Patient education: Pulmonary nodule (The Basics)

What is a pulmonary nodule? — 

A pulmonary nodule, also called a lung nodule, is a "spot" on the lungs seen on a chest X-ray or CT scan. These are imaging tests that create pictures of the inside of the body. If there is only 1 spot, it's called a "single" (or "solitary") pulmonary nodule.

A single pulmonary nodule usually causes no symptoms. People usually find out they have it after they have a chest X-ray or CT scan for another reason.

What causes a pulmonary nodule? — 

It is caused by either:

●A condition that is not cancer – In most cases, a pulmonary nodule is not cancer. It is usually a non-cancerous growth (a "hamartoma"), small area of inflammation caused by infection (a "granuloma"), or old scar in the lungs.

●Cancer – A pulmonary nodule can be lung cancer, which is when normal cells in the lungs change into abnormal cells and grow out of control. It can also be cancer that started in another part of the body and then spread to the lungs.

Is my pulmonary nodule cancer? — 

To help figure this out, your doctor will use the following information:

●Your age

●If you have other symptoms or other known cancers

●If you smoke or used to smoke

●If you have family members with lung cancer

●If you worked with or around asbestos or other materials that can cause cancer

●The spot's size and shape on the X-ray or CT scan

●If the spot changed over time – Your doctor will look at any old chest X-rays and CT scans you had to see if the spot changed.

Based on this information, your doctor will know whether there is a high, medium, or low chance your nodule is cancer.

What if there is a high chance my pulmonary nodule is cancer? — 

Your doctor will most likely do surgery to remove the nodule. If surgery is not possible, your doctor will do a biopsy to find out if the nodule is cancer. For a biopsy, the doctor takes a small sample of tissue from the nodule. Another doctor will look at the sample under a microscope to see if cancer is present.

Before a biopsy or surgery, your doctor will order an imaging test called a PET scan. For this test, a doctor puts a substance in your vein through a thin tube called an "IV." Then, a special camera takes pictures of your lungs, liver, brain, and bones. The scan can show if the cancer has spread outside your lungs.

Also, before surgery, you will have breathing tests to make sure it is safe to have part of your lung removed.

After a biopsy or surgery, a doctor will look at the nodule under a microscope to see whether it was cancer. If it was cancer, your doctor will discuss further tests and treatment. If it wasn't cancer, you might not need any more treatment.

What if there is a medium chance my pulmonary nodule is cancer? — 

Your doctor will get more information about the nodule.

For example:

●For medium-sized or large nodules, your doctor will order a PET scan or do a biopsy (or both). Depending on where the nodule is in your lung, they can put a needle through your chest and into the nodule. Or they can put a thin tube with a camera and light on the end (called a "bronchoscope") in your mouth or nose and down into your lungs to take a sample.

Then, another doctor will look at the sample under a microscope to see if cancer is present. If the PET scan or biopsy shows cancer, your doctor will likely recommend surgery to remove the nodule.

●If the nodule is small, or if the PET scan shows the nodule is unlikely to be cancer, your doctor will probably recommend monitoring your nodule. They will repeat a CT scan in 3 to 6 months.

Your doctor will also get more information by doing an exam and ordering some blood tests. Further tests are based on these results. For example, if you have a large lymph node (bean-shaped organ under your skin), you might need other tests.

What if there is a low chance my pulmonary nodule is cancer? — 

Your doctor will monitor the nodule. They will order repeat CT scans. Most people have repeat CT scans done once or twice a year for up to 5 years, but it depends on your individual situation.

If your nodule does not get bigger over time on repeat CT scans, it is most likely not cancer. Your doctor will then stop ordering repeat CT scans.

If your nodule does get bigger over time, your doctor will probably recommend surgery to remove it. Before the surgery, you will probably have a PET scan and breathing tests.

More on this topic

Patient education: Multiple pulmonary nodules (The Basics)
Patient education: Lung cancer (The Basics)
Patient education: CT scan (The Basics)
Patient education: PET scan (The Basics)
Patient education: Lung biopsy (The Basics)
Patient education: Breathing tests (The Basics)
Patient education: Diagnostic bronchoscopy (The Basics)

Patient education: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics)
Patient education: Flexible bronchoscopy (Beyond the Basics)