Lung Cancer

Enlarging lung nodule

09/28/2009

Question:

I am a 58 Y/O female w/40 year H/O smoking. I have RA, which is treated with methatrexate X 7 years, and was DX`ed w/pulmonary fibrosis in 2007, in addition to small nodules in RT. upper lung. A 6 mon. F/U CT showed nodules remained stable.I just had a new CXR, which showed nodules can no longer be identified, but a new, dominate 2.0x2.0cm is identified. I will have CT done this week. Because the change is significant, can cancer be a likely diagnosis? Thank you.

Answer:

Thank you for your question. There are several variables to consider when assessing one's risk for lung cancer. These include smoking history, family history, history of prior malignancy and the size, chronicity and appearance of the nodule. The appearance of a lung nodule of this size in a smoker is concerning, however, given the rapidity with which it has developed, one must also consider benign causes such as infection or connective tissue disease associated nodules (such as RA). A CT scan to better assess this new finding as well as a careful review of prior imaging are reasonable places to start in the evaluation. If this lesion is in fact new, you should have further discussion with your health care provider regarding the next steps such PET Scan and/or biopsy.

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Response by:

Patrick Nana-Sinkam, MD
Assistant professor of medicine
Pulmonary, Allergy, Critical Care & Sleep Medicine
Department of Internal Medicine
College of Medicine
The Ohio State University