Who to believe?

[oldmama]

Well, I finally got to see the lung doctor after waiting a month and a half.  The first person to read my ct lung scan said that there are several less than 5 mm enhancing soft tissue density within the right upper lobe, with an additional lesion in the posterior paraspinal aspect of the left upper lobe, with no suspicious pleural effusion and with mild right hilar/subcarinal adenopathy.  There is mild cardiomegaly with no pericardial effusion.  The esophagus is normal.  The upper abdominal organs are normal.  The skeleton is normal.  This was from the hospital where the ct was done.  The lung doctor said that he thinks these are not nodules but blood vessels.  Maybe one is a nodule but it is calcified.  He told me to come back in a year and they would do a chest x ray.That even if it was anything they would not do anything until it was at least 1cm.  So, my question is isn't a year just a little bit too long to check it out again? and who reads x-rays better, the guy I paid at the hospital or the lung doctor I paid?  Do I go get a third opinion?  Have not had a smoke for 24 days but I gotta tell you getting a clean bill of health yesterday really tested my will power but I made it without having one.  I am so happy for my Chantix.  Thank you for any comebacks.  

[oldmama]

Thanks,  You guys are great.  You have really helped me out in this stressful time of my life.  It is nice to have someone to talk to that listens and cares.  Take care

[HeinrikMD]

Hi,
Lung cancers generally start with a single mass - this is likely the reason why your lung doctor is considering that the soft-tissue densities are unlikely to be malignant. Even if there is a mass, the calcification is a good sign that it isn't likely malignant.

The radiologist generally gives an opinion based on the imaging results. He does not however, examine the patient. Hence, his opinion would generally supplement whatever your lung doctor is currently considering. The possibility that he is correct - the lung doctor has thought of when the plan to monitor was formulated. The alternative scenario would be to perform invasive testing - and it would be technically difficult to obtain samples if the size is pretty small (this is partly the reason behind "not doing anything until it is 1 cm"). Of course - since this is invasive - the risk will not diminish and hence it outweighs the expected gains.  

I understand your anxiety with the 1 year period of observation, which seems too long.  The interval between scans tends to vary depending on size of the initial lesions of interest. The smaller they are - the longer the interval. There is some concern that the scans themselves may also promote cancer - hence we wouldn't want too many scans. Again, this is all about balancing risks and benefits. Another thing to consider is the capability of the scans to detect small changes, different scans would have different thresholds of resolution- this likely has been considered by the lung doctor as well.

I don't think a third opinion would hurt.