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Lung Cancer

Right apical pulmonary nodule

12/19/2008

Question:

Approximate 4 months ago while hospitalized for pneumonia and congestive heart failure I had a CT scan that showed a right apical nodule. I am a 62 yr. old female that smoked for at least 40 yrs. and quit smoking 5 years ago when I had a MI. I am already suffering from emphysema, asthma,(COPD)and have been on oxygen 24/7 since 2003. With my medical history I`m wondering what is the liklihood that this nodule is malignant. I am scheduled for a contrast CT in a couple of weeks, but the stress of waiting and repeating CTs every 3-4 months is difficult. Would it be in my best interest to seek additional opinions or would the repeat CTs be the best option at this time? I would sincerely appreciate your opinion and input.

Answer:

A lung nodule can be from infection, scar tissue or tumor. Depending on the size, shape and character of the nodule we determine the likelihood of cancer. If we cannot rule the possibility of lung cancer, a larger nodule (or mass) may be biopsied either using a bronchoscope by a lung doctor, or a needle biopsy under CT guidance by a radiologist for diagnosis in the least invasive way although there is a small chance of collapsing the lung. However, sometimes none of these tests may yield a diagnosis and we may need surgical intervention if the possibility of cancer is high. Generally, apical lobe nodules are somewhat difficult to biopsy with a bronchoscope because of the location and can be biopsied with a higher success rate by a radiologist. However, if it is too small and if we think we may not be able to access with any of the above procedures, we decide to follow-up the nodules with repeat Chest CT scans every 3-6 months for a period of 2 years to document any increase in size or change in character. Given your age and 40 years of smoking exposure, the likelihood of cancer is higher compared to someone who has never smoked. However, still the possibility of infection or scar cannot be ruled out. Depending on the size of the nodule, a bronchoscopy or CT guided biopsy may be the best initial approach. There is a small risk for lung collapse during the procedure that may require you to spend 3-5 days in the hospital. If it is too small, your lung doctor may just recommend to repeat another CT in 3 months. If you are on oxygen because of COPD, surgery may be too risky to get a diagnosis or even remove it. If you have not done so, I would recommend a detail review of your history and CT scans with a Pulmonologist (lung doctor) to decide on the further management.

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Response by:

Shaheen  Islam, MD, MPH Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
Hematology
College of Medicine
The Ohio State University