Are lung nodules a precursor of cancer?

DEAR DR. DONOHUE: Can lung nodules become cancer? Should I have checks from time to time? I am very concerned.
A.W.
ANSWER: You hit on a topic that's much discussed and that creates many problems. Lung nodules can be cancerous, and they have to be evaluated with care. Each hospital has its own protocol for handling this problem.
A large number of considerations must be evaluated when trying to determine if a lung nodule, seen on an X-ray or scan, is likely to be a cancer. The nodule's size is an important factor. Nodules measuring 3 mm in diameter (.12 inch) are not likely cancers. Nodules that are 2 cm, (0.8 inches) have a 64 percent chance of being cancer. Another consideration in evaluation is the nodule's border. Cancerous nodules have irregular, spiky borders. If you have had a previous chest X-ray, then comparing the present size of the nodule with its past size provides invaluable information. A nodule that hasn't changed size in two years is less of a threat. The smoking history of the patient is another point that's pertinent in judging the risk of a nodule.
Some nodules can be interpreted as not carrying a risk. Others must be followed by serial chest X-rays or scans. And a certain number require immediate biopsy to determine their cancer potential.
I have left this up in the air. You can be sure that neither your doctor nor the radiologist takes pulmonary nodules lightly. They worry everyone.
You should call your doctor and ask his or her opinion on the nature of your nodule and if it needs follow-up X-rays to see if it's enlarging. Your personal doctor is the only one who can ease your concerns, which are justifiable.
DEAR DR. DONOHUE: I am 47 and have been on the birth-control pill for most of my adult life. I now have an IUD. There was some bleeding, and my doctor felt it best to do a dilation and curettage. Ironically, at the same time, I had been getting extreme lower abdominal pain and was later diagnosed as have diverticula and diverticulitis.
Although I am extremely health- conscious and food-conscious, these painful bouts continue. They are truly crippling. They hit anytime. One of my doctors mentioned "smertz," but was in too much of a hurry to tell me what that was.
I have an extremely high pain tolerance, but I am at a point where I can't take another round of pain. What is smertz?
S.S.
ANSWER: The doctor must have been suggesting mittelschmerz. It's two German words: "mittel" for "middle," and "schmerz" for "pain." It's the pain that some women feel in the middle of their menstrual cycle when a follicle releases an ovum. It is short-lived pain and not usually severe. Your pain doesn't fit the typical mittleschmerz pain. Attacks of diverticulitis are a more reasonable explanation. At this point, you need a specialist - a gastroenterologist or a surgeon.

DEAR DR. DONOHUE: I ate breakfast before my blood was drawn. My lipids were high. Would having breakfast cause the numbers to be high?
D.B.
ANSWER: When people are scheduled to have a blood test and if the lab or doctor's office can't be reached to confirm, then it's a good policy to fast before the test. Fasting means not eating or drinking.
Water is OK. Eight to 12 hours is usually the length of the fast.
For total cholesterol and an HDL cholesterol, you don't need to fast.
For LDL cholesterol and triglycerides, you do need to fast. Your slight elevation of those lipids might be due to not having fasted.