Ground-Glass Nodules: Risks and Family History Insights

Q: Ground-Glass Nodules: Risks and Family History Insights

Dear Kai： Regarding your question, 1. <br>The presence of ground-glass opacities is not a concern; however, we cannot rule out the possibility of other issues, so regular HRCT scans are necessary. <br>2. <br>For the interpretation of the scans, please consult your physician. <br>

The retest of the ground-glass opacities is still ongoing?

Seventeen years ago, my mother discovered an approximately 8mm ground-glass nodule at the age of 46.
She underwent surgery at National Taiwan University Hospital, which confirmed it was stage 0 lung adenocarcinoma (she is still alive today, although about 14 years ago another 4mm ground-glass nodule was found, which has shown no changes since).
I am now 30 years old, do not smoke, and earlier this year during a health check at Far Eastern Memorial Hospital in Banqiao, a low-dose computed tomography (LDCT) scan revealed a ground-glass nodule approximately 5.4mm on the edge of my left upper lung, along with three solid nodules measuring 0.3-0.5cm.
Due to a recent COVID-19 diagnosis prior to the health check, the thoracic surgeons considered the nodules not significant and suggested a follow-up in six months.
At that time, Professor Tsai Chun-Ming believed I had an allergic constitution, and since the shadow was faint, it was likely just secretions that might disappear in six months.
Last week, I underwent a second LDCT at Cathay General Hospital in Taipei, and I just saw the report through the National Health Insurance system, which noted a 0.4cm ground-glass nodule in the left upper lung, along with two solid nodules measuring 0.2-0.3cm.
I would like to ask the doctor the following questions:
1.
If the ground-glass nodule remains after six months, is there a possibility that it could develop into lung adenocarcinoma in the future?
2.
Can my mother's nodule size and age at diagnosis serve as a reference point?
3.
If future examinations show no significant changes, is there a possibility that it could suddenly progress rapidly at some point?
4.
Given my age and family history, would you recommend aggressive treatment such as surgery?
Thank you, doctor, for taking the time to read and respond.

Kai, 30~39 year old female. Ask Date: 2023/07/27

Dr. Huang Yiwen reply Pulmonology

Dear Kai: Regarding your question, 1.
The presence of ground-glass opacities is not a concern; however, we cannot rule out the possibility of other issues, so regular HRCT scans are necessary.
2.
For the interpretation of the scans, please consult your physician.
3.
If you are undergoing regular check-ups, there should be no issues.
4.
Currently, the focus remains on monitoring your condition.
Changhua Hospital cares about you.

Reply Date: 2023/07/27

More Info

Understanding ground-glass nodules (GGNs) and their potential implications, especially in the context of family history of lung cancer, is crucial for assessing personal risk and determining appropriate follow-up actions. Your situation, particularly with a family history of lung cancer, raises valid concerns that merit careful consideration.

1. Potential for Progression to Lung Adenocarcinoma: Ground-glass nodules can represent a range of conditions, from benign processes to pre-cancerous lesions. The fact that your mother had a GGN that progressed to stage 0 lung adenocarcinoma at a relatively young age (46) does place you at a higher vigilance level. However, not all GGNs progress to cancer, and many remain stable over time. The size and characteristics of the GGN, along with your age and overall health, will guide the assessment. Generally, GGNs that are stable over two years are less likely to be malignant, but continuous monitoring is essential.

2. Reference Points from Family History: Your mother’s experience with GGNs and subsequent lung cancer can serve as a reference point, but it is important to remember that each case is unique. The size of her nodule and her age at diagnosis are factors to consider, but they do not directly dictate your risk. Your current GGN is smaller than what your mother had, and the stability of the nodules over time is a critical factor. Regular follow-ups with imaging studies, such as LDCT (low-dose computed tomography), are recommended to monitor any changes.

3. Risk of Sudden Progression: While it is possible for a GGN to remain stable for years and then suddenly progress, this is not the norm. Most GGNs that are benign or indolent will not exhibit rapid changes. However, it is essential to maintain regular follow-ups as recommended by your healthcare provider. If there are any changes in symptoms, such as persistent cough, unexplained weight loss, or hemoptysis, these should be reported immediately.

4. Age and Family History Considerations for Treatment: Given your age (30) and the family history of lung cancer, it is understandable to consider more aggressive treatment options. However, the decision to pursue surgical intervention should be based on a comprehensive evaluation by a multidisciplinary team, including a pulmonologist and a thoracic surgeon. They will consider the characteristics of the nodules, your overall health, and the potential risks and benefits of surgery versus continued monitoring.
In conclusion, while your family history does increase your vigilance regarding lung cancer, it is essential to approach the situation with a balanced perspective. Regular monitoring through imaging, maintaining a healthy lifestyle, and discussing any concerns with your healthcare provider will be key in managing your health. If you have not already, consider genetic counseling to assess your risk further and discuss potential screening strategies tailored to your family history. Remember, early detection and intervention are vital in managing lung cancer risks effectively.

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