Upper Right Lobe Mass

[gwhitman]

I am 53 year old male that just quit smoking 5 months ago after 30 plus years of smoking.  I have lost approximately 13 pounds since I quit smoking.

I have been having the pain since mid June.  A abdominal CT was performed (with and without contrast) 6 weeks ago to verify no kidney stones present.  Results were negative for stones but small lesion found on left kidney later determined to be cist.

Last week I had an MRI due to pain in upper right back (adjacent to shoulder blade and down).  Written results state:

1. Large right upper lobe mass with mediastinal adenopathy
2. Enlarged right adrenal suspicious for metastisis
3. small right paracentral disc protrusions T7-T8 and T10-T11, without spinal stenosis

Since I quit smoking I do not cough much and don't seem to be too short of breath when climbing a flight of stairs, although I am somewhat lethargic (although it doesn't seem too bad).  Also, though I need to take pain pills for the pain and it is getting worse over time, it is not excruciating.

I Just had a CT scan (with contrast) today of lungs and waiting on results.  However, I saw the images from the scan and there is a huge mass that seems to take up at least 50% of my upper right lobe.  I don't know that I saw very distinct edges on the mass.  They seemed to fade away, but the mass itself was very well defined.

My question:

What else besides cancer could account for a mass as described in my upper right lobe?  I am going crazy projecting, but want to prepare myself (and my wife) for the most likely outcome.

Please get back to me.  I am desparate for information.

Jerry

[Hagwife]

Hi Jerry- I'm not a doctor, but I didn't want you just hanging out there- thinking no one read your post.  I am sure that you and your wife are very concerned about this scary sounding report. What a blessing that you can have such a huge mass and still not be very short of breath.   I do have a couple of questions for you though.  1. Have you spoken with your doctor about the results, or did you just request your records before talking to them?  2.  What is your understanding of what it means?  Lastly, and probably most importantly, how are you both holding up?  Like I said- my only contribution is just to let you know that there is someone out there that is pulling for you both.  I think it took about a week before Dr. Tinkleman got back to me after I posted- so just hang in there.  I am sure they will be helping you both soon. pamela

[David Tinkelman, M.D.]

A mass of the size you describe is highly likely to be a tumor, especially with your history of cigarette smoking, but need not be a malignant tumor.  And, if malignant need not be a classical type of lung cancer.  Lymphomas are another type of malignant tumor that can occur in the lung, but these tumors, unlike what are referred to as solid lung cancers, are often more responsive to X-ray therapy and chemotherapy.  And there are a number of other, relatively rare, lung tumors that may show some but not all of the pathology features of a true malignancy.

Mass lesions can also be infectious in nature and, not infrequently associated with lymph node enlargement but, based on your description an infectious cause is unlikely.  I assume that the lung lesion has been determined with some certainty, by an experienced radiologist, to be tissue rather than a fluid-filled cavity.  Were it the latter, the possibility of infection would be greater.

You should strive to prepare yourself and your wife emotionally, for the diagnosis of a malignant tumor, but also persuade your physicians to proceed without delay with whatever diagnostic procedures they deem necessary to establish a diagnosis.

Finally, even should this mass lesion prove to be a malignant tumor, it still may be responsive to therapy.

Should there be any doubt about the diagnosis or the prognosis, do not hesitate to request a second opinion from physicians at a different institution, including consideration of hospitals with a national reputation for cancer diagnosis and treatment.

Good luck