Respiratory Disorders Expert Forum
Lung nodule--surgery or not.
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Lung nodule--surgery or not.

My dilemma is similar to the other two that are posted. I have a tiny nodule on my lung. The PET scan came out negative (no activity indicating cancer) but the doctor said it would not show on the PET scan if it is a slow growing cancer. He suggested surgery because I have a history of smoking (I quit 8 years ago) and I had x rays 8 years ago which did not show the nodule. I am having another CT-scan in three months which should show if the nodule has grown. If the nodule is the same size do you recommend surgery to determine if the nodule is cancerous? Thank you.
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I cannot ethically, or as proper medical practice, make a recommendation as to whether you should have surgery.  A great deal of time and energy has gone into clinical research regarding the optimum management of solitary nodules, including the development of algorithms to guide management decisions.  In brief, the finding of a small solitary nodule and its management requires physician expertise, experience, awareness of the medical literature regarding solitary nodule management, knowledge of recent management guidelines and incorporation of the patient’s age, past medical and smoking history and the degree of suspicion of malignancy of the radiologist and pulmonologist involved in your care..  

The best advice I can provide is that you and your spouse, partner or a close friend meet with the physician who has recommended surgery to discuss your options, including the evidence for and against surgery versus further observation.  You might want to keep in mind the following:

Small lesions, especially those  10 mm is strongly suggestive of a benign lesion and justifies a conservative approach with continued observation, including serial imaging.  Most false negative scans are seen with these smaller nodules and, as suggested by your doctor, occasionally with slow growing (indolent) lesions.

Most lesions that show no change in size over a period of two years or more are deemed to be benign.

If you agree to proceed with surgery, request information regarding the various surgical techniques including video assisted thoracic surgery (VATS).

I also suggest that before agreeing to surgery, you request a 2nd opinion from a non-surgical (Pulmonologist) lung specialist.

Above all be informed about your options and the evidence in support of your doctor’s recommendations.

Good luck
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