Online Health Chat with Sajive Aleyas, MD

November 30, 2016


Description

Lung nodules, or small growths in the lung, are quite common and can be detected on an imaging test. As lung nodules often produce no symptoms, they are often first discovered as a spot appearing on the lung on a chest X-ray of CT scan. Depending on the size, some larger nodules can be cancerous and require treatment. Older individuals with a history of smoking are at higher risk of developing malignant lung nodules.

Smaller lung nodules are most often benign and can result from inflammation in the lung following an infection or disease producing inflammation in the body. They can also be the product of scar tissue formation related to prior inflammation. If the nodule is from a lung cancer, the person may develop a new cough or cough up blood. Though most lung nodules are not malignant, it is very important that those representing cancer are identified early in their course, when they are curable. 

The Department of Pulmonary Medicine at Cleveland Clinic Florida specializes in the diagnosis and treatment of patients with illnesses that affect the lungs and breathing. We offer a full spectrum of diagnostic and therapeutic services for lung cancer and other diseases of the lung. Our physicians utilize electromagnetic navigation bronchoscopy, narrow-band imaging bronchoscopy and peripheral (radial probe) and mediastinal (convex linear) endobronchial ultrasound to detect lesions, perform biopsies and aspirate lymph nodes. With onsite pathology, a high proportion of our patients know their diagnosis immediately after their procedure.


About the Speaker

Dr. Sajive Aleyas is a Pulmonologist in the Department of Pulmonary Medicine at Cleveland Clinic Florida.  He is also the Director of Interventional and Advanced Diagnostic Bronchoscopy and the Director of the Respiratory Center Lung Cancer Program.  Dr. Aleyas received his medical degree from the University of Debrecen Medical and Health Science Center in Hungary. He completed his Residency in Internal Medicine at Stony Brook University in Stony Brook, New York. Following residency, Dr. Aleyas went on to complete a Fellowship in Pulmonary Medicine/Critical Care at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania followed by a Fellowship in Interventional Pulmonary Medicine at Henry Ford Hospital in Detroit, Michigan.


Let’s Chat About Lung Nodules: Can They Be Cancerous?

Welcome to our Online Health Chat “Lung Nodules: Can They Be Cancerous "with Sajive Aleyas, MD.  We are thrilled to have him here today for this chat. Let’s begin with the questions.

Smoking And Lung Nodules

DisneyTink: My husband has been short of breath and gaining a bit of weight. He has trouble taking a deep breath and complains of pain when breathing. He was a smoker but quit about 5 years ago. Could this be a lung nodule? If so, is it likely to be cancerous?

Sajive_Aleyas,_MD: Hard to say. Usually cancer is associated with weight loss. If he smoked a pack a day for 30 years he should get a lung cancer screening CT of chest.

Prettycat: I was a smoker many years ago and quit over 30 years ago. I am about 30 pounds overweight and am now 70 years old. Did the smoking cause the nodule and can losing weight help stop growth of a nodule? Thank you.

Sajive_Aleyas,_MD: No, weight gain does not cause pulmonary nodules and losing weight will have no effect on pulmonary nodule, Thank you for question.


Warning Signs & Symptoms

CRC5050: Other than a new cough, are there any symptoms that might indicate someone might have a lung nodule? What are they?

Sajive_Aleyas,_MD: Pulmonary Nodule are when a spot in your lung is anywhere from 1mm - 29mm and generally anything in lung this size does not cause any symptoms. It requires a large mass usually to cause symptoms. Usually symptoms from mass are coughing up blood, chest pain, or cough that is persistent.

loveitaly: My sister is 56 years old. She is pretty healthy with the exception of hypoglycemia which she keeps very controlled due to strict following of her diet, including proteins together with carbohydrates, having several snacks a day, etc. For many years of her adulthood, she has been having a dry cough, which physicians say is due to allergy. When it gets bad, she takes Claritin and uses some nasal sprays. She is a preschool teacher, and since children get sick often, she gets several colds a year too. During a CT of the chest in ER due to a virus several months ago, they detected a small spot in the base of one of her lungs. She has had follow-up twice already and both times doctors have told her is a scar from a previous infection or bad cold. She has never been a smoker. Every 6 months she has to check it up. Her cough is always there, sometimes more soft than others. Any suggestions? Thanks for your time.

Sajive_Aleyas,_MD: I am not sure how big the spot is but it is unlikely to be causing her cough. Generally these nodules have to be quite large to cause a cough. I would recommend a pulmonary function test with bronchodilator challenge and allergy testing in flu and pneumovax if not already done. Thank you for your question. Most common cause of cough is Rhinitis and GERD.

nelmurph: Does the size of the lung nodule have any bearing on the likelihood of it being cancerous? And, a related question, likewise, if the nodule is growing, would that be a warning sign to be looked at?

Sajive_Aleyas,_MD: Yes the larger the nodule the more likely it is to be cancer. For a nodule under 5 mm chances of cancer are 0.5% but at 20mm it is 65%. If nodule is growing, yes that is a red flag for either biopsy or PET scan to be done.

Prettycat: How large must the module be to be of concern?

Sajive_Aleyas,_MD: We usually get concerned when nodule is 8 mm or bigger.

Rosegrl15: Is the location of a nodule on the lobe of the lung an indication of whether it is cancerous or not?

Sajive_Aleyas,_MD: Yes location increase the chances of nodule being cancerous. Generally, nodules in upper lobe have a higher chance of being cancerous then lower lobe nodules. That being said, most nodules upper and lower lobe are not cancerous and are usually benign.

questiongirl: I recently had a CT scan because I have been having frequent dyspnea due to what they believe is pericarditis. My pericarditis symptoms started in august and have mostly just been difficulty breathing and chest tightness - little to no pain. My CT scan came back normal with everything else but I did have a triangular shaped 5mm nodule in left lower lobe and a 2mm subpleural nodule in lower right lobe. They said because I am 29, otherwise healthy and not a smoker that this was not a problem. I wonder is this what is causing my intermittent chest tightness and constructive breathing symptoms. My cardiologist and PCP do not seem concerned by it and still believe I have pericarditis. I have been on colchicine twice and a day some days I feel great but others I have the breathing symptoms again but it doesn't seem to just be going away completely. Thank you in advance.

Sajive_Aleyas,_MD: Hi yes, nodules this small in your age group and the location suggest these nodules are benign. It is also very unlikely for nodules this small to be the cause of the symptoms you are describing. I would suggest getting checked for rheumatic diseases if not done already...blood test including ana, etc. and also getting echo if not already done. Thank you for your question.


Diagnosis & Testing

Steven_Robs: Can you explain how bronchoscopy is used to detect lung nodules and other lung diseases?

Sajive_Aleyas,_MD: Bronchoscopy is an endoscopy procedure. We use a scope with camera and light at end of it to visualize all the airway and it allows us to perform biopsy of lung issue with forceps as well as lymph nodes in the chest. It is an outpatient procedure and considered low risk. 

nutzy: I am 70 and suffer from atrial fibrillation and have a prosthetic mitral valve. In the last time I have breathing problems and chest tightness but my cardiologist said that is not because of my heart; I did a CT scan last year and my doctor did not find special problems. I'm afraid my mistake was my request for low screening (radiation). What do you think about this?

Sajive_Aleyas,_MD: It is very unlikely that something was missed with a low dose CT scan of chest.

Prettycat: My nodule was stable at 3 for two years but is now grown to a 5. I'm worried but the doctor said wait six months for another scan. The last two scans were six months apart and the growth occurred within six months. Should I get another opinion?

Sajive_Aleyas,_MD: While waiting 6 months is not unreasonable, I usually get repeat CT scan in 3 months if there is any question about a possibly growing nodule.

Prettycat: My left lower lung revealed a 3mm nodule two years ago. I have had 3 CT scans since. The last two were 4 months apart (another issue) and the nodule is now 5mm. Pulmonary doctor wants to wait for another CT scan in six months. Says my nodule is probably not cancerous. What is the next step and is a growth spurt like that a bad sign?

Sajive_Aleyas,_MD: There is a margin of error with CT scan for sizing pulmonary nodule especially in the lower lobe...3mm to 5 mm can fall into that margin of error. Personally, if I have a question as to whether a nodule has grown or not recommend repeat CT scan in 3 months. Again, I agree likelihood that this is cancer is still low but needs to be followed.


Treatment Options

SaraP1965: A recent PET/CT scan revealed a 5 mm nodule in my left lung. Do all nodules found in a scan require a biopsy?

Sajive_Aleyas,_MD: Absolutely not. Most nodules do not require biopsy. Once nodule is 8 mm or bigger we will consider biopsy or PET scan. 5 mm nodule does not require biopsy just repeat CT scan.

Andrea30: Are cancerous lung nodules treated with medication or surgically? What surgical procedures are used to treat lung nodules?

Sajive_Aleyas,_MD: Cancerous lung nodules, if they are an early stage and patient is good surgical candidate, we recommend surgery as first option. Surgery done is called at VATS procedure and surgeon will generally make one or two incisions in your chest. In one of them, a camera will be placed to see into your chest and in the other incision a special forceps is used to cut part of lung that contains cancer. Generally, inpatient for 3 days. If it is advanced disease, i.e. involving lymph nodes chemotherapy and radiation is needed.


For Appointments
To make an appointment with Sajive Aleyas, MD, Pulmonologist or any of the other specialists in the Pulmonary Medicine Department at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at http://my.clevelandclinic.org/florida.

For More Information

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