What is a pulmonary nodule?
A pulmonary nodule is a shadow or a rounded or elliptical opacity, in 2 dimensions we would see it as circumferential, in 3 dimensions we could imagine it as elliptical. And we usually detect it either by a chest X-ray or by a scanner. Nowadays with scanners we detect pulmonary nodules of very small dimensions, between 3 millimeters and 20 millimeters for example, which previously we could not detect by chest X-ray. The detection of a pulmonary nodule always generates concern in the person who is detected because at some point it is interpreted as a synonym of a non-benign disease. Fortunately, most of the times that it is detected by chance and not by symptoms, the cause is benign or harmless or innocent, but it is also true that in certain contexts the detection of a pulmonary nodule should never go unnoticed by the physician or the patient.
What are the causes of a pulmonary nodule?
The list of causes of a pulmonary nodule is very long, we could say that there are more than 100 causes of pulmonary nodules, but in the end what interests the physician and above all the patient is whether it is a benign or non-benign lesion. The causes of benign lesions are generally either we do not reach the diagnosis or they are banal or they are infectious, and they may be current infections or they may be old infections. And if they are tumorous, in the lung, although there are benign tumors, such as amartomas or calcinoid tumors, etc., always, in spite of everything, if they are tumors we have to think that they are not benign tumors.
How can a pulmonary nodule be diagnosed?
Normally the same radiological characteristics of the nodule can give us an orientation, if they have fat it could be an amartoma, if they have calcification it could be an old lesion, but many times we cannot make a diagnosis on the first visit and then the criterion will be to know if we have to go on to more complicated, more invasive tests, or if we can simply wait. If the dimensions are small it is possible that all we can do is wait, 3, 6, 12 months and the growth will tell us if it is a benign or non-benign lesion. If the lesion is already at the beginning of, for example, more than 10 millimeters or around 10 millimeters, we will surely need to do more immediate tests that can be either Tac-Pet, brochoscopy, direct puncture or even, if our suspicion is very high that it may be a non-benign lesion then, it is possible that we will indicate surgical intervention and the analysis of the surgical specimen by pathological anatomy is the one that will give us the diagnosis.
What risk factors are there for pulmonary nodules to be cancer?
The risk factors are very well defined, the main one being tobacco and accumulated tobacco, that is to say, the number of packs and the number of years of accumulated smoking. If emphysema is present, which we also detect by Tac, this is also a risk factor. And if there is bronchial obstruction this is also a risk factor. It would have to be said that a person aged 55 – 60 years who is a smoker up to that time, who has emphysema and who has obstruction, the probability that during the next 10 years he/she will develop cancer is 10%, that is, these patients followed, one out of 10 at 10 years will have developed cancer.