Really worried - suspicious chest X-ray

Posted By
JC
8/30/2012 12:42pm
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JC
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Replies: 25
I had a routine Dr appointment yesterday, did bloodwork, palpated my lymph nodes, etc. . I decided to go ahead and get a chest x-ray done, since I never did from a year ago since my 1A diagnosis (figured get a baseline in case would be useful in the future), even though Dr said isn't necessary with an early thin lesion like mine, no symptoms, etc.. He called back today and said there are a few spots of concern in the left lung, and he wants me back today for a chest CT with contrast. I'm in shock. I'm shaking. All this time I've been hearing 95+% survival rate for 1A lesions like mine, 0.3mm, 0-1 mitosis, radial phase, no significant regression, no ulceration, negative node biopsy, and now I've got a concerning chest x-ray, and they want me back today for CT scan. I don't know what to think, I feel like this is the beginning of the end and I'm now on a path to the unthinkable. I have young kids, I'm only in my 30s.

Don't panic yet.....I had suspicious chest x-ray 2 yrs after my primary..... It was nothing....I hope you get the same result.

This ain't no hill for a stepper.

What else can it be?  The doctor called me in person, wants me back today for CT and then wants to go over the results immediately after.  Seems like he thinks it is something of great concern.

Do not go into panic mode.Sometimes  the chest x-rays are not the most reliable diagnostic method.Your doc is doing the right thing just to mkae  double sure it is not just false readings.Will keep you in my prayers.Beat the Beast.  Al

The lungs OFTEN have benign beasties - and X-Rays are not the most detailed views.  I can't tell you the number of times I've seen people like you panic with something in the lungs that turns out to be absolutely NOTHING!  (11 years on this site so lots of experience seeing postings like yours).  Lungs are notorious for having crap that shows up.  Don't panic because the likelihood is probably anything but melanoma given your primary.

Janner

Thanks - your words bring me some comfort.

Dave Jay

I started with suspicious possible scar tissue in one lung and there it still sits, unchanged. I've been falsely diagnosed on PET and CT too. It ain't Mel until they biopsy it or confirm it is growing. Relax.

The chest x-ray comment by the radiologist said for someone with a history of melanoma, what was seen was consistent with metastasis. But, then after the CT, the Dr said a really big calcified granuloma (he said in the midwest people get histoplasmosis infections and this is a result of that?). The radiologist comment in the CT scan said it could be confirmed by PET, but the oncologist said he doesn't think that is necessary. He said if anything, maybe just repeat the chest x ray in 3-6 months to ensure it's still the same size. But, he said he had 2 different radiologists look to confirm calcified granuloma. So he is not recommending a biopsy (he said probably couldn't get a needle through it anyway, since it would be hard). I'm relieved, but still a bit confused about the radiologist comment about doing a PET to confirm, and how an x-ray could show something that looks to be metastasis and then a CT says it's calcified granuloma (he said it's the biggest granuloma he's ever seen).  Thanks to everyone for the responses - it helps tremendously.

Actually, this is why they don't scan stage I individuals.  Too many false positives.  The body makes barnacles - and then because of the cancer history - they have to rule that out.  Lots of expensive test to show you that you don't have a metastases.  But with today's litigious society, they have to err on the side of caution.

Glad it was a benign beastie!

Janner

I guess I'm glad to have this "baseline" though, so if I ever needed a future CXR, I know now that this particular spot is not of concern and wouldnt' worry about it.

These are what the results said.  I still don't know what the " Several tiny noncalcified pulmonary micronodules are identified" part means, though.  Even though CT says can be confirmed with PET, the oncologist says not necessary.  He said chest x-ray can be repeated in 3-6 months to confirm the nodule that they say is granuloma is still same size.

X-Ray: FINDINGS: Multiple left lung nodules are noted. The largest is in the left lower lobe measuring 4.7 cm. Additional nodule in the left upper lung measures 0.9 cm. The right lung is clear. There are mild diffuse degenerative changes of the thoracic spine. No focal consolidation is identified.
IMPRESSION: Multiple left lung nodules are suspicious for metastatic disease in this patient with known melanoma. Further evaluation with a chest CT is recommended.

CT Scan: No frankly enlarged supraclavicular or axillary lymph nodes are identified.  Multiple left hilar and mediastinal calcifications are identified. The lung windows demonstrate multiple calcified pulmonary nodules. The largest is identified in the left lower lobe. It is centrally calcified and measures 3.9 x 2.9 cm in diameter. Several tiny noncalcified pulmonary micronodules are identified. No pleural or
pericardial effusions are visualized. Multiple calcified mediastinal and left hilar lymph nodes are noted. There are multiple calcifications identified within the pulmonary parenchyma as well which most likely represent large calcified granulomata. Their benign nature could be confirmed with a PET imaging as clinically indicated.

Now he says a repeat CT in 3 months would be reasonable - if there's no growth, it's not melanoma.  Do you think repeat CT in 3 months is more reasonable than a repeat x-ray in 6 months? Is the radiation exposure of any concern? If there is still a possibility this could be something not-benign, it's safe to wait 3 months to see if there is growth or not?  I'm unclear as to whether the radiologist is saying definitevly that this is nothing, or whether there is still a chance it is something.

From my own experience at least, my doctors recommended, and I went with, a repeat CT scan in 3 months, after the initial baseline CT scan that showed 8 suspicious lesions. 

I'm almost certain a simple X-ray would not be enough to provide a comparison against your baseline scan to determine if any growth had occurred. A CT scan, as I understand it is hundreds of X-rays, provides a much more thorough picture. 

For me, there was a small amount of growth seen on the 3 month CT scan. At that point we then started talking more seriously about what to do next. In order to qualify for stage IV treatments (if needed), I was told a biopsy would be required to know definitively whether the spots were benign, melanoma, or something else. 
 
The lung, like some other parts of the body, are not the easiest place to get a biopsy.  I could watch and wait again another 3 months (because it was slow growing), or try to get a biopsy. The lesions were still too small for a less invasive lung biopsy option ('needle biopsy'). Since I woulnd't be able to start stage IV treatment (if I needed it) without a positive confirmation by biopsy, I went ahead and asked for the more draconian biopsy option, a VATS procedure (get knocked out, they stop a lung, cut into it and start pulling suspicious tissue for biopsy.) 

So, I'm trying to reconcile having a repeat CT in 3 months with Janner's comments about not scanning Stage I patients.  So hard to know what is the right way to go, right thing to do.

You are a stage 1 patient who's been told there's a small possibility there could be metastases/stage IV cancer.  That's different than a stage I patient who hasn't been told that (like I was for almost 10 years).

If you don't trust your doctors, who are recommending getting a 3 month follow up CT scan, then you should probably get a different team of doctors that you do trust. E.g., you could go to a an NCI-designated cancer center if there is one near you. What your doctors are recommending, however, sounds exactly what mine did, which seemed right to me. If anything I was concerened they were being too cautious, not too aggresive.

 

Get the CT scan in 3 months. They don't routinely scan stage 1 however you had a chest X ray that showed areas of concern. There are other kinds of cancers and diseases besides melanoma...

Advocate for your own treatment.. Stage 4 Melanoma NED Surgery,Radiation, Temodar 300Mg July 2009-March 2010, then Thorocotomy...now "Phase I Study of Anti-PD-1 Human Monoclonal Antibody MDX-1106 and Vaccine Therapy"

I got chest xray again 3 months later. . .masses are stable. . no new masses idenified. . .no interval change. . . so definitely seems to be benign "beasties"

 

I am very beginning of stage IIA, 7 years out. My very first chest xray after diagnosis said I had metastatic melanoma in my lungs. Then another Radiologist read the report and decided it probably wasn't melanoma. This was at home. MD Anderson then decided to do CT's and we found spots in my liver, both lungs, and right breast. Had to have them followed every 3 months for 2 years. Eventually had the breast biopsied. Had several different types of tests on liver to determine what spots were. In the end, nothing ever grew. I am a prime example of someone who had lots of spots turn out to be nothing. But we did have to do scans every 3 months for 2 years to make sure nothing grew.

I think because the ones the CT showed were "calcified" - they seem to indicate calcification means it's something benign like granuloma.  The tiny noncalcified. .they said are tiny, too small for PET scan or biopsy and don't have any concerning properties.  Doc said, "About half or more of all people, young or old, esp in the Midwest have these. Yours have no concerning features"    Doc said he doesn't even really think I need another CT in 3 months, but if I want it I can have it so that if no growth, it's not melanoma.  Seems like the initial xray report was speculative not definitive. It is now definitive by the CT as a benign nodule.

 

Anonymous - (9/2/2012 - 6:28pm)

I'd say don't get the repeat scan.  It will just cause stress for you.  Put it behind you.   It is nothing to worry about. 

The "terms of service" for posting on this forum recommend "Share your personal experiences without giving medical advice." I have been oblivious to this guideline in some of my postings but I understand the reason behind this much better now, and try to not do that. 

Did you get a final recommendation from your doctor on what he/she thinks you should do next (if anything?) Is what you're saying, your doctor's recommendation? 

Doctor says he doesn't think I need a CT at all.  He has talked about the issue of false positives all along, which have come to fruition.  But, he thinks it will be put to rest best by a CT in 3 months to assure no growth, or sooner if we want.  But, I honestly don't think I'm going to do another CT at all if no symptoms, given the characteristics of my primary 1A lesion.  I'm inclined to not get another scan in 3 months, because of the radiation exposure (the risk of that doesn't seem to outweigh the benefit). My interpretation of is that the initial xray report was speculative not definitive. It is now definitive by the CT as a benign nodule.

I also live in the Midwest and had spots we were watching. I however, am stag 4 so was having regular PET Scans. They were stable for awhile and then started to grow. My reason for tells you this is to let you know that I have now had surgery on both lungs and they removed everything and I am fine today. No more spots. It is not a death sentence. Just be sure to keep an eye on things!

Nancy

"I can do all things through Christ who strengthens me." Philippians 4:13

I am pleased I found this web site. It is 23 July 2013. I came back from a two week holiday in turkey (I live in the UK) knowing I had a pre-arranged appointment with my doctor on monday 22 July. I kept the appointment. He carried out normal examinatrions and said all was ok but he decided to send me for a chest x-ray. I was x-rayed the same day - 22 July 2013. Today my doctor called me - i must go for a blood test tomorrow - 23 July 2013 and then a CT scan. Yep guys - I am worried.

Shadows on a chest X-ray can be due to many different things some of which are completely benign or even scars from healed lesions. Is there some reason you are worried about melanoma? Regardless, it's too soon to hit the panic button. Try to keep your cool until you know what it is you are dealing with (I know... easier said than done!).

First of all, don't get panic. Life is full of ups and downs. I suggest you to visit doctor again and take out X ray once again. Make sure that the equipments are totally relaible.