Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
If you've ever had a scan done and heard the words when we found a spot on your lung, your mind probably starts racing with questions. For many people, lung nodules are discovered unexpectedly during imaging for something completely unrelated. They can also be found through a low dose CT Lung Cancer Screening Most lung nodules are not cancer, but it's still important to understand what was found and complete any monitoring or evaluation your care team recommends.
Today we're talking about what lung nodules are, how they are found, and what happens next. We'll also discuss who should talk with their provider about annual lung cancer screening and why early detection can make such a meaningful difference.
I'm Frankie Myers and this is Healthy U, where we break down everyday health topics and introduce you to the experts helping keep our communities well.
Joining me today is Dr. Song Salise, a pulmonologist with Riverside Pulmonary Sleep Specialist who specializes in lung health and the diagnosis and management of lung conditions.
Dr. Salise, welcome to Healthy U.
[00:01:39] Speaker B: Thank you for having me.
[00:01:40] Speaker A: You're welcome anytime.
To get us started, tell us a little bit about the work you do at Riverside and how often lung nodules come up in your everyday work with patients.
[00:01:54] Speaker B: Being a pulmonary and critical care specialist, I take care of patients who are critically ill in medical icu. Regarding this talk today, Being a pulmonologist, I also spend more than half of my time evaluating lung conditions.
I'm passionate about lung health. I evaluate them and manage them and it includes lung nodules.
[00:02:16] Speaker A: Lung nodules. Well, thank you for what you do as a former critical care nurse.
[00:02:22] Speaker B: You're welcome.
[00:02:23] Speaker A: Let's start with the question many patients ask first.
What exactly is a lung nodule?
[00:02:31] Speaker B: A lung nodule is a spot seen on imaging studies.
It is seen as a dense structure surrounded by normal lung tissue.
Depending on how dense it is, it can be solid nodule, ground glass nodule, or a mix of both.
[00:02:48] Speaker A: Okay, okay. Good information.
When someone hears that something showed up on their lung, it can immediately be scary.
How common are lung nodules and how often do they turn out to be harmless?
[00:03:07] Speaker B: That's understandable.
Long nodule. However, most of them are benign, meaning not cancer. Almost 95% of lung nodules are not cancerous. That's great News. And about 5% could be a sign of early cancer. Because of that reason, we recommend our patients to evaluate and follow the appropriate pathway recommended by your healthcare provider.
[00:03:31] Speaker A: Okay, so. So early detection is so important?
[00:03:34] Speaker B: Absolutely. It's very important.
[00:03:36] Speaker A: Yes.
Many people don't even realize they have a lung nodule until imaging is done for something totally unrelated.
How are lung nodules typically discovered and what causes them to form?
[00:03:52] Speaker B: Early lung nodules does not give any symptoms.
So because of that reason, it's typically detected by on some imaging studies. There are two ways of finding a lung nodule. The first is when we take patients for low dose CT scan for lung cancer screening.
[00:04:09] Speaker A: Okay.
[00:04:10] Speaker B: The second way is while doing a CT scan for some other reason, such as patients may present to the emergency room after a motor vehicle accident because of chest pain or abdominal pain. We are getting CT scan for those reasons. And by the way, there is a small spot seen in your lungs.
[00:04:28] Speaker A: Okay. Okay. Great information.
[00:04:31] Speaker B: Whether a lung nozzle is detected by screening or by incidental way, it deserves equal evaluation and monitoring.
[00:04:39] Speaker A: You look at them in depth regardless.
[00:04:42] Speaker B: Absolutely.
[00:04:43] Speaker A: Okay. You mentioned low dose CT screening.
Who should ask their primary care provider about this?
[00:04:51] Speaker B: People with a high risk should get annual low dose CT screening.
And key is annual here. It's just not one time. You have to get CT scan every single year as long as you qualify. And what I mean by high risk, people who are between 50 to 80 years of age and they have smoked at least 20 pack year smoking history, either they are former smoker or current smoker, it doesn't matter. As long as they have smoked 20 pack year, they qualify for low dose CT screen.
[00:05:22] Speaker A: 20 pack year.
[00:05:23] Speaker B: Yeah. And that means packet is a way we find out how much they have smoked over time. Let me give you example. If someone has smoked one pack of cigarette a day for a total of 20 years, that's 20 pack here.
[00:05:40] Speaker A: Really?
[00:05:40] Speaker B: Yeah. If someone has smoked two packs a day every single day for 10 years, that's also 20 pack year.
By the same way, if someone has smoked half pack a day every single day for 40 years, that turns out to be 20 pack here.
[00:05:55] Speaker A: Wow.
[00:05:57] Speaker B: Yeah. And there's a way to calculate this. Your primary care provider will calculate this for you.
[00:06:04] Speaker A: My goodness.
I know some folks that are going to stop smoking.
Why is finding lung cancer early so important?
[00:06:13] Speaker B: Very good question.
Find in the. In lung cancer treatment, early detection is everything.
If you find lung cancer early, we have opportunities to treat patients and potentially cure them. Let me Give you example. You know, lung cancer is divided into different stages.
If lung cancer is found in the lung, they are still small, it has not gone anywhere else. And if that is in the early stage, like stage one, a five year survival for those patients is more than 90%.
So much higher survival.
Whereas if same nodules has spread to other organs, becomes stage four, five year survival drops down to less than 10%.
[00:07:01] Speaker A: There
[00:07:01] Speaker B: is a huge difference in outcome, huge difference in survival. Because of this reason, we highly advocate for lung cancer screening, early detection and early treatment.
[00:07:13] Speaker A: Let me ask this question.
All of the work that has gone on around smoking cessation and education, is lung nodules, lung cancer, less prevalent or more prevalent?
[00:07:28] Speaker B: Lung nodules are not any less prevalent because there are many other reasons outside of smoking to have long nodules. So it is still common. In fact, almost 30 to 50% of CT scan that we perform will show some type of lung nodules. And that comes around 1.5 million lung nodules detected annually within the United States. So that's a lot of nodules.
However, with our work, smoking cessation, early detection screening, we are detecting more and more earlier stages of lung cancers.
[00:08:04] Speaker A: Gotcha. All right, Great stuff. If a lung nodule is found, whether through screening or unexpectedly during another scan, as you mentioned, what are the next steps?
[00:08:16] Speaker B: Next step will be to evaluate those nodules. We look their size, shape, their location and appearance. How does the lung nodule look like on a CT scan?
We try to compare that nodule to the previous one. If someone has already done a CT scan in the past, if they look about similar, that becomes very reassuring. Because lung cancer tend to grow or change their morphology over time.
We also talk to the patient about their symptoms, their health history, did they have any cancer in the past, any other cancer?
Did they have anybody in the family who has lung cancer?
Or if they have a smoking history, how much did they smoke? And this tend to give us good idea about their risk. If they are at a higher risk and depending on the nodule, we can recommend several paths. Some of them could be continue to monitor, active surveillance to monitor for any changes in their size or growth, anything like that. Other time, we may need to recommend for specialized imaging studies such as such as PET scanning, which helps in characterizing further if they are high risk or not. And other time we recommend for biopsy,
[00:09:29] Speaker A: biopsy. Okay.
Some patients may hear we are going to watch and feel as if nothing is being done or feeling alarmed.
Why is it important to repeat imaging studies?
[00:09:46] Speaker B: Very good question. This happens quite frequently.
You know, monitoring is a part of active treatment.
Remember, most of the nodules are not cancerous. Sometimes doing a biopsy or further testing may be more harmful. And it can be difficult to biopsy smaller lung nodules. And if we monitor them with a serial CT scans, if they do not grow in size, if they do not change, stay stable, that becomes very reassuring.
Depending on the type of nodule, sometimes we monitor for a total of two years. Other time we may need to go up to five years.
And if they stay stable, that becomes benign, not cancer. However, with time, as time goes by, if they start to change in their size, if they start to grow, their morphology changes, then we recommend biopsy at that time.
[00:10:39] Speaker A: That's really good information because I can see someone saying, I want to take an aggressive approach and just get it out.
So I'm glad you clarified why that is not the best approach in all cases.
[00:10:53] Speaker B: Yeah, that is not the best approach in all cases. Not all. Long nodules requires invasive procedure.
[00:10:58] Speaker A: Right, thank you.
All right, let's do a quick rapid fire.
[00:11:04] Speaker B: Sure.
[00:11:05] Speaker A: Question.
Round, roundabout.
[00:11:09] Speaker B: Absolutely.
[00:11:09] Speaker A: I just made that up.
All right.
I had a chest X ray after a lingering cough and my doctor says they found a spot on my lung.
[00:11:23] Speaker B: Yes, that can happen.
Sometimes lung nodules are detected for, you know, evaluation of some symptoms, such as, you know, lingering cough. Your cough may or may not be related to that nodule.
However, because now you find out a nodule, we need to evaluate that properly.
[00:11:42] Speaker A: Okay.
I feel perfectly healthy.
But a low dose CT lung cancer screening found a small nodule.
[00:11:52] Speaker B: That's another common scenario. Small nodules does not give any symptoms. The goal is to find out lung cancer when it is at its earliest stage.
So we still need to evaluate that nodule properly.
[00:12:05] Speaker A: Okay.
I have never smoked, which is accurate.
How could a nodule show up on my lungs?
[00:12:13] Speaker B: There are many reasons to have a lung nodule besides smoking, such as infection, inflammation, scar tissue.
And as we discussed earlier, almost 95% of nodules are benign, not related to cancer.
So nodules can still happen. We evaluate you as a complete picture rather than one risk factor of smoking.
[00:12:38] Speaker A: This is my question.
What's the impact of secondhand smoke?
[00:12:43] Speaker B: Secondhand smoke, because it is still a smoke that can increase the risk of having lung cancer or any other lung diseases.
However, we don't have exact data to say how much that impact because second hand smoking is not. We cannot calculate, quantify how much they are getting exposed. But yes, it does increase the risk of having several lung conditions.
[00:13:06] Speaker A: Okay, great, great information.
I'm about 50 and 80. I'm between 50 and 80, but I am about 50 ish. Almost 60.
I'm between 50 and 80 and have at least a 20 pack year smoking history.
But I feel wonderful. I feel fine. Should I wait until I notice some symptoms or do I ask for screening?
[00:13:34] Speaker B: You ask for a screening now.
[00:13:35] Speaker A: Okay.
[00:13:36] Speaker B: You want to get a screening when you feel completely healthy before you have any symptoms. So this is the perfect time for you to ask for a screening.
[00:13:43] Speaker A: Okay.
All right.
[00:13:45] Speaker B: And remember, screening is just not one time. Deal. You have to screen on an annual basis every single year.
[00:13:52] Speaker A: I got it.
I think that's reassuring for our listeners. That was great information.
While lung nodules can sound alarming, the key is getting the right information and following up with your care team.
All right, so Riverside has a lung nodule clinic that helps. Right. Guide patients through this evaluation and process.
What is a lung nodule clinic and how does it help patients?
[00:14:24] Speaker B: Absolutely. Thank you for asking this question. I'm proud. We opened lung nozzle clinic in the year 2022.
Lung Nodule Clinic.
It helps in providing expedited and coordinated care quickly for patients with lung nodule.
We opened a lung nodule clinic within our pulmonary clinic. These are dedicated clinics for patients with lung nodule. Whenever there is any nodule and primary care doctor places a referral. We bring those patients right away to our clinic and evaluate them quickly. Because we understand lung nodule provokes a lot of anxiety to the patient.
[00:15:02] Speaker A: We
[00:15:02] Speaker B: want to answer their questions and give them the right pathway to help them.
What we do in our clinic, we evaluate those nodules, we take a detailed history from patients. We make sure patient understands what's going on with them. And we recommend the appropriate follow up plan if they need active monitoring. We also recommend the timeline when to monitor if they need biopsy. Depending on their location and size, we recommend appropriate type of biopsies. We can do biopsy with several ways. Some patients may need to go to surgery directly. We also recommend them to go to surgery and some patients may need to go to radiation treatment. So there are varieties of things that can happen and we have all other sub specialties available within Riverside. All of them that can happen within the walls of Riverside.
[00:15:53] Speaker A: Thank you for your leadership and your nagyo clinic team for what you do.
[00:16:00] Speaker B: You're welcome. And I want to add one more thing about lung nodule. We keep track of our data and our data shows we are detecting more lung cancer in the earlier stages compared to after we started lung nodule clinic compared to Prior to lung nodule clinic.
[00:16:17] Speaker A: Very good.
[00:16:17] Speaker B: So we are detecting more nodules lung cancers in the earlier stages because of lung nodule clinic.
[00:16:23] Speaker A: And my hope is that this podcast educates others to come and be screened if they fall within the smoking parameters. To be screened
[00:16:34] Speaker B: absolutely.
[00:16:35] Speaker A: In some cases, a lung nodule may need additional testing or treatment. If a nodule turns out to be concerning, what does the care journey look like for someone?
[00:16:45] Speaker B: If the nodule looks concerning, we can either get specialized scanning, like PET scanning, or. Or go into biopsy.
Riverside has advanced technology robotic navigation bronchoscopy for biopsy that can biopsy safer and in a precise way with less complications. We can also reach to the difficult to access nodules. So we are doing biopsy more and more frequently with the help of this robotic navigational bronchoscopy.
Sometimes, if those nodules are located closer to the chest wall, we get help from our intervention radiology colleagues who help in biopsy from outside.
They can take a quick sample from through the skin.
And if we detect lung cancer, depending upon the stage and several other factors, we can send the patient to our thoracic surgery doctor. And if they can remove that cancer, that hopefully will be curative. We'll need to follow up after that.
And we can also send patients to our medical oncologist, radiation oncologist. We have a tumor board where we discuss all these tumors comprehensively if there's any. Difficult to manage, difficult to treat patients. So we will be with the patient all throughout the journey and we help them at every single stage. We keep them notifying. We also have lung cancer navigator who plays a central role to help these patients.
[00:18:12] Speaker A: Yeah. Sounds like your team wraps their arms around this. Yes, it's a team
[00:18:17] Speaker B: approach and we work very closely with all of our Riverside team.
[00:18:21] Speaker A: That's very good.
All right, for anyone listening who may have recently heard the words lung nodule, what would you want them to know?
[00:18:33] Speaker B: I want them not to panic and not to dismiss their finding.
However, take appropriate pathway. Remember, almost 95% of these nodules are not cancer, so there is a hope. Even if this turns out to be cancer, early detection is the key.
So I want them to follow the appropriate recommendation by their caregiver, I mean, by their health care provider.
[00:18:57] Speaker A: Healthcare provider. Yeah. That's really great information. Thank you.
Dr. Solise, thank you again for helping us understand the difference between being alarmed and taking a lung nodule seriously. You're welcome back to the studio anytime, any. Thank you. Annually, if you'd like.
All right. To our listeners remember these two important actions. If you are between the age of 50 and 80 and have at least a 20 pack year smoking history, talk with your healthcare provider about whether annual low dose CT lung cancer screening is right for you and if a lung nodule is found, whether through screening or unexpectedly during another imaging test, get checked and complete the recommended follow up that's so important.
Most lung nodules are not cancer, but when lung cancer is found early it is more treatable, which is why screening and follow up matter.
If you found this conversation helpful, consider sharing it with a friend or family member or who may benefit from hearing it. And as always, understanding your health is a powerful step toward a healthier you. Until next time, stay healthy.
Thank you for listening to this episode of Healthy you. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to Riverside online dot com.
