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Lung Cancer

7mm nodule

06/10/2009

Question:

Today i had a CT scan done for broken vertebra in my back. On the report it made mention of a 7 mm non calcified nodule at the base of the left lung, posteriorly. Then a little further down it said something about an interminate noduleleft lung base. Both were saying image was incomplete but after doing research I am scared that it may be lung cancer. With the wording the way it is is it definately cancer or could it be scar tissue from a previous trauma, i.e. i was crushed by my truck 20 yrs ago and broke a couple ribs on the left side where the nodule is located. what should be my next step and how quickly should it be done. thanks

Answer:

A 7mm non-calcified nodule in the lung may represent an infection or a old scar. However, depending on the age (>50 years) and smoking history (e.g. at least one pack per day for 20 years or more) the possibility of this being a tumor may be high. If the nodules are smaller than 10mm the ideal approach would be to wait for 3-6 months to repeat another CT scan to see if the nodules have changed in size or shape. A tumor usually grows and most tumors double in size in two years. So, we like to continue to follow-up with CT for a total of TWO years. However, if it is an infection and is not treated, it may get bigger rapidly (faster than a tumor) or may disappear completely on the follow-up scans. A scar usually will not change and remain the same. The reason we prefer to wait is because a nodule smaller than 10mm is hard to biopsy. At the same time if they disappear on follow up then there is no need to worry. If they do get bigger, depending on the location and size of the nodule, your doctor may want to get a biopsy (by a radiologist or pulmonologist) to determine if it is infection or tumor. Sometimes, a surgical biopsy may be needed where the whole nodule may be removed. I assume you had a CT of the vertebra, which is mostly focused to view the vertebrae and spine and not the lung. Only a small part of the lung is viewed in these CTs. That is why the report said incomplete examination. I would recommend that you contact your doctor to get a chest CT scan with contrast to examine the whole lung. This will help us to determine the characteristics of these nodule and also to see if there are any other nodules. Depending on the characteristics of these nodules your doctor may want to get a repeat CT in 3-6 months or set you up for a biopsy. If multiple nodules are seen, the possibility of infection would be higher.

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Response by:

Shaheen  Islam, MD, MPH Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
Hematology
College of Medicine
The Ohio State University