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Long-term loose stools, had CT showed pancreatic cyst and lung nodules, no cough or breathlessness.

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HELP PLEASE...after tests and 'basic' diagnosis. My gastroenterologist (on vacation) other docs
in the group practice are unavailable!

I had a CT 5 days ago (abdomen-pelvis-emphasis on pancreas) with IV and night before, 2 (450ml) bottles of Barium,
will IV contrast during CT

CT ordered on basis of long term loose stools (no other symptoms) Doc suspected pancreatic insuff'cy/
chronic pancreatitis I had ACUTE p'titis 30 years ago. No symptoms except IBS episode that is over Prior
IBS episode 5 years ago (started 25 years ago)

Also type 2 DM 9 years

(a week before and since scan stools firm and regular . Not sticky or other signs of fat,
mostly do not float. No symptoms whatsoever)

Doc left for vacation before CT results...Nurse would only tell me I had a pancreatic cyst not the type, nor blood work
(amylase-glipase - stool stain) Would it be a likelyhood that this is a harmless cyst like pseudocyst or other?


ALSO the nurse told me there was an incidental finding on my abd-pelvis CT. of 2 lung nodules....No mention of size. No other
Gastro Doc avail. to explain finding. Nurse was surprised about my extreme concern. Doctor ordered
another CT,,,,, this time, chest, while he's on vacation. No further scans or blood work til my appt with
him on 12/7.

no lung symptoms like cough or breathlessness...I jog fast 5 days a week..no change in endurance
or otherwise.

Medical websites show conflicting information:

Some say that 50% of lung nodules are MALIGNANT in smokers over 50

Others say MALIGNANCY IS 1%....EVEN IN SMOKERSs

and several others say 50% of smokers have a lung nodule, and amount of nodules increases over time

I've seen that it is recommended by many Docs to 'watch' and retest after a period of a few months.

(I'm 57 M smoker)

Kindly give me you're gut feelings, based on you're experience. I am terribly stressed and worried, and
mostly incapacitated over this. Agony having to wait 8 days til I see my Gastro Doc, compounded by
getting limited info on my CT scan 'pancreatic cyst' and '2 lung nodules'....Nothing else..very cruel.

With this limited info, I hope you can give me something encouraging.

Thank you so much!
Posted Sat, 5 May 2012 in Cancer
 
 
Answered by Dr. Indranil Ghosh 12 hours later
Hi.

Thanks for posting your query.

Usually, any lung nodule which has newly developed in a smoker warrants further evaluation. Some show typical radiologic features of Granuloma or Hamartoma (benign disorders) and do not need further tests.

Unfortunately, the details you are sending me does not give much information. You may ask for a final report of your scans (I think that is your right!).

However, cyst (if it's really a cyst) in the pancreas, especially if small, does not need much attention. It may be followed up with serial CT/Ultrasound.

One way to go about your lung nodules is that, if they do not show the typical features of benign diseases (as mentioned above) is to get a PET-CT (Positron Emission Tomography - Computed Tomography). If the PET-CT shows uptake, then needle aspiration should be done, otherwise follow-up. If the nodules are relatively large (> 2cm) then straightaway needle aspiration may also be done.

One thing is absolutely clear that you should immediately refrain from smoking as that increases the risks of lung and other cancers.

Overall, keeping in mind your symptom profile and reports (though very vague), I feel that you do do not have anything serious. Please keep me posted on further developments.

Hope, this answers your query. Please accept my answer in case you do not have follow up queries.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Long-term loose stools, had CT showed pancreatic cyst and lung nodules, no cough or breathlessness. 16 hours later
There a few medical websites that say things like. "Multiple lung nodules are usually caused by mestasis from a solid organ"

...Many sites (incl. a Mayo Clinic page says " 50% of nodules in smokers over 50
ARE Malignant....no mentions of size(s) of nodules.The Fleischer Society says " 50% of ALL male smokers 50+ HAVE a LUNG NODULE, and most develop another
within a year.

A bit more info....fractured 4 RIGHT SIDE ribs 9 years ago, resulting in severe RIGHT LUNG PNEUMONIA. (HOSP 4 days)

18 months ago an accident caused a few badly bruised ribs on RIGHT SIDE (XRAYED).

and just 10 weeks ago fell down dark stairs....again, bruising of RIGHT RIBS...cennection to nodules perhaps ? (if in right lung)

Can smoking create benign scarring mistaken for nodules? Chest ct done today...last week CT abd-pelvis showed 2 'nodules'
I assume in lower lobe(s) only part of lungs seen by abd CT?....Wont get info til my doctor returns next monday.

I have no pain, breathlessness, coughing and run regularly without impairment. I don't want to pirck up records,
and I may not anylize them correctly...causing more unwarranted stress, or unwarranted optimism.

Some of these Medical websites have scared the hell out of me. Hopefully you can give me your feelings on
what I saw on the web about single/multiple nodules....

Thank you, I'm quite sure I will ACCEPT your answers RandyThe Fleischer Society says " 50% of ALL male smokers 50+ HAVE a LUNG NODULE, and most develop another
within a year.

A bit more info....fractured 4 RIGHT SIDE ribs 9 years ago, resulting in severe RIGHT LUNG PNEUMONIA. (HOSP 4 days)

18 months ago an accident caused a few badly bruised ribs on RIGHT SIDE (XRAYED).

and just 10 weeks ago fell down dark stairs....again, bruising of RIGHT RIBS...cennection to nodules perhaps ? (if in right lung)

Can smoking create benign scarring mistaken for nodules? Chest ct done today...last week CT abd-pelvis showed 2 'nodules'
I assume in lower lobe(s) only part of lungs seen by abd CT?....Wont get info til my doctor returns next monday.

I have no pain, breathlessness, coughing and run regularly without impairment. I don't want to pirck up records,
and I may not anylize them correctly...causing more unwarranted stress, or unwarranted optimism.

Some of these Medical websites have scared the hell out of me. Hopefully you can give me your feelings on
what I saw on the web about single/multiple nodules....

Thank you, I'm quite sure I will ACCEPT your answers Randy

 
 
Answered by Dr. Indranil Ghosh 1 hour later
Hello again XXXXXXX

I don't think the various traumas you have cited have anything to do with the nodules. Many things depend upon the size and characteristic of the nodules. If the size is < 8mm and no features of malignancy, then they may be followed up.

Though you have two nodules, I don't know the size. If they are tiny then I am not worried. Multiple lung nodules suggest metastasis but usually over a certain size (>10 mm).

I think that the Mayo Clinic and Fleischner Society guidelines should be interpreted in the correct perspective. Here are some excerpts from the Fleischner guidelines.."the majority of smokers who undergo thin-section CT have been found to have small lung nodules, most of which are smaller than 7 mm in diameter"..but "fewer than 1% of very small ( 5-mm) nodules in patients without a history of cancer will demonstrate malignant behavior" ..."a likelihood of malignancy of 0.2% for nodules smaller than 3 mm, 0.9% for those 4–7 mm, 18% for those
8–20 mm and 50% for those larger than 20 mm"

So you can see that, though the percentage of nodules in smokers is quite high, the risk of cancer is quite low in <8 mm sized nodules. But it is > 50% for > 2cm nodules, exactly what the Mayo clinic statement meant.

Hope I answered all your questions. Wish you Good Health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Long-term loose stools, had CT showed pancreatic cyst and lung nodules, no cough or breathlessness. 3 hours later
Am I correct in assuming my nodules are most likely to be of typical of smokers Mostly less than 7mm? with

chance of malignancy are low.....Seems that nodules in centimeter range increase chances of malignancy.

If one or more nodules are malignant and not from metastisis, do they have a good cure rate? ie:stage?

I know it is it is difficult to answer without specifics.

I've seen that it is often that doctors take a wait and see strategy retesting with CT at certain intervals.
Should I seek a second opinion more aggressive diagnostics are recommended, non-surgical and surgical?

Thank you ....I will approve after answer. thanks again

Randy
 
 
Answered by Dr. Indranil Ghosh 9 hours later
Hello again XXXXXXX

Thanks for writing back.

To answer your queries one by one....

Yes, if your nodules are less than 8 mm then the chance of cancer is low.

If one or both are malignant but not metastases then we need to do a proper staging evaluation (preferably with PET-CT). If no disease elsewhere is seen (early stage), then results with surgery are good.

If they are tiny then follow-up with CT scans is accepted.

Hope my answers have been of help to you. You are most welcome to ask me if you have any more doubts, I will certainly help you to the best of my knowledge.

Wishing you good health and good luck.

Regards.
Above answer was peer-reviewed by
 
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