Do my CT and lymph nodes indicate lung cancer?

Question

Hello doctor,

I am a 22-year-old non-smoker, and I have been through a huge number of tests trying to figure out what is wrong. My biggest fear is lung cancer, specifically bronchoalveolar carcinoma. I have had shortness of breath on mild exertion for about two months, a cough with white and sometimes yellow phlegm for about a month, finger clubbing for 2.5 months, and firm, fixed lymph nodes in my supraclavicular and posterior cervical area for four months. The supraclavicular node started soft and gradually got firmer. One posterior cervical node on the side of my mid-neck was movable until recently, then rapidly became firm and fixed. Another area at the rear of my neck near the shoulder has felt firm and fixed, and the shoulder and neck pain near it keeps getting worse. I have also had sharp pains radiating from the back-left of my neck into my head and arms for about 1.5 months, plus fatigue for four months. My doctors would not biopsy because they could not palpate the nodes. My specific questions:

Could the mild ground glass opacification on the contrast CT be bronchoalveolar carcinoma even with no mass?
Why did the non-contrast CT not pick it up?
Does the ground glass have any malignant features like spiculation, lobulation, or pleural indentation?
Have the nodes grown between the November MRI and the more recent CT and MRI?
Is not the left supraclavicular node basically Virchow's node pointing to lung cancer since abdominal causes are ruled out? We have ruled out autoimmune disease and interstitial lung disease with blood tests. Is it not lung cancer, the one thing we can not rule out the same way?
What does 'mild ill-defined soft tissue stranding in the left neck' actually mean, and should I be worried?
Could my neck and head pain point to a brain or neck lesion, and would it show up on the neck CT or MRI? I am currently on fluticasone furoate or vilanterol (Breo Ellipta).

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Let me help you understand what your CT scan results could mean. In your CT (computed tomography) scan report (attachment removed to protect the patient’s identity), there is no mass, just the ground glass opacity, and that is nonspecific on its own. Bronchoalveolar carcinoma has a different appearance from this, so I would not go there yet. Follow-up imaging is what tells you whether anything is actually changing.

Ground glass gets missed on non-contrast CT fairly often, so that gap between the two scans is not surprising. The ground glass you have does not show spiculation, pleural indentation, bubble lucency, or the other features that raise real concern for malignancy.

Your supraclavicular and cervical nodes are enlarged, but enlarged nodes have a lot of causes. Inflammation or a chronic infection are both plausible here, especially with your asthma history. Run an antibiotic course if the nodes do not shrink. Tumor markers and a lymph node biopsy are the next step, and you should push for that.

The soft tissue stranding in your neck just means the tissue margin is not sharply defined, which you see with inflammation or edema. No abnormal lesions showed up on the brain portion of your neck imaging, and the head and neck pain you are describing does not match anything visible on these scans. Get the follow-up chest imaging after the antibiotics and see where things land.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

Looking at everything, including your imaging (attachment removed to protect the patient’s identity), I cannot call this lung cancer. There is no mass or lesion in the lung tissue, and for bronchoalveolar carcinoma, the evidence just is not there. In non-smokers, non-small cell lung cancer tends to grow and spread very slowly.

For tumor markers, you would want to add the ALK gene, AFP, CYFRA 21-1, EGFR, and NSE to what you have already run. On the bronchoalveolar carcinoma question, the main distinction is that PET scans are more useful alongside CT for figuring out where the disease is present, unlike most other lung cancers. Fine needle aspiration can usually get you the diagnosis.

Soft tissue stranding can come from a few different things: chronic or acute infection, injury, or possibly an allergic reaction. Your supraclavicular node is over 1 cm, which is where we would call it "mildly enlarged"; under 1 cm is normal. Finish the antibiotic course first. If your symptoms are still there after that, a biopsy is the next step.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.