(OSV News) -- As Pope Leo XIV undergoes surgery for a lung nodule, medical experts consulted by OSV News said the condition is typically benign -- but requires careful scrutiny and early intervention to address any possible cancer.
In addition, the experts -- none of whom are part of Pope Leo's care team -- offered varying views on how much post-operative downtime patients typically face after the type of procedure Pope Leo is undergoing Oct. 13.
That downtime may affect the pope's planned Nov. 6-17 apostolic visit to Latin America.
Nodules due to 'laundry list of reasons'
Pope Leo was admitted to Rome's Gemelli Hospital Oct. 13 for lung surgery, following his Oct. 11 disclosure that a scan had revealed a "well-contained" lung nodule that had been "detected at a very early stage."
The pope's expected week-long hospitalization, confirmed by the Vatican, has led to a slew of cancelled papal appearances, including meetings, addresses, ceremonies and participation in a Mass in St. Peter's Square.
While not speculating on Pope Leo's specific circumstances, medical experts with whom OSV News spoke explained that lung nodules, or abnormal growths on the lungs, are far from unusual -- and, for the most part, are not life-threatening.
"Lung nodules are very common, and 90% of the time, they are benign," said Dr. Stacey Su, chief of thoracic surgery at Fox Chase Cancer Center in Philadelphia and associate professor of surgical oncology at Temple University's Lewis Katz School of Medicine.
But, she said, "the potential impact of lung cancers is so grave that any lung nodule deserves serious attention."
Dr. Sonali Sethi, an interventional pulmonologist at the Cleveland Clinic, told OSV News that "in the U.S. alone, 1.5 million lung nodules are seen in imaging a year" -- and of those, "95% of the time, what we see is benign."
Such nodules "can be caused by a whole laundry list of reasons," said Su. "Sometimes it's from infection, sometimes it's an old scar. But in some cases, it is a growth, with the potential to grow and spread."
Lung nodules, "depending on their size and location," can develop "without any symptoms at all" for the patient, said Su. "Patients will come all the time to the clinic saying, 'I feel completely fine,' and they doubt the veracity of the lung nodule."
"Size is an important component," said Dr. Nirmal Veeramachaneni, professor of cardiothoracic surgery at St. Louis University School of Medicine and medical director for lung cancer screening at SSM Health. "So if you see a lesion that's 4 or 5 millimeters versus 8 or 10 millimeters -- we're talking fractions of an inch -- the guidelines on what the follow-up should look like are different, and they're evidence-based."
He pointed to standards from the Fleischner Society -- an international, multidisciplinary group of medical experts focused on chest diseases -- that recommend a range of follow-up protocols for lung nodules discovered outside of formal lung cancer screening.
The guidelines take into account the size, location and margins of the nodule, as well as the patient's overall risk factors, including age and tobacco use.
Pope Leo does not have any history of tobacco use, said Veeramachaneni -- but he and other experts pointed out that lung nodules can sometimes be attributed to genetics, exposure to particulates such as asbestos, and pulmonary histoplasmosis.
The fungus that causes histoplasmosis is particularly found in the Mississippi and Ohio River valleys, and in certain areas of Central and South America -- including Peru, where Pope Leo once spent some two decades as an Augustinian missionary.
However, said Sethi, while histoplasmosis "does cause a lot of scares," the condition "doesn't cause malignancy."
Surgical options for lung nodules
Medical experts at Sweden's renowned Karolinska University Hospital said surgical intervention for a lung nodule is standard when imaging raises concerns "that the nodule may be more serious."
In a joint response sent to OSV News Oct. 13, Simon Ekman and Signe Friesland, senior oncologists at Karolinska University Hospital, also noted generally that if a "nodule is difficult to biopsy, surgery is a way to get material (tissue) to analyse."
Both experts stressed that their remarks reflected standard clinical practice rather than direct knowledge of the pontiff's medical history.
Veeramachaneni said that treating lung nodules involves "a multidisciplinary approach."
"You have lung doctors, surgeons, radiation oncologists, medical oncologists involved," he said.
According to Ekman and Friesland, the typical surgical procedure "for all patients regardless of condition" is a Video-Assisted Thoracoscopic Surgery. VATS is a minimally invasive surgery using a camera inserted through one to three keyhole incisions.
After the operation: Risks and recovery time vary
The oncologists told OSV News that postoperative recovery includes pain medication, breathing exercises to expand the lungs, and having the patient move around "as early as possible."
While chest tubes with suction are sometimes required to evacuate trapped air, the specialists noted that "this is not the usual case."
While Pope Leo expressed his intention pre-surgery to carry out a 12-day apostolic visit to Uruguay, Argentina, and Peru in November, his medical team may advise the pontiff otherwise depending on the outcome.
Ekman and Friesland noted that some risks of flying not long after lung surgery include possible air leakage "when the outside pressure (cabin pressure) gets lower."
"If you get an air leakage, the lung may collapse if the air gets trapped inside the chest wall. Blood clots are also a risk," they said.
However, both specialists noted that "potential risks in individual cases depend on the recovery of the patients, and it varies between patients when it is deemed safe to fly again."
"It really depends on the type and extent of the surgery and of course the speed of the recovery afterward, any complication factors, etc.," Ekman and Friesland said. "Generally, we recommend not to fly within a month after lung surgery, but it is really a judgment by the treating physicians to recommend what is safe or not."
Veeramachaneni said his patients typically spend just over two days in the hospital following surgery, "especially with minimally invasive techniques."
"Usually at the one- to two-week standpoint, if it's somebody who's not doing hard physical labor, I pretty much clear them to do whatever their body tells them is OK," he said.
Sethi said Pope Leo "may in one week be perfectly fine to continue with whatever he had scheduled."
Su said that a needle biopsy "should be relatively well tolerated," with a patient "potentially going back to work the next day."
But, she said, a patient whose biopsy involves an excision, or full removal, would possibly need "three to four weeks to recover before they're back at work."
"They may be home from surgery within one to three days," she said. "But it still requires recovery time, management of pain that may be associated with the surgery, and just getting up and moving around well enough to go back to work."
