Oncology (General Cancer)/Nodule lower right lung

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QUESTION: I was told yesterday I had a 5x3 mm nodule in my lower right lung. I am 37 years old and I have smoke about half a pack a day for about 20 years. Is this something I should be concerned about? It was found in the ER from a CT scan of my chest. All they really told me was to follow up with my doctor within 3 days but she is out of the office all next week.

ANSWER: Generally we advise that small nodules in the lungs of a smoker be carefully followed and if there is any indication of growth they should be removed.  So the first step would be to do a second CT scan in four to six weeks, and if stable, six more weeks, then three months, the six months, then one year.  If there is no change in two years, some people recommend discontinuing the follow -up.  However, persistent nodules in the lungs are associated with an increased cancer risk so you should be discontinuing your smoking immediately, and if you were my patient, I'd probably get a CT scan every two years until six or seven years had passed.  Nodules in the lungs are often due to inflammation or scar tissue from old lung infections; they can also be from granulomas, which in turn might be from exposure in the past to tuberculosis, coccidiomycosis, or histoplasmosis.  All of these conditions are not terribly serious but your family doctor may want to test you for these conditions.  Don't worry  about the delay; as I said, the next step is a CT scan to see if there has been interval change.  

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QUESTION: So I saw my doctor today and said she wasn't going to revist it again with a CT or anything because she feels I'm low risk. I told her everything I had read would put me in the high risk i.e. nodule being 5x3 in size, over 35 years of age and smoking for over 20 years. Any advise on how to get a second opinion?

Answer
http://my.clevelandclinic.org/health/diseases_conditions/hic_Pulmonary_Nodules
http://www.mayoclinic.org/diseases-conditions/lung-cancer/expert-answers/lung-no

The above links, from the Cleveland Clinic and the Mayo Clinic, respectively, make the same recommendation: there has to be demonstration that the lung nodule has not changed before concluding it is not cancerous.  This should be followed over two years, as the first note says.  If your doctor has no previous images, then you need another to prove that it's stable.  
If your doctor won't do this, I'd suggest you consult a second physician -- a chest surgeon or a medical oncologist might be more up on what to do.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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