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Lung Cancer

Nodule increase after almost 5 years

07/27/2009

Question:

A small nodule showed in a CT scan in my upper left lung in late 2004. This scan was done as follow up to endometrial cancer I had in 2003. Nodule has remained stable until June 2009 scan, when it increased to 12 mm. Surgeon has scheduled removal of 5% of lung because it also took up color on PET scan. Does this small increase after 5 years stability mean major surgery is needed? I am 57 white female, never smoked. No recurrance of 2003 cancer at all.

Answer:

With your history of endometrial cancer, any lung nodule is always worrisome for malignancy. However, if a nodule remained stable for 4 years and then suddenly increased in size, then there is a SMALL chance that this could be infection as well. You did not mention how big it was when it was stable. Prior to surgery, a diagnosis can be made with biopsy. Needle biopsy can be done by a radiologist with CT scan guidance. A pulmonologist may also obtain tissue sample with a bronchoscope. However, depending on the location of the nodule, the yield will vary. If it is close to the chest wall, a CT guided biopsy may be a better option. On the other hand, if it is close to the center of the lung, CT guided biopsy may not be the best option. In that case, a good specimen may or may not be obtained with the bronchoscope. Navigational Bronchoscopy is another technique that is available at some centers to biopsy similar lung nodules. There is always a small risk of collapsing the lung with needle biopsies. If the biopsy shows infection, you will need antibiotic. However, if the biopsy is non-diagnostic your oncologist may prefer to have a surgical resection, because it will be diagnostic and curative at the same time (provided your PET scan was negative for any other lesions) or s/he may decide to observe for another 3-6 months. If the biopsy suggests cancer and if you do not have evidence of any other cancer, surgical resection may be the best option. At this time I would recommend to check with your cancer doctor and a pulmonologist to determine whether to wait or get a biopsy.

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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