DEAR DOCTOR K: I saw my doctor because I’ve been getting short of breath. He did an X-ray and CT scan that found three small “pulmonary nodules.” Do I have lung cancer?
DEAR READER: There are few things more frustrating, for both you and your doctor, than when the doctor says: “Well, it’s almost surely nothing to worry about ... but there is a small possibility that it’s bad.” How often does that happen? Pretty much every day, in my experience. The tests we have available today — particularly imaging tests — are much better at spotting possible problems than the tests available when I was in medical school. But how good are they at giving you a clear answer to the simple question: “Do I have something to worry about, doctor?” Not very good at all. Pulmonary nodules are a good example. The term nodule usually describes a small rounded growth or lump. Nodules can be a sign of cancer. But more often they are benign (noncancerous) growths. Pulmonary nodules are found in the lung and have several possible causes. These include:
Lung infections, including infections that occurred years or decades ago.
Exposure to lung irritants, such as coal dust or silica.
Abnormal blood vessels.
Minor abnormalities that have been present since birth.
Cancer that started in another organ and spread to the lung.
To determine what caused your nodules, your doctor will perform a thorough evaluation. This usually starts with your medical history. For example, a small lung nodule in a healthy 40-year-old who quit smoking 15 years ago is probably benign.
On the other hand, several large nodules in a woman with breast cancer could mean the cancer has spread. Next, your doctor will review your X-rays. Certain characteristics may make the nodules appear more or less worrisome.
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