Prevention is better than cure. This may not be true for all medical problems, but actively screening for presence of disease can help physicians to detect and treat it more efficiently. Lung cancer is the number one cause for cancer related death in the world.
Screening of cancer is always an important phase in detection of lung cancer and to make appropriate treatment plans. Computed Tomography (CT) scans is the only method to screen lung cancer, which appears in the form of spots or mass; these are called pulmonary nodules.
Lung cancer start as small nodule and with time it grows. Not all nodules seen in CT scan are malignant. However, during follow up screening a new nodule may develop; this new nodule has high chance of being cancerous and is more dangerous.
Dr. Mohan Rudrappa, a NRI specialist Physician in Pulmonary and Critical Care Medicine at the Mercy Medical Center in Joplin, Missouri, in United States, has reported it to be important to may more attention to this new nodule. Sreerupa Patronobish recently caught up with Dr. Rudrappa who discusses his advanced methodology in lung cancer screening.
SP: Welcome Dr. Rudrappa
MR: Thank you for having me.
SP: What is lung nodule and what is the potential risk in lung cancer?
MR: Small growth in lung is called a lung nodule. It can be cancerous or non-cancerous. Nodules are very common and can be found one in every third person getting a CT scan. Only 5% nodules end up being a lung cancer. Noncancerous lung nodules develop due to infections in lungs, non-cancer growth such as fibroma or could be scar from old infection. Any nodules that grows with time is considered cancer unless proven otherwise. So, when nodules are seen on CT scans, repeat CT scan are done to detect the growth of these nodules and to treat them in timely manner. It is important to know the nature by which the future treatment regimens can be done.
SP: What is solitary pulmonary nodule?
MR: A solitary pulmonary nodule is around 3 cm round spot seen on the CT scan. They are usually single and hence called solitary and should have normal lungs all around. As they are very small they do not cause any problems to patients. As most nodules are not cancers, it is very important to detect the one which can turn cancerous.
SP: How much risk is there for the nodules to be cancerous?
MR: It depends on lot of factors. Bigger the nodule higher is the risk. Any nodule above 3mm is considered as masses and have more tendency of being malignant. Bigger nodules and nodules in heavy smokers turn malignant more often. Also, new nodules which develop in short interval can also turn malignant more often. The risks of nodules becoming cancer is around 5% in health people and can be as high as 42% in heavy smoker with other medical problems.
SP: What are the methods for screening lung cancer?
MR: Computed Tomography (CT) scan is the only way to screen for lung cancer. If nodule is seen on CT scan but is smaller than one cms, then they will get repeat CT scan. The interval depends can be from 3 months to 12 months and bigger nodules get in short interval. This step is important and is crucial, if we wait too long to get repeat CT scan, the cancer can spread to other organs. Lung cancer can be detected at very early stage and can be effectively treated so that patients live long and live better. Preliminary findings of my work has been published in Chest. I serve as the Director of Lung Nodules Surveillance Program at Overton Brooks VA Medical Center from 2013-2018. It was a great opportunity for me to serve the veterans, many of whom are at increased risk for lung cancer due to their environmental exposure. From a pioneering view point I introduced the electromagnetic navigation bronchoscopy system to detect lung cancer at an early stage.
SP: How can you assess the chance of malignancy from pulmonary nodules? And what are the treatment plans for them?
MR: Good question. As nodules are common, it is very important to identify the bad ones. It can be challenging to pick the only those nodules that can turn cancer and need to be treated from noncancerous lesions that does need not be treated. Getting this right not only help treat the cancer early but also prevent unnecessary procedures or tests on others. The nature of the nodule like its size, borders can give clues but the growth of lesion is the main determinant to assess its risk. Also, my study on nodules has revealed that new nodules that are seen in the subsequent CT scans are at higher risk for becoming cancer. Regarding treatment options, depending on how far cancer has spread, they are treated with surgery, chemotherapy or radiation. Screening detects they at early stage and hence most patients who get surgery.
SP: Please elaborate the risks associated with the screening.
MR: Screening for lung cancer does come with risks and is not for everyone. Screening CT scan does not pose much risks but following invasive tests that patient undergo does carry risk. Anxiety of having lung cancer is another biggest risk that everyone suffers from after nodules detected. There is also a negligible risk of radiation exposure by repeated CT scans. Screening should be done by experts in this field so that only appropriate patients are selected for screening and if nodules are detected they should be managed correctly. If done in proper settings, the benift of screening far exceeds the risks of it.
SP: Thank for Dr Rudrappa for your time.