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Is Malignant Lung Nodule The Reason For Cough And Slight Pain?

Posted on Fri, 27 Dec 2013

Question: My husband went for his scan. they said one nodule is 5mm not 6mm and the other is tiny. the dr phoned last night as she was going on holiday today and is making an apt for him for respiratory specialist as they want to make sure with biopsy. is this normal procedure or should I be worried now? Could he have this cough and slight pain from the nodule without it being malignant. I have a problem with thinking that because most people have no symptoms with nodules that because he has two, that it is cancer? I know it sounds irrational. Would they seen anything else suspicious on the ct like if it had spread or the lymh nodes ect, they seen to just be interested in this nodule. Again he has a great appetitie , no weight loss and very active

Answered by Dr. Satyadeo Choubey (3 hours later)

Brief Answer: Don't worry...It is still not proven of malignancy Detailed Answer: Hi, Thanks for your query. Lung nodule can be benign most of the time and can cause symptoms of cough, chest pain depending on their location. Now coming to your case. Since the nodule is two i.e is one satellite nodule, its not the case of solitary pulmonary nodule, which is benign mostly. The chance of malignancy depends on various factors like shape, Hounsefield unit of that nodule on CT, calcification pattern etc. Now further treatment depends on the choice of treating physician and patient's concern. It is always safer to rule out malignancy at early stage. Biopsy can be surgical or non surgical. Non surgical biopsy can be CT guided, Ultrasound guided, bronchoscopic depending on the site of the nodule. A PET scan can judge whether nodule is hot or cold. Non surgical biopsy is just a matter of minutes and after 2 or 3 hours of observations patient can be sent home. Surgical lung biopsy is an invasive procedure where the nodule is reached at OT table, resected and sent for histopathological examination. Now a days Video assisted thoracoscopic surgeries (VATS) is done which is less invasive, but again it can be done if the lesion is peripheral in location. I think the doctor will opt for non surgical biopsy and if itcomes inconlusive then only they will go for surgical one. Or they can opt for following up of the lesion by CT scan every 3 monthly. No. of lesion doesn't mean that it is cancerous.... Even if it comes cancerous and if there is no lymph node or other spread then it will be stage IA which needs simple resection and has best outcome.... Don't worry...be relaxed....just wait for doctor decision....It has not been proven malignant.....There are a good chances of it to come as tubercular/fungal granuloma or other benign lesion... Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (3 days later)

Hi there, Where you say, one is satelite nodule, not solitary nodule, do you mean satellite nodule is more often benign or solitary nodule? what does satellite nodule mean? What would chances be that there would be a primary cancer elsewhere that could cause these to be metastic (sorry spelling) when he has no other pains or concerns. My Husband is not one to ignore his body. I have done so much reading on the internet which I know is the wrong thing and everything I read is doom and gloom. I have even had the dr prescribe me with diazepam which is not in my character at all, just cant function well with the worry and the death sentence stories. He is waiting for appt to see the respiratory specialist but I don't know if they want to be sure or if they are concerned, or is it just tht he is a smoker? On the internet it says if they not concerened by looking at ct, they usually just keep a check on them, but I am worried that a) they think they can get a biopsy ( does that mean they have seen something strange?) or are they just be thourough>and b) about this cough, why would the nodules be so small but cause this cough? he has no clubbing of fingers or lumps in neck. The internet can be a XXXXXXX place! am I being irrational in assuming the worst just because of cough and nodules. I know I am babbling, just need bit of reassurance, I also read, people with positive attitude can go on for years with treatment, I know I should keep off the internet but its very difficult when you are desperately trying to hopeful.

Answered by Dr. Satyadeo Choubey (15 minutes later)

Brief Answer: Just relax and don't be panic Detailed Answer: Hi Thanks for follow up. First I will ask you to just relax....... Satellite nodule is a nodule in the vicinity of a bigger nodule. There may be chances of malignancy. The options are either you can go for serial follow ups and see whether nodule is increasing in size. The other thing can be, if you are more anxious and just want to rule out the malignancy, can go for biopsy and histopathology report. Now coming to your questions.... a) They are just following the protocol. Seeing a nodule means work up must be done.....either by follow ups or going for biopsy to rule out malignancy......Here I am using word 'ruling out'. This does not mean they have seen something strange... b)Clubbing may be present in malignancy but it's not necessary. So absence of clubbing doesn't rule out the former. Lumps in the neck suggests metastasis means spread of cancer...so if it is not that there then you must be happy. Cough can have various reason starting from infection, asthma, ILD, .....to malignancy. It may or may not have been associated with malignancy..... Just relax and .....relax......doctor has not done their full job...let them do it.....whatever you are thinking is just possibilities.....Don't be panic... Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (48 hours later)

Thank you He has had blood done no results yet. Respiratory specialist on 12th Dec. They want him to have another scan of lower body, I guess to rule out any other primary cancer. He has no symptoms of pain anywhere else, would he not be more ill if there were a primary cancer and these nodules secondary, like weight loss, loss of appetite etc. should they not do full body? I am feeling a bit better as I have read that people can live a good long life even sometimes if it is slightly further on, there must be people out there that make up the 15% after 5 year survival and my husband is very positive about everything in life. I know I am still thinking the worst but knowing a lot can be done treatment wise is a help.

Answered by Dr. Satyadeo Choubey (2 hours later)

Brief Answer: Relax.... Detailed Answer: Actually the doctors are becoming radical. What I feel is they must be ruling out any primary or metastasis to abdomen or bone....Usually with such a metastasis, symptoms may be present pertaining to such organ.... You must feel better and your husband too.....it has not been confirmed yet....and if it is will be stage 1a, which is almost curable.....with a good survival....But again that will be if cancer is at all present..... Relax mad best wishes.....

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar