DOUBLING TIME AND VARIATION

    I see many patients who have abnormal CT scan and the scan shows nodule , we do tests to find out as to the cause of the nodules . Just for the sake of knowledge, the solid nodules , and nodules with speculations are more likely to be cancerous than ground glass  nodule which is like haziness. There are many things taken in to account when we think of the nodules and they may be male- female, size of the nodules and characters of the nodule , smoking history, age , upper lobe -lower lobe etc. But with smaller size we tend to do follow up of scans . How often one should do scans is based on possibility of the nodule being cancer and growth pattern and how our science can detect it at it's earliest . The nodules which are very small are impossible to be biopsied. Her we think of doubling time of cancer - how long does it take for the nodule to become double it's size in volume. The fast growing cancer will double in 45 days and slow growing will double in more than 1 year , but many will do size change which can be detected , in 90-120 days . This brings me to the story for the day. 

   I have seen this patient and his wife for last 10 years or so. Bothe of them were smoker and had COPD -emphysema and they were on medications , needed oxygen at times and steroids . Also needed hospitalization. But continued to smoke . He had a ct scan of chest may be 2and half years ago and gthat showed a nodule . The nodule was small and so we talked about the possibility of cancer as he has been smoker and he did not want much testing and ,so, we did do follow up of the scan and he agreed . The new scan was done and that did not show much change . Then we did do another follow up and that showed that the nodule had grown and now it was over an centimeter . So I asked him to do PET scan . He was not very keen on doing PET scan, but finally he did it. The nodule did pick up and so it was now more likely to be cancerous . He was not a good candidate for surgery as he needed oxygen and had poor reserve - based on breathing test to undergo surgery and resection. So I suggested doing radiation after doing a needle biopsy. He refused biopsy and did not want radiation, but wanted to just do follow up .I told him that if the nodule becomes too big - larger than an inch, short course f radiation will not be option and then he will need prolonged course of radiation. He still did not want radiation. So I have done few more scans and then nodule has grown by very small amount may be 2 mm - 25 mm make an inch . Almost 3 years have passed by since we detected the nodule first time. I am sure that he has a cancer , but it is growing at such low rate that he falls out side the 90-120 days rule. 

 So much for the doubling time discussion.