Chest C-Scan Question

[jaybird]

This is my first post. When I first got TC 7 years ago I was very involved on TCRC webpage and helped out many emailers. Reading post here brings back a lot of memories.

Anyway, just went for the anual check-up. (I was a non-sem., 100% embry. cell carc., had rplnd//found micro-invasion//, then had 2-cycles of BEP). All this time I have had Chest x-rays and abn/pelvis scans. Just moved to a new city and my new doctor order a chest scan, my first ever so nothing to compare it to.

Abn/pelvis scan came back clean as usual. My chest x-ray showed occasional irregular nodules in right middle lung lobe (5mm and smaller). The impression said it may represent noncalcified granulomas or scars however other etiologies cannot be excluded. They want to follow up with a chest x-ray to be safe but the doctor is saying that there is a 2% chance it could be something bad.

I am 31 so lung cancer is ruled out and I am a pretty healthy guy. I have been told that people have these things in there lungs all the time and I am guessing the bleomycin has something to do with it.

I guess my question is, has anyone had experience with this and if cancer came back after all this time would it come back in the lungs and no where else? My markers were normal but I never had elevated markers.

Thanks for any response.

[dadmo]

I know it's hard not to stress but it's probably nothing. I Think this could be cleared up by having you current doctor contact the one you used to go to. It might be that simple.

[Alex_G]

5 mm node is not even considered enlarged.
As far as I remember 1.5 mm is margin.
Also nodes can become enlarged because of flue. You definitely want to keep an eye on it.

[Fish]

Hi Jaybird:

Ct scans of the chest are notorious for picking up these small nodules. I had a scare 3 months into my surveillence for my second TC when they saw a 7x5mm nodule in my left lung. At that time the oncologist told me that CT's were almost too sensitive for the chest and these findings are not uncommon. After a rough 3 months, a repeat CT showed the nodule was smaller ~3x5. Since then, it's been seen off and on, but really hasn't changed. I'd bet yours is nothing to worry about, just something to watch. Don't forget to keep up the exams on your other testicle.

Seven years would be a long time for embryonal cell to hide. My brother in law was recently found to have multiple lung nodules that upon biopsy were shown to be scar tissue. So keep positive thoughts.

Best wishes,

Fish

[jaybird]

Thanks for the responses.

Are there types of Non-Seminoma Germ Cell Cancers that are more likely to come back later (7-20 years)?

[AdrianB1971]

.

CAT scan of the lungs has saved my life. The small nodules less than 8-9 mm where cancerous and the chemo worked very nice [X-rays has showed nothing !!!].

After 5 years, paradoxaly, seminoma has greater odds to reccurence. Also, unresected teratoma can suffer multiple mutations and become cancerous.

All the best

[Scott]

Ct scans of the chest are notorious for picking up these small nodules. I had a scare 3 months into my surveillence for my second TC when they saw a 7x5mm nodule in my left lung. At that time the oncologist told me that CT's were almost too sensitive for the chest and these findings are not uncommon.

Along those lines, I just read this publication, titled, "CT of the chest can hinder the management of seminoma of the testis; it detects irrelevant abnormalities."

[jaybird]

So is there a risk in intial diagnosis that teratoma simply was not found (but was there)? I was told I hade 100% emb. cell carc and the primary tumor was very small (I am the poster child for getting on it early). I had two microscopic involvement postive lymph nodes and both had vascular invastion. If there was teratoma present then they would have found it in the lymph nodes, Right? I will also mention that my pathology was done by a doctor on TCRC's list of experts.

Thanks again for your responses, I'm learning alot.

[Fed]

So is there a risk in intial diagnosis that teratoma simply was not found (but was there)? I was told I hade 100% emb. cell carc and the primary tumor was very small [...]

Teratomas are tumors that should be easy to distinguish microscopically from something like embryonal. Teratomas are quite more developed than embryonal carcinoma, so if your post-I/O pathology showed all EC, then it is very likely that the nodal involvement found after your RPLND was likely also EC. If there was indeed teratoma found in the nodal pathology, then the path report would show it. Hope this helps out.

[intannette]

Harmless looking nodules on CT scan

My son was diagnosed with TC in may 2005, treated with orchidectomy only. Ct scan january 2006 showed a 5mm nodule in his upper left lobe. Blood tests were normal. The oncologist said "it's probably not cancer, come back in a month". After a month it had to grown to 6mm and the onc once again, on the advice of a thoracic surgeon, declared it not to be cancer. Well it kept growing very slowly, two paratracheal lymph nodes also started to grow. After 5 months and a couple of phonecalls from my sons urologist to the oncologist, she and the thoracic surgeon decided to investigate it properly. The nodule was removed with VATS and it was cancerous, embryonic carcinoma.
From what I've read, most nodules on the lung in a young healthy person are nothing to worry about. But it's a totally different story if you've had cancer before.
After 3 BEP he's now doing well (fingers crossed, he has a scan next week).
My point...even if it's tiny it can still be cancer. I know there are guidelines on the size of nodules and nodes on which doctors base their diagnosis and treatment but they're not foolproof. My son had untreated lung cancer for 5 months. Perhaps you should get a second opinion. I'm trying not to be alarmist but I'm kicking myself for not insisting on a second opinion when his lung lesion was first detected.
All the best.

[dadmo]

If your son had embryonal carcinoma as part of the original pathology the doctors should have been more aware of the possibility for distant metastasis. For what it's worth it's always better to catch these things early but it wouldn't have changerd your sons treatment protocol.

[jaybird]

Well, I’ve gotten a 2nd, 3rd, and 4th opinion as to how I should follow up with my recent findings (two of them well known TC Docs). 1 doctor told me to follow up with a ct-scan and the others said an x-ray should suffice. They all told me that in my case I’ve got about a 0% chance of this being reoccurrence of TC. I guess that’s reassuring but as we all know piece of mind does not come till after a good follow up. They all agreed that I should have not had a CT Scan in the first place.

So do I get total piece of mind with a follow up CT Scan, knowing I’m putting my body through another round of heavy duty radiation, or do I go with the chest x-ray which probably will not tell me anything definitive, but a lot less radiation? If for some rare reason it was a slow growing cancer I would like to know now than 9 months from now.

Man, being a cancer survivor has turned me into a hypochondriac.

[dadmo]

A hypochondriac with good reason. Don't let that almost 0% sway you away from doing your followups.

[jaybird]

Went in for my 3 month x-ray and blood work this morning. Will not know anything till next Friday.

It doesnt matter how many times I walk into a cancer center, I'm humbled every time. Waiting for my name to be called I had a great conversation with a women that was in for breast cancer treatment. She was full of optimism and had a great laugh.

Anyway just thought I would share.

[Margaret]

Jay I am wishing you great results.