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Lung Cancer

DDX includes malignancy versus AVM

09/10/2008

Question:

My mother recently had a thin section contrast ct of chest to follow up on abnormal ct. Findings are 1.7x1.3 cm lobular mass left upper lobe posteriorly adjacent to oblique fissure. Vessels do appear to extend to this region.Tiny nodule left lower lobe as well as presumed focal area of atelectasis in left lung base. Other nodules in right lung measuring 5mm or less and non-calcified include nodules in right upper, middle, and lower lobe. No adenopathy or effusions seen. Also 2 small masses one each hepatic lobe possible hemangiomas. Rec. PET/CT scan. My mother had cervical cancer 29 years ago treated at Sloan Kettering partial hsterectomy and 21 radiation treatments. My question is what are chances this is cancer versus pavm. She is 67 never smoked was exposed to tb as a child. Only sister died of uterine cancer at 37. I appologize for length. Thank you.

Answer:

While smoking accounts for 90% of lung cancer, there are some non-smokers who develop lung cancer. A newly identified nodule may be due to a variety of causes. Cancers that can lead to lung masses include lung cancer, as well as spread from other sites (metastases). There are also benign causes, including infection and congenital. A PET/CT is reasonable. However, it will not absolutely prove or disprove cancer. Rather, a positive PET is suggestive of cancer while a negative PET is suggestive of a benign lesion. If positive, a tissue diagnosis is required via a needle biopsy, bronchoscopy, or minimally-invasive lung surgery (VATS). If the PET is negative and no biopsy is planned, the mass should be carefully followed by serial CT scans and any growth warrants biopsy. She should consider consultation with a lung cancer expert such thoracic surgeon experienced in minimally-invasive surgery, a pulmonologist or an oncologist.

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Response by:

Michael F Reed, MD Michael F Reed, MD
Assistant Professor of Surgery
College of Medicine
University of Cincinnati