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Two Lung Nodules
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Two Lung Nodules

Thank you in advanc for the chance to ask this question!

I can't provide a lot of information to you as I am asking a question for my father, who is 64 years old with chronic emphysema from smoking. About six weeks ago he came down with a cold which made it extra hard to breathe. The doctor didn't like his O2 stats so he was put on home oxygen.He was given prednisone which helped some. His cold has cleared up but his breathing never seemed to get back to what it was before the cold. He was given a chest X-Ray which was negative. He was then given A CT scan that showed two nodules in his right lung. One was small and the other was larger but I do not know measurements. My father said the doctor told him they might not be anything to worry about but he sent him for A PET scan which he had Friday. We get the results on monday. The doctor says my father is a good candidate for the Lung Volume Reduction Surgery and is currently looking for a high volume center to have this done. The doctor told my father that these nodules could be removed during the surgey (LVR). What do you think the odds are that the nodules could be cancer? And do you think the doctor would even be talking about this surgery if he thought there was a possibilty of these nodules being cancer? The doctor did mention that he would need to keep an eye on these nodules. I'm sorry I couldn't get any more information. I would have grabbed the CT report if I could have. I guess the PET scan will reveal more. Thanks for your time!


Erik
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A nodule is usually a small, round shadow seen on chest x-ray anywhere in the lungs.  A chest CT scan is usually the next test that is done because it is more sensitive and shows more detail than a chest x-ray.  The shape, smoothness, and density of the nodule will be seen on the CT scan.  This will help in determining what this could be.  If your father has had previous chest x-rays or CT scans it would be helpful to locate them.  Then his doctor could compare them with his most recent chest x-ray and CT scan.  The comparison could be most helpful to his doctor, in interpreting these findings and the significance of the nodules.  A positron emission tomography (PET) scan is a very accurate test to tell if a nodule is or is not cancer.  However it is not perfect.  This test is less reliable when the nodule is smaller than 1.5 cm in size.

Nodules are due to infections, inflammation, or tumors.  Nodules that are 1 centimeter (10 millimeters) in size or smaller are very unlikely to be cancer.  A nodule that will eventually grow may be unchanged for 6 months.  The important thing is that they have not grown after 6 months.  As long as your father feels well it is reasonable to repeat the CT scan in 6 months, again in another 6 months, and then, if no change is seen repeating the CT scan 2 years from when the nodules were first discovered.  Only if they have grown would more testing be done to know what these nodules could be.  When the nodules have not changed for 2 years they are considered stable and no further testing would be needed.

You will need to rely on the expertise of the lung doctor and the radiologist regarding their evaluation of your father as a good candidate for lung volume reduction surgery (LVRS).  People with emphysema mainly in the upper lobes of the lungs and low baseline exercise capacity benefit from LVRS.
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