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Forum Name: Lung Cancer

Question: Lung nodule, plus liver and spleen


 emilie05 - Wed Sep 21, 2005 5:28 pm

This is a great forum, thank you to all the doctors and nurses who give their time.

Ok. I am a 30 year old female, non-smoker. I had been having a pain in my right side around my waist so I saw my doctor, who drew blood and took a urine sample. Actually she only took the urine because I thought she'd want it and I filled the cup just in case. Turned out I had a kidney infection and a fever, blood was normal so I got antibiotics and was sent on my merry way.

A month later and I still have the pain. She re-examined me (I'd also had a normal gyno exam in the meantime) and ordered a CT scan. I got the results today because I called and asked about it, and was told that they didn't find anything that would cause me pain. It was mostly normal but they found a nodule in my left lung, one on my liver and one on my spleen. They want me to have another CT in six months to see if they've changed.

Other than that, that's all the info I got from them. I'm nervous because you can't search on "nodule" without finding cancer. I would like to think that they would have called me right away and ordered more tests sooner if they felt it was something to worry about, but is a "wait and see" approach appropriate at this time? Other than the side pain (I'm starting to examine my diet for clues on that), I have had no problems and feel great.

My doctor just called and said I have nothing to worry about since I'm young and healthy. She said that most people have little things like this come up in a scan and that they're just imperfections like a mole on your skin, but since the nodules came up in a scan they want to follow up with another to be safe. The radiologist seems to agree. Does this sounds right?

Thank you!
 Dr. A. De la Guerra - Sat Sep 24, 2005 9:33 pm

User avatar Emilie05, what I understood is that the CT scan was taken because you complaint about a back or lower abdominal pain, which was attributed to a urinary infection, and did not disappeared with medical treatment. The doctors also told you they didn't find anything that would cause you pain. So what they found on the CT scan is called "incidental finding"; it is very common to find minor, "incidental" structures on CT scans. Is called "incidental" when someone goes to the doctor for another reason and they find something else (by chance), that was not bothering.

On screening CT exams, the following types of incidental findings are common: benign nodules or masses that do not cause any symptoms, or small benign tumors that do not grow. Variations of normal anatomic structures (I can have 6 fingers in a hand but I'm not sick). Changes related to surgical operations or from old trauma (scars).

Minimal areas of scarring are not uncommon in the lung, and are often a sequela of prior infections such as pneumonia. Lung granulomas, which are small benign nodules that are caused by certain kinds of old, healed infections, are also very common, specially in the Midwestern United States, including Wisconsin. Most pulmonary nodules have benign causes. In fact, the most common lung tumor is the hamartoma, a benign one. Over 90% of suspected abnormalities seen on screening studies prove to be benign.

Small lesions in the liver are not uncommon, and are typically either simply cysts or hemangiomas. Hemangiomas are benign vascular tumors that can be seen in 10% of the population. Hemangiomas are typically in the 1-2 cm size but can be as large as 5 cm. Simple cysts are also common and are typically several millimeters to several centimeters in size and rarely grow.

Splenic lesions such as hemangiomas or cysts are also common findings. Malignant splenic tumors are rare, so small lesions in the 1-2 cms range are recognized as benign (by definition a nodule is no more than 3 cms in diameter).

At last, the worst case scenario: I find a nodule in the lung, other in the liver, and another one in the spleen; if I suspect it is cancer, I will have to assume that the primary tumor (the one that appeared first) is the lung nodule (by frequency). But, when a pulmonary nodule (3 cm or less) is found in a woman, less than 50 years old, and non-smoker, the chances of cancer are very, very little.

So I think your doctor is right.

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