Lung Abnormality/Nodule?

[AdAstra]

So, my mom was diagnosed with colon cancer back in September. Last we knew, she was probably stage 2B/C; however, she hadn't had a CT scan since the pelvic/abdominal CT she had back in late-June. Back then, apart from the mass in her cecum, everything looked well, though the scan didn't look at her full thoracic cavity (just the lower chest).

At the beginning of October, my mom came down with a gnarly respiratory infection, along with sinus issues and pink eye. She went to a local urgent care, where she had a chest x-ray and was told that everything looked good. She was given medication and sent on her way. Well, nearly two weeks later, she received a call from the doctor at the urgent care saying a "minor abnormality" was found on her scan. He didn't say what the abnormality was or anything about its size, but he told her to follow up with her doctor to make sure it wasn't anything serious.

She has a chest, abdomen, and pelvic CT scheduled for next week, but I'm extremely freaked out in the meantime and thinking the worst. How freaked out should I be? How common is it for there to be lung mets when there was no lymph node involvement and a clear liver back in late June? I'm not 100% sure if this is relevant, but she's had pneumonia years ago, and she is a current smoker.

[MadMed]

I'm not a doctor but i can share my experience.

Did they explain what they mean by "abnormality" ?
I went through a similar experience. A Dr read my CT and pointed out a nodule, the regular Dr that reads my CT had not. When we went back to him, he clarified that the nodule had been there for years, even before my diagnosis and had not changed. Lungs apparently have lots of nodules and only the ones that grow are suspicious.
I also have fibrosis in my lung that was mentioned once.

Hoping in your mom's case it's just a stupid, basic nodule. See this https://facty.com/ailments/body/what-are-lung-nodules/?style=quick&utm_source=adwords&adid=448728735313&ad_group_id=68028542592&utm_medium=c-search&utm_term=lung%20nodule&utm_campaign=FH-USA---Search---What-are-Lung-Nodules---Desktop&gclid=Cj0KCQjwrJOMBhCZARIsAGEd4VExZe4cDDTrtL8Bw8Zl20320lx7G9EBfqMh27l3Pyk86P7SBQY0N8gaAvXXEALw_wcB

[claudine]

How common is it for there to be lung mets when there was no lymph node involvement and a clear liver back in late June? I'm not 100% sure if this is relevant, but she's had pneumonia years ago, and she is a current smoker.

My husband had lung mets without any node or liver involvement; that said, like IsmaelMehdi wrote, it's not uncommon to have benign lung nodules, especially since she had pneumonia. Fingers crossed that's what this is!

[AdAstra]

Did they explain what they mean by "abnormality" ?

No, unfortunately, we don't have much info about what they meant. My guess is that it's probably not super large or noticeable if they didn't see it during her initial urgent care visit, but I can't be sure. The doctor apparently sent some info to her PCP, but the PCP didn't say much about it, either. She just said there was mention of an "opacity." It'll be good to get more info after she has her CT scan, but at the same time, I'm terrified of receiving bad news.

[AdAstra]

My husband had lung mets without any node or liver involvement; that said, like IsmaelMehdi wrote, it's not uncommon to have benign lung nodules, especially since she had pneumonia. Fingers crossed that's what this is!

Has your husband had chemo continuously since his diagnosis? My mom would be really sad if she had to have chemo for life with no end in sight. I hope she doesn't have any mets, but if she does, I hope it's/they're operable and potentially curable.

[claudine]

Has your husband had chemo continuously since his diagnosis?

No! He's been off chemo since January 2020 (so almost two years). His oncologist isn't one to push it unless there's something to treat (right now my husband is stable, despite a rather high CEA value). The plan is to resume chemo if/when something pops up on scan (unless it can be resected or irradiated). Cancer, even stage 4, is more and more akin to a chronic disease, not a death sentence

[AdAstra]

No! He's been off chemo since January 2020 (so almost two years). His oncologist isn't one to push it unless there's something to treat (right now my husband is stable, despite a rather high CEA value). The plan is to resume chemo if/when something pops up on scan (unless it can be resected or irradiated). Cancer, even stage 4, is more and more akin to a chronic disease, not a death sentence

That's really encouraging to hear. Here and on Colontown, I've been really heartened to see so many long-term stage 4 survivors. Some people are even considered cured, which is really remarkable. I've also been really pleased to see the shift towards viewing advanced cancer as a chronic disease. I bet that in 10-25 years, having stage 4 cancer will be like having diabetes, heart disease, or even HIV; people will be able to live good, long lives while keeping the cancer in check.

[roadrunner]

Just a little reality, which fortunately for you should be very comforting (too often it is not). You say your mother is “a current smoker” and just had a respiratory infection. Nearly all such patients would have pulmonary “abnormalities,” opacities, nodules, scarring, etc. Well, it’s probably not “nearly all” on CT. It’s “all.” Plus the doctor called it a “minor abnormality,” which makes what I said even more significant. But there’s more. Your mother had colon, not rectal cancer. In that situation, lung mets without liver mets are very uncommon, if not rare (and she had a CT that covered the liver). The only issue here is the fact that this was an x-ray, not a CT. I don’t know much about x-ray findings in the lungs (CT is usually used for cancer, or PET-CT). But I doubt that changes the picture too much.

So: Is it good to get a thoracic CT? Sure! One never knows. But please don’t be “freaked out” or “terrified.” That’s an overreaction to this situation IMO. It’s understandable to be scared once you (or someone close) gets a cancer diagnosis. But this fact pattern is very likely to end well. (Well, other than the smoking!) Good luck!

[AdAstra]

Thanks, roadrunner. Your post made me feel a lot less worried. I'm pretty neurotic, so I'm still a bit worried, but I'm not freaking out as much any more. I'm hoping her liver is still clear since it's been four months since her CT, but I'd imagine her surgeon would have seen her liver during her right hemicolectomy in September.

[boxhill]

Little lung nodules appear in the majority of the general population, and the vast majority of them are nothing to worry about. Left over from an infection or whatever. I have one. They took a look at it a couple times, decided it was nothing, and haven't looked since.

If you want to worry about something, worry about her smoking! Maybe you can get her to quit. There are drugs that help, nicotine patches, etc.

[AdAstra]

If you want to worry about something, worry about her smoking! Maybe you can get her to quit. There are drugs that help, nicotine patches, etc.

I told her that even if the abnormality turns out to be nothing (fingers crossed!), there's a not-so-insignificant chance that she'll end up with lung cancer in the future if she keeps smoking. She really wants to quit, so I hope she will now that she'll be starting chemo. She'll be on CAPOX, and I'd imagine the dry mouth one can get from smoking might put her more at risk for mouth sores, so that's another good reason to quit soon.

[AdAstra]

Update: My mom had her thoracic, abdominal, and pelvic CT scan yesterday, and it seems the results are indeterminate. Thankfully, her liver and her lymph nodes look okay, but she has "scattered non-specific 4 mm and smaller bilateral pulmonary nodules, for example 4 mm left lower lobe pulmonary nodule (series 4 image 42), and 4 mm right middle lobe pulmonary nodule (series 4 image 35). Pleural-parenchymal scarring at the bilateral lung apices." The radiologist recommended that we keep an eye on them, but otherwise wrote that there was no definitive evidence of metastatic disease.

I'm not sure what to think. Thoughts? Should I be worried? I guess I was thrown by there being several of them, though I'm glad they're pretty small at this point.

[roadrunner]

This is probably as good a result as you could have received. I believe in excess of 50% (possibly well in excess) of healthy people in your mother’s situation (smoker, 63) would have small pulmonary nodules on CT. Even more because of the recent respiratory infection you reported. Also, her liver’s clear, and since she had colon, not rectal, cancer the chance of “skip” metastases is quite low. The vast majority of sub-5mm nodules are benign. That said, she’s a crc patient and a smoker, so these bear watching (which is exactly what they are doing). They could theoretically reflect metastatic disease or a primary lung cancer (again because of the smoking). I think the CEA is also pretty much normal for a smoker. If it were me, I’d feel pretty good about it but get a scan in 3 months (to check for growth). Usually the radiologist’s report will include a follow-up recommendation. Though if I recall right, she’s going to do adjuvant chemo, so growth, shrinkage, or stability are all possibilities. It may just not be easy to tell for a while.

[AdAstra]

Hypothetically, if they grow or shrink, would that necessarily indicate cancer, or would it take a few scans to be sure? If they're mets, I'm hoping she'd eventually be a candidate for surgery, but if not, do other procedures like cryoablation work well to keep them at bay? I know I shouldn't get too ahead of myself, but I also want to be prepared if worse comes to worse.

[boxhill]

If you want information about lung mets, the Lungston "neighborhood" of Colontown--a large, private community on Facebook--would be a good place to look. Colontown is a superb resource for support and science-based information, and posts are visible only to members.