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Lung diseases

HELP with What to Do Next.

10/14/2010

Question:

My husband is 54 YOA, quit smoking 20 Yrs ago. Also used to be a welder. He resently had a breathing test that showed his breathing went from 44% down to 40%. He has also had several CAT & PET SCANs done. The most recent CAT scan w/o dye showed the following: In the Left upper lobe of his lung are pulmonary nodules. The largest was in the left upper lobe apicoposterior segment that measured 0.0 X 1.2 cm, which had increased from 0.8 X 1.0 cm in 10/2009. There are several other adjacent nodules that appear to be calcified suggesting granulomatous disease. We live in the southestern part of Ohio where histoplasmosis is present along with sarcoidosis. His doctor want to perform surgery to remove some of the lung, which isn`t sure that it`s cancer or fungal. What should we do???? HELP PLEASE

Answer:

Pulmonary nodules are very common. In Ohio, histoplasmosis is a common cause of benign pulmonary nodules. Persons who have smoked in the past are at higher risk that their nodules can be due to cancer. When nodules enlarge, the chance of them being cancer is much greater and so additional testing is frequently done. 

Possible testing options can include a PET scan (lung cancer scan), CT-guided needle biopsy, bronchoscopic biopsy, or surgical biopsy. The decision about which of these tests to perform can depend on the location of the nodule, the physician's determination of how likely it is to be cancer, a patient's overall medical condition, and the availability of different tests at one's local hospital. 

Although no one wants to go through unnecessary chest surgery, the best chance for curing lung cancer is to remove it in as early of a stage as possible so the decision about whether to proceed directly to surgery or not should be one that you make after discussing the risks and benefits with your physician.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University