer-fact-sheet_0.pdf
   
   

   People with certain medical conditions
   The influenza vaccine is free for people 6 months and over with the following conditions:
   

   • cardiac disease
   • chronic respiratory condition
   • immunocompromising condition
   • haematological disorder
   • chronic metabolic disorder
   • chronic kidney disease
   • chronic neurological condition
   • long-term aspirin therapy in children aged 5 to 10 years.

   Talk to your health professional about your medical history and eligibility.

Interesting, thanks will look into this...


BTW- I know I got really good advice in this thread, and I appreciate that, but I've been getting really anxious lately. I stupidly went down the rabbit hole. I've seen people post about how they had colon cancer, and also had small lung nodules even as small as 5-10mm which grew and turned out to be cancerous. This has really triggered me and worried me. I'm starting to think what if mine are cancerous? What if they grow? Why weren't they on my original scan? How can I just sit here and wait ? Can't i do anything? I'm just getting worried, I also read some study that said 25% of lung nodules for colon cancer patietns were malignant ?? and the rest were cancerous? I just got a bad feeling, i felt this way before i was diagnosed. I'm trying to keep active, exercising and eating well, but i'm scared and tired.