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Thursday, December 18, 2014
My husband was told that he had a small lung nodule--detected during a CT scan when he was passing a small kidney stone. His doctor asked him if he is a smoker and since he is not, and since he is only 35, she told that he will have another CT in a year to see if the nodule is growing. He had a regular check-up recently and his regular blood test came out okay. (They didn`t check the sedimentation rate.) His grandfather and his uncle who were heavy smokers had lung cancer. There were other cancer patients in his family. What role do your genes play in this? My husband eats healthy, and exercises. His immune system seems to be strong. I cannot stop thinking about this nodule and this is affecting my life. As far as I understand, many people have lung nodules that are harmless. But lung nodules can be an early sign of lung cancer. What can we do to know more about this nodule other than waiting for another year?
Thank you for your question. Following the course of a lung nodule can be very stressful for patients. When evaluating a patient with a newly discovered lung nodule, there are several factors that we take into consideration. First and foremost, by looking at previous scans we can determine how long the nodule has been present. A nodule that has been present for greater than two years is often (but not always) benign. Secondly, we attempt to assess the risk of malignancy based on the patient's age, smoking history, family history, and history of malignancy and characteristics of the nodule itself (size, appearance). You are correct that given your husband's age and smoking history, he would fall into a lower risk category. The family history should be considered given that lung cancer is the result of a combination of environmental (e.g. cigarette smoke, diet, pollution) and genetic factors. There are established guidelines for timing of repeat imaging. These guidelines are based on the patient's risk factors and the characteristics of the nodule. In addition, there are other studies including nodule enhancement and PET scan that are sometimes used to further clarify risk for malignancy. I would suggest that you discuss further with your care provider.
Patrick Nana-Sinkam, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University