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.

The booklet on diverticulitis explains this common illness in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 502, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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.

DEAR DR. DONOHUE: I am a 46-year-old pilot with kidney stones. Consequently, I have been grounded. There is a small stone in both my right and left kidney. My local urologist and a urologist at Mayo Clinic advocate lithotripsy. I have concerns about lithotripsy because of a Mayo Clinic report linking it to diabetes and hypertension. I am looking for the safest and best option. What do you say? – C.C.

ANSWER: Extracorporeal shock wave lithotripsy, ESWL, dissolves kidney stones by pulverizing them with sound waves. The procedure is particularly successful with small stones like yours. Doctors at the Mayo Clinic did publish a paper that suggested lithotripsy might be associated with the development of diabetes or high blood pressure in a few people. You have a Mayo Clinic doctor who’s suggesting the procedure to you. ESWL is still being carried out throughout the world. If I were a pilot wanting to get back to work, I’d have this done in a New York minute. (I’m not positive how long a New York minute is.)

READERS: Women inquiring about the common condition endometriosis can obtain the facts on it in the endometriosis booklet. To obtain a copy, write to: Dr. Donohue – No. 1105, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.