Pulmonary care

According to The American Cancer Society, lung cancer is responsible for more deaths than breast, colorectal, melanoma and prostate cancer combined. However, when found in its early stages, it is curable. High-risk individuals who are routinely screened are more likely to have their lung cancer detected at an earlier, more treatable stage than those who are not.

At our hospital, we offer noninvasive, low-dose computerized tomography (LDCT) lung cancer screenings for at-risk adults. The LDCT screening is designed to catch cancer in its early stages. It is painless, only takes a few minutes and offers five times less radiation exposure compared to a regular CT scan.

After the exam, your report will be sent to your primary care provider and a result letter will be mailed to you. If necessary, you may be referred for pulmonary care. Should this be the case, a lung nodule coordinator will schedule an appointment for you with a pulmonologist.

Many pulmonary nodules are discovered each year during imaging exams and are referred to as "incidental findings." However, most nodules are benign (noncancerous), not malignant (cancerous).

Typically, there are no symptoms associated with pulmonary nodules. If present, signs would be related to the condition that led to the nodule developing. If an otherwise healthy adult develops a new cough or coughs up blood, the nodule could be from lung cancer.

Types of pulmonary nodules

The two primary types of pulmonary nodules are malignant and benign. In addition to old age, smoking is a major cause of malignant pulmonary nodules. As such, the best way to avoid getting one is to forgo smoking or quit if you are already a smoker.

Benign pulmonary nodules can be caused by a variety of factors. Many are the result of inflammation in the lungs caused by an infection or underlying disease. Alternatively, these nodules can represent an active process or scar tissue as a result of prior inflammation.

Testing for pulmonary nodules

Most of the time, you will not know you have a lung nodule until an imaging exam is performed. A variety of testing options can be used to detect nodules, including:

• Biopsy — These tests remove small tissue samples via a needle, so they may be examined under a microscope. When other tests are deemed inconclusive, biopsies can rule out the possibility of malignant growths. Bronchoscopy biopsies insert breathing tubes into the windpipe to reach the nodule, while needle biopsies insert a needle through the chest wall and into the nodule.
• Chest X-rays and computerized tomography (CT) scans — Doctors typically perform these tests when you visit for a respiratory illness. If there is the possibility for a pulmonary nodule, your doctor will ask about your medical history, including whether you have previously had cancer. After an X-ray, your doctor may recommend that you undergo a CT scan to obtain a more detailed image of the nodule.
• Endobronchial ultrasound (EBUS) — This test inserts a flexible tube through your mouth and into your lungs.
• Positron emission tomography (PET) scans — This test captures an image of the nodule's metabolic activity level through the use of a radiolabeled substance, such as glucose. The nodule then absorbs this substance to illuminate any potential complications. Nodules can light up on PET scans if they are malignant, or if there is active inflammation.

If any of these tests are ruled inconclusive, or the nodule has a concerning appearance or growth pattern, one of our pulmonary disease specialists can assist you in determining the best course of treatment.

Pulmonary nodule treatment

If the pulmonary nodule is benign, it likely will not require treatment. If an active infection or disease is found, treatment would depend on the type of condition and any present symptoms.

If the nodule is malignant, but there is no appearance of cancerous spread, then the cancer should be surgically removed. If there is a high concern for malignancy, and a nonsurgical biopsy is deemed inconclusive, it is also recommended that the nodule be removed.

We use the following surgeries to remove pulmonary nodules:

• Thoracotomy — This procedure is considered open lung surgery and is performed by making a cut in the chest wall to remove pieces of diseased lung tissue. You usually need to remain in the hospital for a few days after the operation.
• Video-assisted thoracoscopy — This less invasive procedure utilizes a thoracoscope, a flexible tube with a miniature camera on its end. The thoracoscope is inserted through a small cut into the chest wall, and allows the surgeon to view an image of the nodule on a television screen. This technique requires a smaller cut, and a has shorter recovery time than a traditional thoracotomy.