May 23, 2016
The high occurrence of ‘spots on the lung’ prompted Marshall Medical Centers to open a clinic to treat lung nodules one year ago so residents could get diagnosis and treatment within 48 hours of a diagnosis.
Dr. Chris Manganaris, a pulmonologist, recognized the need to start the Marshall Pulmonary Lung Nodule Clinic, giving sufferers somewhere to go locally.
By far the largest cause of lung nodules that are determined to be cancerous are from smoking, he says. That’s because Alabama and Marshall County in particular have more smokers than the national average. About 20 percent of local folks are addicted to tobacco. That’s why Dr. Manganaris includes counseling as part of the treatment at the clinic. Patients who are smokers get additional counseling aside from discussion about their pulmonary nodule diagnosis.
“The risk of cancer makes people fearful,” he says. “Lung cancer mortality is very high. Most of the time the only cure is resection – removing a lobe of the lung. I had one patient lose an entire lung. He managed fine with only one lung. I’ve seen cancer in smokers as young as 25 years old.”
A pulmonary nodule is a small, round growth of tissue in the lung. They can range in size from less than 1/5 inch (4 mm) to a little bigger than an inch (25 mm). Most pulmonary nodules are detected when imaging tests of the lung are being performed for a different problem. Pulmonary nodules are usually not cancerous. Follow-up treatment or testing is based on the size of the pulmonary nodule and your risk of getting lung cancer. A thoracic surgeon cannot operate on a lung nodule smaller than 8 mm, which is less than half an inch. It takes months to double in size.
Malignant pulmonary nodules can result from lung cancer or from cancers that spread to the lung from other places in the body.
Benign pulmonary nodules can be caused by various things. Some of the causes include:
One source of a lung nodule is Histoplasmosis, an infection caused by breathing in spores of a fungus often found in bird and bat droppings. A person can be exposed from walking along the lake where ducks and geese live or from exploring caves, home to bats, giving the infection the nicknames “spelunker’s lung" and "caver's disease."
Histoplasmosis causes flu-like symptoms, including fever and cough. The body fights off the infection leaving scar tissue, which later shows up on an x-ray or CT scan as a lung nodule.
“I’ve had to hospitalize several people for histoplasmosis,” Dr. Manganaris says. “It’s rare – less than 5 percent of people can't fight it off and require hospitalization and treatment.”
Another case a few weeks ago involved a woman who was rolling her own homegrown tobacco and got the infection. It apparently came from fertilizer used on the plant.
“She’ll likely need a year of treatment,” he says.
Dr. Manganaris estimates he sees about 10 cases a year of histoplasmosis in the hospital or clinic.
Pulmonary nodules that are benign normally do not require any treatment because they usually do not cause symptoms or breathing problems, but may be monitored with follow-up CT scans. The frequency of these CT scans will vary based on the size of the nodule and the risk factors for lung cancer
The Marshall Nodule Clinic is staffed by a group of physicians who take a team approach to treatment. They are:
Dr. Gideon Ewing - Medical Oncology
Dr. Tom Payne - Radiation Oncology
Dr. Jenna Carpenter - Pulmonology
Dr. Christopher Manganaris - Pulmonology
Dr. Dustin Bright - Interventional Radiologist
Dr. Jonathan Storey - Medical Oncology
The Marshall Pulmonary Lung Nodule Clinic schedules patients on Tuesdays and Thursdays. It is located in the Marshall Professional Center, next to the Marshall Cancer Care Center.
If you have been diagnosed with a lung nodule, your doctor may refer you to the Clinic.For more information call 256.894.6910.