Spiculated nodule found on right lung on post chemotherapy scan after lobectomy on left lung in December 2022.

[K2471147]

Hello everyone,

Has anyone undergone a lobectomy and four cycles of chemo to find that there is another suspicious nodule on the opposite lung. If so,what were the options?

[RoyCastleHelpline Partner Ask the Nurse Roy Castle]

Hello K2471147 so sorry to hear a suspicious nodule has been found on the opposite lung. This must be a very difficult time for you especially considering your previous lobectomy and chemotherapy.

Not all suspicious nodules turn out to be cancerous, they can be caused by infection or inflammation, and it may be that the Oncology team may wish to observe this nodule to see if it progresses. Treatment options depend on many factors including location, size, lymph involvement and your general health and so these options need to be discussed with your Oncology team.

You will get good support here in this forum but should you wish to discuss anything with us, you can email ask the nurse at [e-mail] or call our free phone nurse led helpline number on 0800 358 7200 Monday to Thursday 0900-1700 and Friday 0900-1600

Wishing you all the very best

The Roy Castle Support Team

[Concerned2021]

hello, my dad had a Lobectomy last year. Had his first scan in feb which showed another nodule in the same lung (different lobe) and a further nodule in the other lung . I totally panicked on his behalf thinking the worst. He was left for a 3 months as a watch and wait . He had a further scan in May which shows the nodules are still there but haven’t changed or grown. He had a nasty bout of covid in Jan so they believe the nodules could have been caused by that . So hoping your further nodule is something innocent xx

[K2471147 in reply to Concerned2021]

Hello Concerned,

Thank you for taking the time to reply. I have an appointment with the oncologist today and imagine he will send me for a pet scan to see if there is any activity. My main concern is,if it’s a wait and see approach it may move into the lymph nodes which is why I had the lobectomy last year on the other lung. I read SBRT is possible but will have to wait and see. Thank you for your kindness

[Concerned2021 in reply to K2471147]

No problem . Very best of luck to you today. I’m the same with my dad . His next scan is 6 months away now so makes me worry what can happen in the meantime xx

[JanetteR57 in reply to Concerned2021]

there are strict guidelines (British thoracic society) for nodule management as most don't develop or resolve on their own and many stay the same for years. without harming the patient or needing anything done. The lungs are sensitive and removing parts of the lung surgically or giving people anti-cancer treatments who do not have cancer would amount to medical harm or negligence.

Targeted lung health checks and screening in other countries have shown how common lung nodules are - like moles on the skin with very few actually developing into anything sinister. We don't all panic when a mole appears thinking it's skin cancer unless it fits the suggested characteristics and the same is true for lung nodules - they have strict characteristics - size, volume doubling size, repeat images etc and when to intervene or when to watch and wait. hoping you can get some reassurance - life is really too short to worry about what happens or 'what if' - having lost too many close relatives suddenly and unexpectedly - the most recent spent most of her life worrying about 'what if' yet died from a completely unrelated undiagnosed condition that killed her rather than the things she sought mental health support worrying about. Be there for him but live your lives as best as you can in the meantime.

[Hidden in reply to JanetteR57]

hi Janette, do you know how to find a copy of the nodule management guideline, or if they are very complex, a summary? Tia if possible thanks

[JanetteR57 in reply to Hidden]

the guidelines are highly technical - aimed at clinicians rather than a lay audience.

Clinicians also use an app which has the detail for their management.

The guidelines are 64 pages long downloadable in a pdf, full of clinical data, charts, images, volume doubling size, size and many other factors - quite hard to penetrate unless specialised -certainly most of it is over my head!

'Thorax BMJ British Thoracic Society guidelines for the investigation and management of pulmonary nodules' is their title. There is a 4 page article on guidelines for waiting times within the management of pulmonary nodules on Roy Castle lung cancer foundation website on the clinical Expert group page relating to which ones can be discharged and which ones need following up over what time period. As more people have been screened under the targeted lung health checks and now as more are screened in Europe, it is becoming apparent how common lung nodules are. Often described like moles on the skin but on the inside of our lungs, most will not develop. This video created by Roy Castle foundation with UCL although a few years old may explain further... youtu.be/U3oirXkufno(Not working as expected?)

I've never seen a simplified version of the technical guidelines - but they are the standard that everyone refers to within lung screening (UK or international)

Is there something specific you need to find out? The information about targeted lung health checks and the prevalence and management of lung nodules is aimed at a lay audience so may be more relevant? Maybe worth asking your clinical team how they're using them in your own specific case. It is not uncommon to rescan in 3 months time to compare images - as many people have nodules that flare up with inflammation but settle down by the time of the next image.

[Hidden in reply to JanetteR57]

Oh thank you so very much Janette! I’m sorry to take up so much of your evening, you go above and beyond in your time to help and reply. This is really detailed and informative, and I will have a good look through tomorrow, I think it answers some questions I have this evening. I just hope it hasn’t taken up all your evening. Very best wishes to you, and thank you again for your advice and support x

[Eglingham]

Hi, I had a bilobectomy then a completion pneumonectomy 6wks later in 2020. 6mths later my regular scan showed nodule on the other lung so they kept an eye on. 6 mths after that it showed a little growth so sent for a Pet scan but it did not light up. It grew again so had another PET that showed low grade so they decided on chemo but still not sure if cancerous, it is now a little scar which they now think was maybe from infection. Are you going for a Pet scan?

[K2471147 in reply to Eglingham]

Hello Eglington,

I am seeing the oncologist today so will get an idea what next. The problem is this nodule is spiculated so more likely to be cancerous. Since it’s very small, it might be a watch and wait but I’m concerned that in that time a lymph node may become infected like the one on the left which resulted in lobectomy. I imagine he will order a pet scan since because I have had a course of antibiotics as after a Bronchoscopy he thought it was inflammation. Unfortunately,it’s still there. Two CT scans a month apart.

[K2471147 in reply to K2471147]

Thank you for your kindness in responding

[Eglingham in reply to K2471147]

The main thing is they are watching it and it's very small. Sometimes they don't light up on PET if to small not sure why!? Keep positive thoughts don't let this horrible disease bring you down 💪

[JanetteR57]

As others have said, not all nodules develop into anything sinister and spiculated describes the shapes/appearance on the scan. I have had several things show on scans including a sessile polyp on oesophagus (not followed up - likely benign), liver cyst. Many nodules are a results of inflammation and many resolve on their own which is why repeat scans are suggested. There are strict guidelines for nodule management in the UK from the British thoracic society (followed as part of the national optimum lung cancer pathway) which determine size, volume doubling and other risk factors to determine which ones may need additional 'surveillance'. The majority do not need this. hope you get the answers you're seeking soon.

[K2471147]

He’ll everyone,

I saw the oncologist yesterday and his take is we watch and wait until October when I will do another CT scan to see if it has grown.

Best wishes and courage to all.

[sassassas in reply to K2471147]

Best wishes to you K2471147

[K2471147 in reply to sassassas]

Thank you so much.

[Susie215]

I am surprised they are just going to watch a spiculated nodule. That is how I pretty much knew before my biopsy that it was cancer. Only very small chance with a spiculated nodule it being anything else. Can they not just go ahead and biopsy it? I just had my 1st CT scan 3 months after my right upper lobe lobectomy and now I am showing 3 new nodules in right lower lobe. These are round though so I am ok with seeing if they grow in 3 months but still so scary to get new nodules so soon. I pray that both of us get some good news. If I was you though I would get 2nd opinion on waiting in regards to your spiculated nodule

[K2471147 in reply to Susie215]

Hi Susie,

Thanks for your input. I feel extremely nervous that monitoring a spiculated nodule is the right way to go. I’m in France and in all probably the protocol is not as sophisticated as the US,so I will find another oncologist to give a second opinion. My oncologist being asked the question about spiculated nodules was not a bit concerned and clearly stated it was a watch and wait scenario. His take was it could not be biopsied until it was 1cm as it may be any number of other types. I’m not sure what to believe. My best wishes are with you for a good result on your reoccurring nodules.

[Susie215 in reply to K2471147]

my spiculated mass was 3.2 cm when they found it so maybe different if small but all I know is spiculated not good and my Dr was upset with me that I waited so long to get another CT after 1st one showed something suspicious. I waited over a year and then they found the 3.2 spiculated mass. What size is your spiculated nodule now?