### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
i recently went to the er with shortness of breath and a fever of at least 103 for over a week. The er doctor ordered a blood test to check for a blood clot, then a ct scan with the dye or whatever it is that you get through an i.v. The doctor let me know that I have empysema, swollen lymphnodes in my chest, pneumonia (at the time), and that the scan showed two spots on my lungs that he said could be some form of malignous cancer, I probably did not say that exactly correct, but those words was included. I did a follow up with a family doctor. He took a chest x-ray and did a breathing test on me. My percentage was 61 before a breathing treatment, and 81 after a treatment. He said he did not really see nothing to indicate cancer from the x-ray but I did have the swollen lymphnodes and he wanted to examine the ct scan a little more and have another one done in 3 months. Two radiologists, that looked at my scan results from the er, told me I needed to get to a doctor as quickly as possible, and I did, Im kinda concerned that he did not seem to take much interest in the possible spots and am very concerned and would like to know what I am dealing with. The COPD is bad enough and I have alot of trouble with shortness of breath just walking a very short distance and my back has began to hurt alot just under my shoulder blades. Any advice???

### output:

Hello, I can imagine that these spots in the lungs are distressing, and I hope I can shed some light here. Pulmonary nodules (spots in the lungs) are fairly common, and as you know they can be caused by very minor/benign issues like an infection/pneumonia, or they can be serious and represent a growing cancer. In most cases there is no way to tell right away which one it is. With your COPD, and assuming that you have smoked during your lifetime, you are at a higher risk for lung cancer. The main factor that determines the next step is the size of the nodules. Bigger nodules warrant closer follow up. Smaller nodules can be followed at a wider time interval (for example 12 months instead of 3 months). Three months is a reasonable interval to repeat the CT to assess if there is any growth in the nodules and this is most likely what I would order for you as well if I was seeing you in my clinic (of course this depends on the actual size of and other characteristics of the nodules). If there is growth, you most likely will need surgical resection of the nodules depending on where they are located and the function of your lungs. I hope this answers your questions.