Oncology (General Cancer)/lung hamartoma
QUESTION: Dr. Higby: What is the standard procedure after a lung hamartoma is discovered and removed in someone? A lung nodule was discovered during a CT for something else. I think the size was 2 cm. A pet scan was done, which was unremarkable (had slight uptake in the nodule area). The edges were smooth. Another scan was done 3 months later, and showed a very small increase in size. It was done on a different machine,and I've always wondered if that was responsible for the minor size increase. Could that be possible? The location prevented a biopsy and surgery was recommended. A lung resection was done, and the diagnosis was benign hamartoma. I know it surprised the doctors that it was benign because I was a long time smoker.
It's a year and a half after the surgery, and the lung doctor wants another CT done to see if any other nodules have formed. Is it standard procedure to keep looking for possible nodules after a person has had one removed? I'm concerned about all of this radiation and the dye. I've already lost a lobe to something that turned out to be benign, and I'm terrified I'll keep losing parts of my lung to benign growths! I don't want to get the test for this reason. Thank you in advance for answering my question.
ANSWER: There is some evidence that abnormalities in the lungs of a smoker seem to be associated with a significant increase in the risk of developing lung cancer at some point in the future. And the cancer doesn't have to pop up in the area of the abnormality. For this reason, some are advocating periodic "spiral" CT scans in people who were smokers. This is a special scan technique that reduces the amount of radiation. As for your situation, your doctors did exactly what they should have -- a nodule of 2 cm needs to be followed, and if there is any hint of growth, it should be biopsied or removed. The method of removal depends on the location and the surgeon. As for the test being done on a different machine, with CT scans, since the image is created by a computer, the issue of measurement differences from machine to machine is not significant, unlike the situation with a chest x-ray. Finally, given that you've had a hamartoma, I'm sure that in the event that another nodule was found, your doctors would take that into account, as well as the fact that you've lost a lobe. Neveretheless, it might be necessary to undergo another excision; next time (if there is a next time) there are procedures that would not remove the whole lobe, which is the standard when it is highly likely (as it was in your case) that you had lung cancer. So I suggest that you go through with the procedure, and make further decisions based on the findings. I'm sure a negative CT would do wonders for your anxiety. And by the way, the risk of the radiation is really minimal, and the dye, if you've tolerated it before, will not be a problem. And if you haven't already, STOP SMOKING. Hope this helps.
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QUESTION: The doctor wants to see if any more nodules have developed. I find this confusing. Why look for nodules if one has had one before? I thought if a nodule is found, after a certain length of time without growth,it's no longer followed. If that's the case, why look for more just because there was one before, and especially since it's no longer followed? Thanks.
As I mentioned before, I would certainly have another CT scan at or about this point. As for the benign hamartoma, we wouldnt' expect that one to return; however, there may be other abnormalities which have developed in the meantime. Strictly speaking, you don't need to have a CT scan if you don't want to, and, strictly speaking, you woudn't need to get another CT scan to follow the complete removal of a benign hamartoma. But with your smoking history and history of an abnormality in the lung, I'd recommend one to act as a "baseline" in case something comes up in the future.