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.
■ Inflammatory conditions.
■ Lung cancer.
■ 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.