Lung Nodule 8mm lower left Surgery & H-Pylori

[SusieQ2u]

ineDuring a vascular contrast CT on my lower extremities an 8mm spur shaped nodule was found in the extreme lower left lung.  The pulmonary doctor has ordered a PET scan next Tuesday, but has already said whatever this is should be removed.  He says that if it is malignant it could go from stage 1 to stage 4 quickly if it goes through the wall.  I am a 53-year-old female ... up to a pack a day smoker for 30 years ... family history of cancers on both sides.  I understand I may be in the higher risk bracket but have never been severely ill.  I passed all pulmonary breathing tests.  Doc said biopsy would be high risk for puncturing the lung.  I believe this could be a histo ... mold ... etc.  I had a reaction to Tilex/ScrubFree chlorine mix in 1986; my lungs filled in an hour and I was in hosp three days.  Now sensitive to many cleaners but no more issues.  I do live in the south in an old 1950’s cypress home.  Is there no way of determining the real nodule issue without losing a pie shaped hunk of my lung?  Is it best to get this out?  I go back and forth in my mind.  Hopefully, no more will be found on the PET.  I take no regular meds ... currently on Leviquin in the middle of an H-pylori treatment.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Please keep me posted about your progress. I also look forward to your message saying that you have quit smoking!
Good luck!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Smoking is extremely unhealthy for everyone. If you have a family history of cancer, it is even more important that you quit smoking. Immediately. Even if you have to seek hospitalization (it is hard to break a 30 year old habit, but not impossible).
About your concerns about the 8 mm nodule, speak to your doctor about the possibility of doing a PET guided FNAC during the PET scan due on Tuesday. An FNAC has a much lower risk of lung rupture as compared to a biopsy. It is quite reliable in distinguishing fungal infection from cancers.
Do you have any previous imaging films of the chest for comparison? Why was the CT ordered on your lower extremity?
All the best, and God Bless!

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Most chest and thoracic lesions are amenable to FNAC.
However, let us wait for his opinion. He would be in the best position to judge, after reviewing the PET and doing a physical examination.
Good Luck!

[SusieQ2u]

My husband reminded me that my pulmonary Doctor will probably not agree to FNAC as the nodule was laying on (near protruding into the wall of the lung) and had said that it was best to do the pie shaped removal.  This just scares me as I do not know if it will work correctly and how much I may lose.  
Anyway, I will pursue this week asking the more technical questions.
I have a starter pack of Chantix laying next to me and will begin right away.  I had hesitated with it also, as I was against chemical assistance.  However, I have been unable to stop alone these last four weeks.  Hope Chantix doesn't ring in more trouble!
I will check in after PET Tuesday evening and go into Doctor on Thursday.  If you think of any other questions, I will be glad to ask (and ponder).  
All opinions are valuable at this time.  Thank You once again.

[SusieQ2u]

I will ask Monday about an FNAC, Thank You.  In 1992 I had lingering edema all over .... but mainly the lower extremities ... after a pregnancy and my legs ankles & feet stayed so swollen and painful that eventually it effected my toes and the Naval doctors did a vascular stripping of the main vein in my right leg.  It did help with the endema.  In recent years I have gained 30 pounds and the legs have deep aches and pain to the point they wake me up from sleep.  Back in 1992 , short of wearing surgical hose all my life, there wasn't much else to do.  I had asked this year, during my physical, for a contrast CT to be sure my viens were okay ... no clots ... etc.  The legs were found to have some acceptable calcifications, no clots, but the nodule became the focus.  
I do have CT shots of the chest from about two years ago.  At that physical I had been complaining of upper stomach cramping and painful digestion ... which turned out to be the H-Pylori ... which I do not feel is gone.  
I will achieve the two year old CT for my current pulmonary doctor.
I hope an FNAC may be achieved ......... if not , I feel a second opinion is in order.
Thank you very much Dr. Saini