small lung nodules

[pvk]

I had a chest CT as part of a general workup and it revealed two lung nodules, 3 mm and 4 mm.  Dr. says not to worry, they're so small that it's very unlikely that they're cancer and we'll rescan in 6 months just to make sure.  However, I have researched this on the net and I keep reading that 40% of nodules are malignant.  I am 47 years old and do have a smoking history (15-20 pack years).  Anyone have any opinions/experience on this issue?

[National Jewish]

By the accepted criteria, 3 millimeter (mm) and 4 mm nodules are very small.  It is not correct that 40% of nodules are malignant.  In fact it is inappropriate to group all nodules together to make such a statement.  There are well-established criteria for establishing the likelihood that a nodule is or isn’t malignant.  You should ask your doctor or the radiologist about this.  A nodule is less likely to be malignant when it is:  
· less than 2 centimeters (cm) or 20 mm in size;
· smooth, regular edges, and
· calcified.
Assuming that you are in apparently good health, the odds are very much in your favor that these nodules are not malignant.

However, a chest CT scan is generally not part of "a general workup".  The reason that the CT scan was done might also need to be taken into consideration in assessing these nodules.

Your doctor's recommendation of re-examination in 6 months is reasonable.  In the meantime, you should try to locate all chest x-rays that have been taken in the past.  Given their size, these nodules might not have shown up on a chest x-ray, even if they were present in the past.  However, it would be very reassuring that the nodules are not malignant if they are seen on a chest x-ray from 2 years ago or longer.

[usnvet]

i also had 2 lung noduels found on a cat. i was sent for a pet scan and they showed uptake,next came 2 biopsys,both negative. followed up for 3 years,they are still there but not cancer.i would get another scan (pet/cat) and see a pulmanary doctor for a recommendation as to what to do next.best to make sure even if you need a biopsy.
good luck

[pvk]

How big were your nodules originally?  Have they gotten any bigger while they have been observed?

[Jay000]

I had a chest x ray, looked like I may of had an area of my lung that had something called sub segmental atelectis or something like that. Well the Dr sent me for a CT. The sub segmental thing was gone but I had a 5mm plueral based nodule, re scan in 3 months. In 3 months that was gone but now I have a 3 mm nodule that is stable was not noticed on the first CT but after review it was there, re scan in 3 months. Well it is 6 months now and the 3 mm nodule is still stable but they find another nodule that is tiny and was on the first CT and it is stable as well. Going back to the first nodule being found the Dr said it was not cancer because of the size and so far so good, no change. What I have read and understand is you are correct that 40% of nodules are cancer but nodules are spots smaller then 3cm. Nodules less then 1cm or 10mm are benign more then 96% of the time, and that is in high risk older patients. Mayo has a very informitive study. Type this into your browser,   lung cancer screening with ct mayo experience swenson et al. The information that comes up covers everything and helped me out a lot dealing with the stress.

[usnvet]

pvk they were 1.8 and 2.o in size. they have not grownin over 3 years since dicovered

[THERESA66]

MY MOTHER WHO IS 69 YEARS OLD HAD A REALLY BAD BOUT OF BRONCHITIS 2 MONTHS AGO AND THEY TOOK A CHEST X-RAY WHERE THEY DISCOVERED A 4MM NODULE,WE WERE JUST CRUSHED, ESPECIALLY WHEN YOU RESEARCH ON THE INTERNET, ALL YOU READ IS THE BIG "C" WORD. HER DOCTOR SUGGESTED WE WAIT A COUPLE OF MONTHS AND THEN GO FOR ANOTHER X-RAY IN OCTOBER.....WE JUST GOT THE RESULTS IN TODAY AND THANKFULLY THE 4MM NODULE HAS DISSAPEARED. SO FOR ANYONE GOING THRU ANXIETY ABOUT NODULES OR SPOTS FOUND ON CHEST X-RAYS, PLEASE DON'T PANIC, NOT ALL NODULES ARE CANCER, MY MOM'S WAS FROM HER BRONCHITIS INFECTION. SO GOOD LUCK TO EVERYONE AND GOD BLESS!!!!

[pvk]

Thanks for your responses, they have helped me to get through these months of waiting for my follow-up scan.  I'll post results when I get the scan in November.

[JNG]

I am a 65 yr.old female and in late July I was told I had a small nodule on my lung.  I had a ct and pet scan, which showed as a hot spot.  But they still cannot tell me if it is the big C or not.  I chose to have another ct done after 3 months, against my surgeon's wishes, turned out there was NO change, which is in my favor...I believe we all have to be our own advocate, and go with your gut feeling.  I also have been diagnosed with polymyalgia rheumatica and am taking prednisone and this could of possibly caused the nodule also.  So I guess I am taking a chance and going to wait 3 months and have another ct done.  If anyone has any comments please advise.

[pvk]

I promised I'd post the results of my 3 month follow up CT scan, so here they are.  I'm worried.  I welcome anybody's input.

3 months ago I had a 4mm nodule in the right lower lobe and a 3mm nodule in the left lower lobe.  Now these are 5mm and 4mm, respectively.  The description of the 5mm nodule is puzzling: "it is unchanged in appearance and size when compared with the previous study"; however, in the preceding study it was 4mm and now it's 5mm.  Also, its appearance is now said to be "suggestive of a small arteriovenous malformation" (this is new, there wasn't this description three months ago).  

There are also three small nodules that weren't noticed on the prior scan: 1) a 3mm nodule just caudal and anterior to the 5mm nodule; 2) a 2mm nodule in the left lower lobe, and 3) a 2mm nodule in the lingula.  The radiologist wrote that both 2mm nodules were present on the previous study (although they weren't mentioned until now).  Nothing was said about the 3 mm nodule, but my dr. subsequently viewed the images together with the radiologist and now they say the 3mm nodule was there three months ago too.  

In addition, they found a 3mm "ovoid low-density lesion in the posterior segment of the right lobe of the liver which was not definitely seen on the prior study.  It is too small to characterize."

My dr. says that he's not worried, but I don't find him convincing.  He says that there can be fluctuations between one reading and another, that the increase in size could be due to the CT being done at a slightly different angle or something like that.  Same for the appearance of the new nodules and the liver lesion.  

He says in any case all these things are too small to biopsy and all I can do is wait and rescan in 3 or 6 months.  He didn't respond directly to my questions about what would be the likelihood that this is cancer.  I am very worried.

So, if anyone has any knowledge about these areas, please tell me what you think about what this all might mean, whether I should be worried, and whether there are other tests or avenues I should pursue at this time.

God bless and thank you for your help.  

[ctannie]

I've been researching this problem for my husband who has non-calcified "scattered" pulmonary nodules.  I will tell you what I have done before and plan to do again, this time for him:

I was 32 years old and diagnosed with adenocarcinoma in multiple colon polyps.  They were rather large and deep when they found them.   My local community hospital felt it was safe to say the cancer in the polyps was "likely" contained and had not spread. Likely??  I didn't feel comfortable with that.  I went to the hospital's pathology lab and requested my slides.  I then took a train into New York City, went to Sloan-Kettering Cancer Center and hand-delivered my slides and my chart to one of the most prominent doctors for this problem in the country to review.  Was it overkill?  Possibly.  But I certainly felt much better after I had his opinion.  

So, all of this to say, if you are concerned and confused (and rightly should be with the new findings that were "missed" at each CT), I would research the best medical center in your geographical area for cancer.  Get ALL of your CT scans, PET scans and x-rays (the films, not just the reports), your entire chart from your physician and have an expert review all of it.   Your piece of mind is worth it!  Telling you not to worry is insulting, especially with the conflicting  information being provided to you.  If the expert comes up with the same conclusion, just to continue serial CTs, you'll still feel better about it.  Good luck.

[Deneen]

Here is a my CT Scan results from 12-1-2006.  The theory that nodules smaller than 2 cm are not cancer was shot in my case.    

Numerous small well circumscribed nodules 5mm or less in diameter are scattered throughout both lungs.  Two of the nodules were present on 11/1/2005 and 1/10/2006 and are unchanged.  However, the vast majority of these nodules have developed de novo and the appearance is consistent with metastasis disease.  The lungs show no infiltrates.  The heart is normal in size.  The aorta and pulmonary arteries are normal.  There is no adenopathy and there are no chest wall abnormalities.  The gallbladder is surgically absent.



Conclusion:  Numerous small nodules 5 mm or less have developed throughout both lungs since 1/10/2006 and the appearances of consistent with metastic disease.

[franci]

My husband had breathing difficulties for almost 6 months.  When he finally went to the docs, xray showed nothing, but the cat showed several irregular inflamed nodes.  She did 8 biopsies.  Results are not in till Wednesday maybe....but she says she is 99.9% certain nothing with the big C.  I hope she is right.  She felt maybe hypersensitivity to a pet, but told us to get rid of nothing till the results come in.  Do size and shape really matter in this one?  We were so scard all week long, but greatly releaved that she did not think the big c was the issue.

[rick c]

I was diagnosed with a solitary lower left lung nodule in 3/06 .followed up by negative pet,subsequent ct showed no change,then 11/1 a new finding of right lung nodule new pet- slight uptake.follow up cat of abdomen and pelvis revealed everything clear but slight node enlargemet around heart.Nodules in lung are 1.5 cm ,dianosis bilateral lung nodules and gland involvement indeterminate,,follow up with ct scan in 3 months,My question is should I insist on biopsy,my dermatolgist says I am nuts if I do not demand a biopsy,I  am 53 and heavy smoker .severe weight loss(56 pounds in 10 months)father died from small cell lung cancer,please help

[franci]

Yesterday our doctor cancelled our appointment today.  The biopsies showed emphasema, pulmanary fibrosis and something else unknown to her.  She is forwarding the biopsies to the Mayo Clinic for more help.  She has him on 60 mg of prednisone daily.  We have a new appointment in three weeks.  Is this junk really terminal?  I am not finding anything with a positive outcome.  He is not done with his fishing days!

[rick c]

does anyone answer this site

[charmingnl]

I had pulmonary emboli possibly from hormone replacement when the upped the dose occ.  The CT of chest showed 1 hilar lung nodule at time of diagnosis.  6 monthes later, I had 2 hilar lung node both less than 1 cm.  I have been working with my primary doctor to do cancer screening in all areas that can possibly seed mets to lungs.  In April, I will have a repeat CT of chest with follow up appt.  I was told if I have any additional nodules or they grew that I would be getting a biopsy.  They would have done the biopsy at 6 monthes if I had the following risk factors: hx of heavy smoking, wt loss and family hx.  I would encourage you to advocate for yourself, talk with your primary MD and insist of a screening, biopsy etc.  If it happens to be cancer, the earlier the stage the better the long term prognosis.  All of you are in my prayers.

[reenee]

My husband had hodgkin disease in nov. 1986, for which he received high doses of radiation as treatment. He is a vet and was exposed to agent orange. For the last three years he has experienced shortness of breath, fatique and many other symptons.
long story short, he had two stints placed in his lad in march of 2006. His shortness of breath did not improve, however he has passed the pulmonary functions test(sitting down blowing in a machine) In february the doctors noticed several nodules in his lungs. Follow up ct scans were ordered with the last in November.
The nodules increased in size but in November his doctor blew it off stating that a lot of people have nodules that they don't even know about. Thus no more follow up has been scheduled. I feel helpless knowing his history of cancer, the high doses of radiation and the exposure to agent orange. any advice would be greatly appreciated.  Did I mention that his doctors were through the Veterans Administration!!!!

[cat71]

Hi all...I am a nervous,had an incidental finding of a nodule in my right lower lobe...also a finding that shows some emphasymic changes going on in my lungs. I am 36 years old and have never smoked plus am very physically active. I don't even have asthma. The Dr. ran a blood test to test for valley fever, spores but it came back negative.
My father died of Lung Cancer 2 years ago. He was a smoker. I am getting some more CT's done. The Dr. told me that there is a genetic disease where a person can have a deficency and be suseptable to lung diseases. Has anyone ever heard of this. Thanks.

[Finding help]

To Rick.... As I was reading these comments today to find out some info. for my mom I read your question. I am sorry that no one has addressed your question , so I will I do not have any experience in these nodules but, according to what everyone is saying if you have lost a lot of weight, are a heavy smoked and have a history of cancer in your family you are a prime target. I would seek prof. help fast. Good Luck and God Bless!

[baileykelsey]

I hope someone has some information--My father died in 1987 of lung cancer, my brother who is 42 was just diagnosed with Stage 3 lung cancer.  I went to my dr got a chest xray and all was clear--went and got a CT scan done and shows two small nodules less than 1 cm on each lung upper lobes.  Yes, I have smoked but quit 6 weeks ago.  I am 37 years old.  Two radiologists have looked at the results but they don't think it's anything to get excited about and come back in three months and recheck.  Needless to say I am terrified.

[ruthiebirdie]

LAST WEEK I WAS RUSHED TO THE HOSPITAL, I KNEW I HAD A STOMACH VIRUS, BUT I COULDN'T BREATHE.  X RAYS WERE TAKEN AND THEY FOUND A LOWER LEFT NODULE IN MY LUNG.  I HAD TO SCHEDULE A CAT SCAN, I WENT CRAZY FOR FIVE DAYS, I DID EVERYTHING BUT PICK OUT MY FUNERAL CLOTHING.  I AM FIFTY SEVEN, NEVER SMOKED, BUT HAVE BEEN WITH SMOKERS MY WHOLE LIFE.  I WAS SO DEPRESSED AND I THREW UP EVERYDAY UNTIL I GOT THE RESULTS.  GUESS WHAT....IT WAS NEGATIVE, NO NODULES, CLEAR LUNGS.  MY ADVICE TO ANYONE WHO IS DIAGNOSED WITH NODULES, DON'T WORRY YOURSELF TO DEATH, UNTIL YOU GET THE RESULTS.....OR YOU'LL BE NURSING AN ULCER.  I WILL NEVER DO THAT AGAIN.  SO GOOD LUCK TO EVERYONE.

[TangibleLife]

A related discussion, Two, now three nodules was started.

[Milmic02]

A related discussion, Plueral Based Nodule /Questions about CT scan findings was started.

[shirey]

A related discussion, Lung Nodules was started.