Additional nodules and they have grown... Now what?

[Patman23]

I was diagnosed with multiple nodules in both lungs all less than 1cm in size.  A PET scan revealed mild increased uptake in the nodules  as well as a few lymphnodes.  The doctor advised a watch a wait approach stating that the nodules were too small to biopsy at that size.  

I just had my 6 month CT scan and it showed more small nodues as well as a slight increase in size bringing the largest ones to 1cm in size.  I have lost about 20 lbs with out tying and my wife and I are a litle concerned.  

The doctor says that it is still more than likely not a big deal so he wants to do another CT scan in 3 months.

I am asking for a second opinion, however, in your opinion, should I push for a biopsy?

This is all pretty new to me and like I said I'm startng to get concerned.

[Patman23]

So if I understand correctly:

1.  I need to have another PET scan to have a better feel for what is going on.
2.  As long as the nodules are larger than 1cm a biopsy is adviseable pending the direction of a pathololigst.

Meanwhile, if this is a metastatic deisease, it is likely from a primary source menning that these would be secondary tumors.  

If this is incorrect please let me know...

So assuming that I am correct in understanding your responce the following may be helpful to know.

When these were first discovered (about 10 months ago) I had a full work up done.  I was referred to and ID clinic and they did a full on work up looking for anything out of the ordinary.  All tests came back normal.  Including for a fungal infection like Histo and others.  

An ultra sound on my liver did reveal some fatty diposits but nothing too bad.  

Keeping in mind that I am 6ft tall and at the time weighed about 220.  Now I am at about 190  Again, this is with no diet or change in life style or eating habiths.

A contrasted MRI was done and it did not reveal any abnormalities. This was done upon the initial finding of the nodules some 10 months ago.

If this information is helpful in guiding your response please feel free to of your opinion / advice.  

Thank you again for your time and knowledge.

[Dr Sharma]

Hi there.  Multiple pulmonary nodules are commonly encountered in metastatic disease of the lungs. Other less common causes are infections, arteriovenous malformations, wegener’s granulomatosis and lymphoma. Secondary lung tumors manifest as discrete nodules, usually multiple, interstitial infiltrate or endobronchial lesions with or without distal atelectiasis and charcterisitc round appearance on x-ray chest. Any cancer has the ability to spread to lungs most common being bladder, colon, breast and prostate cancer. You will need a PET scan to confirm and differentiate from pneumoconiosis since malignant cells have higher rate of glucose metabolism.  Thus, the principle of PET scan is intracellular accumulation of FDG and preferential accumulation of glucose in malignant cells, leads to visualization of malignancy on PET scan. It is the diagnostic and staging tool in cancer, assesses malignant potential in a pulmonary nodule if it is solid and more than 1 cm in dia. management would depend on the diagnosis. Primaries would need to be searched if these are secondaries.You have non-specific symptoms like significant weight loss too.  You can discuss with the pathologist the feasibility of transthoracic needle biopsy of the nodule. Hope this helps. Take care.