Overview
● What is a lung nodule?
A lung nodule, also called a pulmonary nodule, is a small “spot,” “shadow” or “coin lesion” on the lung found during an imaging scan of the chest. They can be round or irregular in shape, solitary or multiple.
● How common are lung nodules?
Lung nodules are quite common. The American Thoracic Society reports that as many as half of the adults who get a chest X-ray or CT scan have lung nodules, especially individuals over the age of 50.
● How big is a lung nodule?
Your pulmonologist can determine the size of the nodule based on your CT scan. Nodules are typically less than or equal to 3 cm. If a nodule is larger than 3 cm, doctors call it a mass, and it usually has a higher chance of being cancerous.
● Does size matter?
Doctors consider size one of the main factors in diagnosing a nodule. In most cases, the smaller the nodule, the lower the risk of it being cancerous.
● Can lung nodules be cancerous?
Approximately 95% of lung nodules are non-cancerous (benign) and do not require treatment. Only about 5% are cancerous (malignant). If a nodule is malignant, it is most often early-stage cancer, which has a higher treatment success rate.
Causes
● What causes lung nodules?
Non-cancerous lung nodules can be caused by a variety of things, including chronic inflammation, infections, old scars, abnormal tissue growth, and precancerous lesions. Cancerous nodules, which, as the name suggests, are caused by cancer, make up only 5% of lung nodules.
● Does smoking cause lung nodules?
Smoking is a major risk factor for lung cancer. Individuals with a smoking history, particularly heavy smoking, have a much higher risk of developing cancerous lung nodules.
Risk factors
● What are the risk factors for lung nodules?
Most lung nodules are non-cancerous. However, certain risk factors increase the chances that a nodule is cancerous, which include: size larger than 3 cm, part-solid composition, spiculated margins, age over 60, smoking history, and family history of lung cancer.
Symptoms
● Can lung nodules cause any symptoms?
Lung nodules are small and usually do not cause any symptoms. If a nodule presses on the airway, it may cause breathing problems such as cough, wheezing, or shortness of breath. Symptoms such as chest or back pain, coughing up blood and unexplained weight loss are rare but may be early signs of cancer.
Diagnosis
● What specialist to consult for lung-nodule diagnosis?
Several types of physicians are involved in the diagnosis and treatment of lung nodules. After finding a nodule, you will typically consult a pulmonologist, who is a lung specialist and can evaluate it to determine whether it’s of concern. You can also consult with a thoracic surgeon, a radiologist (imaging specialist), and sometimes an oncologist (cancer specialist) when necessary.
● How are lung nodules diagnosed?
Once found, your doctor will assess characteristics such as size, shape, and density, and certain risk factors to make a diagnosis. If it’s small or the risk is low, doctors usually recommend follow-up CT scans at 3, 6, or 12 months to see if it grows or changes. If it’s large and/or suspicious, further tests are likely to be recommended. Commonly used tests include lab tests, bronchoscopy, biopsy, and PET scans.
Treatment
● How are lung nodules managed or treated?
Small lung nodules typically require no treatment. Doctors typically recommend monitoring via repeated chest CT scans over time to see if they grow. If a nodule is causing symptoms, is at high risk, or is cancerous, surgery may be necessary to remove it.
● How are lung nodules surgically removed?
There are two major types of lung nodule surgery: minimally invasive surgery and thoracotomy (open-chest surgery). The former is more commonly used, including video-assisted thoracic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS). The surgeon may remove a small portion of the tumor up to an entire lung. The type of surgery you undergo depends on the characteristics of the nodule and your physical condition.
● Why is it important to monitor lung nodules?
Most lung nodules are benign. However, if a nodule is cancerous, the earlier it is detected and treated, the better the chance of successful treatment. Follow-up monitoring is necessary to ensure early detection of lung cancer.
Prevention
● Can lung nodules be prevented?
There is no guaranteed way to prevent lung nodules, but there are many ways to reduce your risk of cancerous nodules and improve lung health. Smoking is a major risk factor, and the best way to reduce your risk is to avoid tobacco. Other methods include exposure to fresh air, maintaining a healthy lifestyle (including a balanced diet, regular exercise, and stress management), and avoiding exposure to pollutants and harmful chemicals. If you have a history of smoking or other risk factors, talk to your doctor about screening recommendations and how to reduce your risk.
Outlook
● What is the outlook of lung nodules?
Most lung nodules are non-cancerous and usually require no treatment. They typically do not affect your quality of life. In some cases, a nodule may be early cancer. When detected early, it is more treatable with surgery.
Summary
Lung nodules are fairly common and are often found incidentally during other imaging scans. They usually cause no symptoms. Most lung nodules are not cancerous and don’t need treatment. Follow-up imaging tests are often recommended to check for growth over time. If a nodule is cancerous, it is more likely early-stage cancer and can be surgically removed more easily.