Leison on lung

sunsetcity

had a mastectomy September of 2016. No chemo, no rads...on an AI now. Sever months ago started dry cough..persistent. mentioned at an oncology follow up. Did CT scan. Found lesion I upper right quad...initial reading indicated highly suspicious for malignancy, eccentric calcification, 1cm x 1.2cm. The docs had the radiologist and head radiologist reread it...now they ate saying its a granuloma...but not to rule out Mets...and put me on antibiotics. I don't understand how the report could be read 2 different ways...and very unsettled by the whole thing. Suggesting a RE scan in 3 months.

vlnrph

Good to have a second set of eyes on a scan because interpretation can vary. X-rays give a two dimensional/flat image of a 3D structure. Also important to have a reference for comparison which is why they want a repeat in a few months, to look for changes. Small solitary nodules are often left over from past infections.

Has anyone suggested a biopsy? That could possibly be done via bronchoscope under sedation. I have heard about people being treated for lung cancer when their actual disease was pulmonary sarcoidosis, a rare condition which is characterized by granuloma formation along with elevated serum calcium (found during routine labs).

A somewhat common cause of annoying unproductive cough is use of the ACE inhibitor class of antihypertensive agents such as lisinopril, enalapril, benzapril, etc. I had several customers over the years get a different prescription for high blood pressure due to this phenomenon when I worked as a pharmacist...

pajim

Hi sunsetcity, reading CT scans and MRIs are an art. Actually reading mammograms is an art as well. You're looking at white blobs and often there's no way to tell exactly what it is. All sorts of things look the same.

For instance, on a CT scan there isn't a way to tell which bone lesions are active/growing/wounds and which are healed up scabs. That why they invented PET scans. Although even with PET scans all sorts of fast-growing cells light up and they aren't cancer.

The gold standard to decide if this is mets is [as vlnrph says] to do a biopsy. But look at this from your doctor's point of view. Scans find all sorts of things in lungs and most of them are benign or inflammatory. Why would you take all the risks of a lung biopsy if you don't have to? Anesthesia, cutting in, heaven forfend that the knife slips, maybe something bad happens. . .

What I'm guessing is that you'll be on antibiotics for a while in hopes that it solves the cough problem. If it doesn't, or the nodule grows in the next three months, they would then go for a biopsy. If the nodule is the same size in three months, it's likely not cancer and you think about a different diagnostic path.

Here's hoping the antibiotics do the trick and your cough stops.

carmstr835

I had 2 new lung lesions found last November and had a PET scan, however my lesions were just under 1 cm, each one was attached to a blood vessel. I read that pet scans on such small lesions are not really accurate. It was rescanned again in Jan and again in March, but neither was visible because of developing radiation pneumonitis and the inflammation obscured the ability to see those lesions. I had a rescan this month and they could see now that the inflammation has subsided. I am left with some fibrosis but no symptoms.The lesions are completely gone. Not sure what they were, but they are gone now. There is no plan to rescan. It scares me a bit because I believe my targeted treatment of Herceptin and Perjeta as well as my fasting diet may have destroyed it, if it was cancer. It was only found because I had issues immediately following my radiation treatments and there was a concern of a lung embolism. I was also not on perjeta during that time and it was restarted, about that time. Now I am finished with my all my targeted treatment (herceptin and perjeta), if it was cancer, will it grow back now and perhaps it will not be scanned or known? I do know once you have stage 4 you are treated indefinitely and never considered cured. They have never classified me stage 4 because they don't know what those lesions were.

I plan to continue with my monthly fasting, hopefully if it is cancer, that will keep it at bay. I also plan to start the new Her2+ treatment of nerylinx. But,not for at least another 4 weeks. I am having reconstruction surgery next week.

sunsetcity

thank you -- when looking at from a doctors point of view as carmstr835 indicates, it makes a little more sense as to why this course of action - and I appreciate that the doc's are not jumping to conclusions and doing unnecessary tests...before ruling anything else out. Feeling a bit better about the scan results now...though that iniitial reading tends to haunt me. Yes...hoping the antibiotics work...though still coughing.