Lung Nodule, What Does It Mean?

May 28, 2008 1:38 PM

Paging all medicos - question about a lung nodule.

My mom just recently told me that during her regular check-up, the doctor found a "nodule" in her lung via her chest X-Ray. Her primary care physician said that it was less than 5 cm, and he didn't "think it was anything," but yet he's scheduled her for a CT scan in June. Nevertheless during that same appointment he again reassured her that he didn't think it was anything, but on the other hand, if ("heaven forbid" - his words) it was something, he doesn't know what he would do if he were her.

Mom had a lumpectomy in the very early 90s (1992, I think), in which a malignant tumor less than 2cm was removed. Her lymph nodes were all clear, and she undewent many months of radiation therapy after the fact. Thirteen years later, another small lump (again, less than 2cm) was found on the other breast, a lumpectomy was performed, all lymph nodes were negative, and another series of radiation treatments ensued.

So now, during her routine check-up, this nodule is found. I did some Googling, and it mentioned that the probability of such a thing being cancerous increases with the patient's age. Mom will be 77 in July. I can't help but be worried sick about this situation... she is one of six daughters of a family of 10 children, and the only one to have had breast cancer (although one sister had thyroid cancer and her mother was dx'd with kidney cancer when she was in her late 80s). Mom never smoked or had any other typical cancerous lifestyle indicators other than the fact that when she was 14 years old my grandma got her a job at a dry cleaning store. This was in the days before One Hour Martinizing, and Mom spent the next two years handling and inhaling all sorts of chemicals and solvents.

Even though her doctor pretty much said he though the nodule was nothing to worry about, his subsequent comment about if it *was* something, he didn't know what he would do if he was in her position, at her age, etc., worries me. I'm just scared to death that my Mom is now in the early stages of lung cancer. I'm wondering if the Google articles/statistics about lung nodules being malignant 50% of the time when the patient is over 50 years old is over-stated, if there are any statistics about the frequency of benign lung nodules, and if...worst case scenario...this nodule is something more serious, what should a patient of Mom's age do? Major surgery (like removing a lung) seems sketchy to me, as does chemotherapy... but, on the other hand, most of her older siblings are still alive, so it is conceivable that despite her age, she still has another 12 years or so ahead of her.

What are the chances of a lung nodule being benign in a patient in her late 70s who has had two malignant breast tumors? In a patient who has exhibited no symptoms whatsoever breathing-wise, if the nodule *is* malignant, what is the projected lifespan of a patient who doesn't undergo major therapy (such as surgery or chemo)? What is the prognosis if such a nodule is malignant and the patient doesn't undergo any treatment?

posted by Oriole Adams to health (6 comments total)

Usually when a doctor says "I don't think it's anything to worry about", they are quite sure about what they are saying. I have a lump in my lungs, diagnosed in an X-Ray as well (which I was later told is actually the best imagiology device for lung tumour/lump/whatever diagnostic). The doctor immediately said the same thing. I am 29, though, but tumours in younger people are actually more agressive. I underwent loads of diagnostic examinations, and in the end we came to the conclusion that it's best left alone (though monitored, obviously).

Hang in there, and try not to worry too much. Best of luck to you and your Mom.
posted by neblina_matinal at 1:52 PM on May 28

We say "don't worry" to lessen anxiety. It's not necessarily an indicator of wellness. The 50% chance of malignancy sounds about right. And "less than 5cm" is meaningless, as 5 cm is huge for a lung nodule. You're just gonna have to wait until the CT. Meanwhile, don't worry.
posted by neuron at 2:18 PM on May 28

The stats you are looking for probably don't exist because that's so specific. You really can't know anything until the CT results come in. Really, though, in the meantime, don't worry.
Neuron's comment seems really unhelpful. "50% chance" is a totally wrong way of saying the stat that 50% of the time it is malignant. What is really means is that 50% of the time in all people they studied over 50 years of age, the nodule was malignant. That does not take into consideration the individual patient's personal history and health (including smoking, other hazards, etc.).
posted by fructose at 3:19 PM on May 28

Agree with fructose- what to do is wait for more data to come in.
posted by gjc at 8:24 PM on May 28

This is all very premature, and with due respect, though I personally have some professional expertise on this subject, folks here simply can't give you the information you need yet. At this point this could be anything from a benign lesion with no impact on her life expectancy to something potentially quite serious. What I can tell you is that firstly, in general, I have seen plenty of patients her age who have both tolerated wedge resections of the lung as well as chemotherapy for a variety of cancers without regret, and if these sorts of things ultimately are on the table her specialists will be able to give you and her a better picture of what to expect in the coming weeks.

But again, she's not at that point yet and may never be. So what can you and she expect? First she'll end up getting CT and it'll be interpreted by a radiologist and your primary doctor. In this day and age, CT provides so much more information the plain x-rays in terms of the anatomy. Maybe they'll find that what they saw on the x-ray isn't really there or was some sort of imaging artifact or is something clearly benign, or maybe they'll say it looks suspicious. They'll also be able to have a much better look at the lymph nodes in the chest, which might help give them an idea about what this is and what stage it's at. If it looks fishy, at 5cm the next step will probably be consultation with a lung and/or cancer specialist and the possibility of a biopsy. Once her doctors have all that information, they will be in a good position to address your concerns in a substantive way.

For now however, as hard as it may be, try to be positive. Worrying about a diagnosis she doesn't yet have is likely to be counterproductive for both of you.
posted by drpynchon at 10:17 PM on May 28

Just FYI, the medical buzzword you're looking for that we use for these is "solitary pulmonary nodule."
posted by gramcracker at 10:35 PM on May 28