Expert: Claes-Gustaf Nordquist, M.D. - 7/8/2011

Question
In March three lung nodules were detected on a CT scan.  I had a sharp pain in my chest and was diagnosed with atypical chest pain.  Two of the nodules were in my right lung and measured 6mm and one was in my left lung and also measured 6mm.  I had a followup CT scan and the two nodules in the right lung were unchanged, but the one nodule in my left lung had grown to 11mm.  I will be scheduled for a 3rd scan in Aug/Sept.

I was diagnosed with IDC breast cancer in Sept. 09 and a 2.5 cm grade 3 tumor was removed (lumpectomy with clear margins).  I received 6 cycles of taxotere and cytoxen, 30 radiation treatments and have been taking arimidex/anastrozole for a year.  I breezed through my treatments and felt great before, during and after treatment.  I just turned 60.

I think my surgeon and oncologist believe that the growing nodule is a distant recurrence of my breast cancer (only 18 months after my diagnosis) and they are switching me from anastrozole to aromasin.  They do not want to do a biopsy yet.  I suppose they are waiting to see if anything changes on my next CT scan.

Are there any other plausible explanations for the nodule to have grown so quickly between scans (5mm in 3 months)?  I have no spots on my liver and by bone scan in 09 was clean.  My blood tests for tumor markers always come back normal.  Can an infection or inflammation cause the growth?  Can radiation cause a scar that would change?  Is there any reasonable explanation other than a recurrence and distant metastasis?  I am hoping for the best but preparing for the worst.  

My oncologist is switching me from arimidex/anastrozole that I have taken for the last 14 months to aromasin.  I am 100%ER+ (PR- and HER2-).   If my growing nodule is due to a breast cancer recurrence (does a distant recurrence really happen so quickly?), what effect, if any, could aromasin have on it and/or its continued growth that anastrozole did not have?  Do lung nodules ever shrink or go away with AIs?

Answer
CT scans often find a lot of nodules in lungs. Most of these have nothing to do with cancer. In your case though a growing nodule must be regarded as a suspected cancer though the only way to be sure is by - if possible - a biopsy. If it indeed is a cancer your breast cancer must be regarded as at least a prime suspect. Well the most we probably can hope for with regards to effects of your change in anti estrogen treatment is a slow down of the growth rate of your lesion. If it is a cancer the only possible way to make it smaller is probably by chemotherapy. But a slow down is also important. However your situation is still unclear & uncertain. Please do keep me posted!


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