Lung Nodules Treatment in Delhi, India

Small lung nodules rarely cause symptoms. However, if the growth presses against the airway, cough, wheezing, or difficulty breathing are common symptoms.

Also, rarely signs of early-stage lung cancer may be evident since the nodules are too small to interfere with breathing or lung function. However, if the following symptoms appear, contact a doctor immediately.

1. Chest pain
2. Chronic cough or coughing up blood
3. Fatigue
4. Back pain
5. Hoarseness
6. Fever (only in patients with pneumonia)
7. Loss of appetite and unexplained weight loss
8. Recurring respiratory infections like bronchitis or pneumonia
9. Shortness of breath (dyspnoea) or wheezing

When lung tissue is inflamed, a granuloma is formed. This granuloma may calcify with time and develop into a benign lung nodule. Other causes of benign lung nodules are:

1. Air irritants or pollutants
2. Autoimmune diseases - rheumatoid arthritis and sarcoidosis
3. Fungal infections - histoplasmosis
4. Respiratory system infections - tuberculosis (TB)
5. Scar tissue
6. Lung abscess
7. Pulmonary hematoma

A lung nodule may not always indicate lung cancer, and most of them are diagnosed benign.

Lung nodules are commonly diagnosed on a regular scan or when symptoms appear. The doctor first records a thorough medical history and assesses the symptoms. Accordingly, the doctor advises specific tests to confirm the diagnosis. If no signs are evident, the doctor may recommend waiting and watching how the nodule behaves.

Regular visits and two-year scans help check the nodule's growth pattern when it is less than 6mm or lesser in size. Such small nodules are considered low-risk types. Benign nodules tend to grow very slowly, if at all they do. On the contrary, on average, malignant nodules proliferate rapidly at about double in four months. Hence, the doctor may recommend checking the nodule every year for up to five years to ensure it is noncancerous.

The doctor may advise other tests if growth or proliferation is suspected. These tests include:

1. Blood tests
2. Positron emission tomography (PET) scan
3. Tuberculin skin test to check for TB
4. Single-photo emission CT (SPECT)
5. Magnetic resonance imaging (rarely)
6. Biopsy
7. Bronchoscopy

Treatment of Noncancerous Nodules

Lung nodules are at low risk of cancer. However, for benign nodules, doctors recommend checking on the nodule every two years with a CT scan to identify any possible malignant changes in the shape or size.

Doctors consider various factors when determining the correct frequency of follow-up visits and scans. These factors may be the patient's overall risk of developing cancer and the size of the nodule.

It is unlikely to be cancerous if the lung nodule does not grow and remains the same over the years unless an external factor develops in the body that may stimulate it. In such cases, further imaging tests are not required. However, if the nodule has developed due to a pre-existing infection like tuberculosis, treating the infection is the ideal approach.

Treatment of Malignant Nodules

If the nodules appear cancerous in biopsy reports, the treatment option depends on the type and stage of the cancer. Doctors usually modify the treatment as and when the patient's condition improves.

Based on the culture test reports, small and benign nodules that may have formed due to infection can be treated with antibiotics or antifungal medications. The nodules usually disappear as the infection subsides.

Surgical modalities to treat cancerous lung nodules are:

1. Video-assisted thoracic surgery (VATS)

   For this procedure, the operating doctor inserts a thoracoscope which is a scope with a camera along with tiny surgical instruments through the small incisions made in the chest. The images from the camera are seen on a television screen. Using these images, the doctor removes the nodule.

2. Thoracotomy

   Thoracotomy may be advised to excise the cancerous nodules. In this procedure, the nodule is removed by making an incision in the chest wall, below the shoulder blade, and between the ribs. A tube is inserted to drain the excess fluid from the chest for a few weeks after the surgery. Additionally, chemotherapy, radiation therapy, and other surgical procedures can be used as adjuncts to thoracotomy.

Benign nodules rarely impinge the airways and cause breathing difficulties. In case that happens, the block has to be removed surgically. If the benign nodules turn malignant, they may metastasize and cause various complications such as:

1. Difficulty breathing
2. Excessive weight loss
3. Breathlessness
4. Weakness
5. Fatigue
6. Untreated or aggressive forms of cancer can be fatal.

Anyone can develop pulmonary nodules. However, a nodule is more likely to be cancerous if any of the following factors resonate:

1. Excessive smoking
2. Age is more than 65 years
3. Family history of cancer
4. History of cancer that has been treated
5. Occupational exposure to dust, metals, or fumes that are linked to causing cancer
6. History of radiation therapy or chemotherapy to the chest
7. History of lung diseases such as COPD or pulmonary fibrosis
8. Exposure to chemicals causing cancer such as asbestos, radon

Nodule size is the most critical factor in assessing the risk of malignancy. Research suggests that nodules less than 6mm in size are harmless.

The most important factor that helps doctors evaluate a nodule is to look at any available old lung imaging studies to see if a nodule was present in a past study and hasn't grown over time.

Nodules located in the upper lung lobe are more likely to be cancerous. Those that show strands extending out from the surface—called spicules—are more dangerous.

Benign lung nodules can be left as it is and require no further treatment. However, regular visits to the doctor to keep a check on them are advised. Noncancerous nodules usually do not cause any complications.

The prognosis for people with malignant lung nodules varies depending on the cancer stage. However, early detection and treatment of cancerous nodules improve the long-term outlook.