Multiple lung nodules are found on a CT scan. Lung cancer surgeon discusses diagnostic and treatment options. Patients with and without history of cancer. Solid and sub-solid lung nodules. Is there perhaps a clinical case that you could discuss? Dr. Anton Titov, MD. A clinical case would illustrate some of the points we discussed today. Perhaps you can discuss a patient with lung cancer or with lung nodules? Dr. Michael Lanuti, MD. Yes, one of the common cases that we often see is this. We will move back towards lung. It is a patient who comes in with not one lung nodule. This patient comes with multiple lung nodules. And that's fairly common situation. They could be a smoker or not. And so we have to manage multiple lung nodules. I think it's important to know how to manage multiple lung nodules well. Dr. Anton Titov, MD. Sometimes you're seeing multiple nodules. Then each lung nodule can be an independent risk. Or they can be related. The treating physician must understand that in the context of the patient. So, for example, sometimes the patient has a previous history of a sarcoma. And they have multiple lung nodules. Then you worry about metastatic sarcoma. Sometimes the patient is a smoker and they never had a history of cancer. Then you have to say this. What is the nature of each lung nodule?. Does each lung nodule represent an independent entity or something that's related? Could it be metastatic lung cancer? Dr. Michael Lanuti, MD. A 60-year-old patient with no cancer history but who's a smoker who now has multiple nodules. But this patient does not have a dominant lung mass. Dr. Anton Titov, MD. Then the chances of that being a stage 4 lung cancer is low. On the other hand, what are they? So if they're solid lung nodules, you manage them differently than if they're sub-solid lung nodules. Sometimes we watch multiple, let's say three, lung nodules. Then we tend to choose the lung nodule that's more aggressive. We choose lung nodule that's the higher risk for lung cancer. And we focus our attention on that nodule. We treat that aggressively. So it might be that the other lung nodules take a backseat. But you're not dismissing other lung nodules. You always have to figure out this. Dr. Anton Titov, MD. Could the other lung nodules be metastatic or not? Dr. Michael Lanuti, MD. That type of nuance really deserves an real lung cancer treatment expert. That situation can't be managed well with with doctors that aren't specialists in lung cancer diagnosis and treatment. And, frankly, surgeons need to spare lung if they're worried about multiple synchronous primary lung cancers. So they need to do things that are going spare a lung. They have to do segmentectomy. This is a surgical resection of a lung segment. They have to do wedge lung resections. This is not the best. but it is less than a lobectomy. That's a certainly a very relevant and very interesting case! Yes. Dr. Michael Lanuti, MD, thank you very much for this conversation. It will be very interesting for people around the world. Dr. Anton Titov, MD. Thank you for curing my mother from lung tumor! You're welcome! Thank you for inviting me.