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32 year old male / 2-3 mm solitary nodule


Erik

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Hello Everyone,

I am a 32 year old male who has recently been told I have a 2-3 mm nodule in the middle right lung. 

I juat got over a severe cold and congestion that lasted for a while. I felt better after finally being put on a z pack. 

During my cold, I was coughing so severely that I fear I injured the bottom rib muscles. This has since got much better; but it was what triggered me to ask for a chest x Ray. All clear nothing to be seen in any capacity. Normal CBC. I asked another doctor a month later (December 2018) to perform a second chest x ray. Nothing to see. All clear. 

Not satisfied I asked for a CT scan of my chest. ER radiologist said all clear in all capacity minus a 5 mm nodule. I same day saw a pulmonologist. After him and his radiologist read both x rays and the CT film he was very unconcerned. He said it is really 2-3 mm. He said too small for biopsy by any method. He said he highly doubts anything and said “to be safe” repeat CT in one year. 

I smoked cigarettes for 5 years in college and regularly smoked marijuana for my ADHD since 2006. I am in every other capacity in good health minus mild GERD (monitored by endoscopy). 

I am scared and don’t know what to think. All I see on google is bad stuff. 

Any thoughts would be appreciated. :)

 

thx

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Erik,

Welcome here.  First, read my go to resource on pulmonary nodules from the Cleveland Clinic here. There are many reasons they form and one might be as a result of your severe chest cold you just experienced.  Most nodules are not cancer so please try and relax.  I'd also try and avoid consulting with Dr. Google.  Too much information can indeed be a bad thing.  Most all of us here have experienced lung nodules.  Indeed, after nearly 15 years of surviving lung cancer, mine still show on my annual scans -- occasionally!  But because these nodules have a history of showing up on scans and not changing in size or shape, my doctors do not consider them to be cancer. 

Your nodule is very small.  It is 1/2 the size of an eraser on a wood lead pencil.  It is too small to biopsy and too small to display a reliable result on a PET scan. (Here is information on a PET).  So I agree with your doctor to wait and repeat your CT scan to see if there is a change.  One of our members recently posted a link on the speed of cancerous nodule growth.  Here it is. This resource suggest that although cancer cells grow faster than normal cells, the time it takes for a cancerous nodule to double in size could be up to a year.  So a year from now, the nodule, if it grows, could be 6mm, the size of an eraser on a wood lead pencil.  That would still be too small for a biopsy and a reliable PET scan result. Even at the fastest doubling growth rate cited, the nodule would only measure 1.5cm, still very small.

I would encourage you to stop smoking, even marijuana. Any kind of smoke can be an irritant and you wouldn't want to encourage any more irritation.  I wouldn't vape either.  I'm not an expert on marijuana but my reading suggests you can eat it and experience the same relief means.

Stay the course.

Tom

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Hi, Erik,

I'd second what Tom says.  One of the reasons the medical profession doesn't recommend CT scans for those who are not at high risk for lung cancer is that something like half the people who get CT scans have nodules.  Obviously we don't have half the population with lung cancer.  In fact, the vast majority of nodules are NOT cancer.  Like Tom, I have a number of nodules that have been in the same place/size since the year before I was diagnosed.  They haven't grown or changed.  They are probably remnants from an old infection or something.  My doctors aren't worried about them.

But yes, do try to give up the smoking.  If your condition requires marijuana (and it's legal where you are), then stick with edibles or something. It isn't the nicotine in cigarettes that gives you cancer; it's breathing in the products of combustion.  FWIW, my oncologist considers me a "non-smoker" even though I do vape--he hasn't told me to quit.  I do use a VERY low level of nicotine in mine, just because nicotine, even if non-carcinogenic, still isn't great for you.  

It wouldn't hurt to have the nodule checked again in a year.  After that, unless your doctor recommends continuing to follow it for some reason, you are probably home free as far as that nodule is concerned.

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3 hours ago, Erik said:

Hello Everyone,

I am a 32 year old male who has recently been told I have a 2-3 mm nodule in the middle right lung. 

I juat got over a severe cold and congestion that lasted for a while. I felt better after finally being put on a z pack. 

During my cold, I was coughing so severely that I fear I injured the bottom rib muscles. This has since got much better; but it was what triggered me to ask for a chest x Ray. All clear nothing to be seen in any capacity. Normal CBC. I asked another doctor a month later (December 2018) to perform a second chest x ray. Nothing to see. All clear. 

Not satisfied I asked for a CT scan of my chest. ER radiologist said all clear in all capacity minus a 5 mm nodule. I same day saw a pulmonologist. After him and his radiologist read both x rays and the CT film he was very unconcerned. He said it is really 2-3 mm. He said too small for biopsy by any method. He said he highly doubts anything and said “to be safe” repeat CT in one year. 

I smoked cigarettes for 5 years in college and regularly smoked marijuana for my ADHD since 2006. I am in every other capacity in good health minus mild GERD (monitored by endoscopy). 

I am scared and don’t know what to think. All I see on google is bad stuff. 

Any thoughts would be appreciated. :)

 

thx

Pet scan and biopsy to make sure it is not malignant. stay calm.

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I think biopsy and PET scan for a 2-3 mm nodule would be considered overkill and probably would not provide any definitive answer.  I don't think doctors would order something like that, for a nodule this size--especially for someone not at high risk.

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1 minute ago, LexieCat said:

I think biopsy and PET scan for a 2-3 mm nodule would be considered overkill and probably would not provide any definitive answer.  I don't think doctors would order something like that, for a nodule this size--especially for someone not at high risk.

Everyone with lung is at risk of lung cancer. Air pollution is a cause for lung cancer! PET scan and after biopsy if PET scan is positive only way to make sure it is lung cancer.

 

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PET scans are not infallible.  They may not light up when a nodule is cancerous (true for at least a couple of people here) and they can also light up due to inflammation or other conditions.  Biopsy is the only way to get a definitive answer, and that isn't always possible--especially not with a nodule that small.  Watching it with a re-scan in a few months is almost always the first step with something this small.

In addition, testing has its own risks.  That's the main reason they don't routinely scan people who are not at high risk for lung cancer.  Though it's true everyone has SOME risk--lots of non-smokers get lung cancer--they don't recommend scans for people not at higher than normal risk--mainly because it leads to unnecessary risk through additional diagnostic procedures.

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4 minutes ago, LexieCat said:

PET scans are not infallible.  They may not light up when a nodule is cancerous (true for at least a couple of people here) and they can also light up due to inflammation or other conditions.  Biopsy is the only way to get a definitive answer, and that isn't always possible--especially not with a nodule that small.  Watching it with a re-scan in a few months is almost always the first step with something this small.

In addition, testing has its own risks.  That's the main reason they don't routinely scan people who are not at high risk for lung cancer.  Though it's true everyone has SOME risk--lots of non-smokers get lung cancer--they don't recommend scans for people not at higher than normal risk--mainly because it leads to unnecessary risk through additional diagnostic procedures.

1

In 2017, I have a nodule 1.7 cm be doing a scan, PET scan and biopsy to make sure it was cancer and it was.

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I have to agree. You are asking people who have been through this. They would be unable to biopsy a nodule that small. Usually it has to be at least 10mm (1cm) and accessible. A 2-3mm nodule is also below the resolution of PET, so you would not learn anything. Your insurance probably would not approve it and you have already had enough radiation. Tom’s article about nodules should reassure you that most people have them from residual respiratory illness and many have more than one. We totally understand a person’s anxiety when anything irregular shows on imaging or medical tests. But the consensus here is that you can relax about it for at least a year and if it hasn’t changed at all in 12 months, it shouldn’t’ concern you. It sounds like you are paying attention to your lung health, but excessive worrying can cause illness too. Happy New Year and thanks for turning to us with your concerns. 

Cynthia

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I spent most of 2017 watching a nodule. It showed up in January and in August was finally big enough for us to address. It was barely big enough to biopsy in August so we did not. So, wait and see is sometimes the best approach. 

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