I Just Learned I Have Lung Nodules: Now What?

Whether you had a chest X-ray or CT scan to detect pneumonia, identify a broken rib, assess your heart, or screen for lung cancer, it can be concerning to see lung nodules on your imaging results — especially because almost all lung cancers begin this way. 

The good news? Lung nodules are very common, and in more than 95% of cases, they’re benign (non-cancerous) and totally harmless.

Given that all lung nodules carry a slight element of uncertainty, however, they generally warrant a thorough evaluation at Fivestar Pulmonary Associates. In this month’s blog, our team takes a closer look at the follow-up process for lung nodule discovery. 

Understanding lung nodules

Health care providers conduct more than 150 million chest X-rays and CT scans each year in the United States. In nearly half of all cases, these imaging tests reveal one or more small spots or shadows on the lungs known as pulmonary nodules. 

Measuring three centimeters or less, these small growths can occur for many reasons, most of which aren’t related to cancer. Lung nodules may develop in response to:

• Congenital lung abnormalities that have been present since birth 
• Chronic respiratory illness (i.e., tuberculosis, pneumonia, fungal infection)
• Lung scarring from a previous illness, injury, surgery, or pollutant exposure 
• Chronic autoimmune inflammation (i.e., sarcoidosis, rheumatoid arthritis) 

In fewer than 5% of cases, lung nodules are a sign of cancer — either early lung cancer, or a different type of cancer that’s spread (metastasized) to the lungs. Because they receive the body’s entire blood output, the lungs are a common site for metastatic cancer. 

For example, advanced breast, colorectal, and kidney cancers often spread to the lungs, as do melanomas (skin cancer) and sarcomas (bone and soft tissue cancers). 

Visual lung nodule evaluation

Given that most lung nodules are simply a result of inflammation or small, harmless scars from past infections or irritants, the first step after lung nodule discovery is seeing our team for a comprehensive risk evaluation. This entails:

• Conducting additional imaging tests of your nodules 
• Evaluating nodule size, shape, and composition
• Gathering information on your personal risk factors

We compare new imaging with previous X-ray or CT scan results to see if the nodules have changed. Lung nodules that are smaller than six millimeters are rarely cause for concern; those that are larger than 10 millimeters (one centimeter) are more suspicious. 

Likewise, round nodules with smooth edges tend to be less problematic than those with jagged or spiculated edges. Calcified nodules, which are dense and appear solid on a scan, aren’t usually cancerous; non-calcified nodules that appear semi-solid on imaging tests have a higher potential for malignancy. 

Lung nodule risk assessment

While certain physical features can help us decide whether your lung nodules warrant further testing, only a biopsy can determine if the growth is cancerous. 

We’ll likely recommend a biopsy for lung nodules that are 10 millimeters or larger, especially if they’re also non-calcified and/or jagged-looking. Whether your lung nodules look suspicious or not, however, we’re also likely to recommend a biopsy if you’re 50 or older and you:

• Smoke or used to smoke cigarettes
• Were exposed to secondhand smoke
• Have a family history of lung cancer 
• Have a personal history of any cancer
• Received radiation therapy to your chest
• Were exposed to asbestos or radon 

These factors strongly increase the odds that your lung nodules may be cancerous, especially when you can check off multiple risk factor boxes. Luckily, malignant lung nodules that occur without symptoms tend to be early-stage and highly treatable.

Common management paths

Lung nodule management is guided by our risk stratification of your specific case, or the calculated risk determined by the physical qualities of the growths and your personal lung cancer risk. We may recommend:

Active surveillance 

This watchful waiting approach for small or low-risk nodules involves regular CT scans every few months to monitor for growth. Nodules that remain unchanged for two years are almost certainly benign.

Advanced imaging 

If a nodule is larger or appears suspicious, we may first order a PET scan to check for increased metabolic activity, as is often seen in cancer. This approach is usually reserved for cases where no other lung cancer risk factors are present.

Lung nodule biopsy

This is the only definitive way to confirm cancer, and it’s the approach we recommend when a patient’s calculated risk is high. We may conduct a CT-guided needle biopsy, or use a minimally invasive technique called bronchoscopy to reach suspicious nodules deep in your lung. 

Treatment options

Benign lung nodules caused by infection may clear with antibiotic treatment or antifungal medication. Early-stage cancerous nodules can often be fully resolved with surgery. 

Small, non-cancerous lung nodules don’t typically cause issues or require treatment. In the rare case that a larger, benign nodule presses against your airway and triggers shortness of breath, a chronic cough, or other symptoms, surgical removal may be advisable.

Lung nodule evaluation experts 

Did you just learn you have lung nodules? Don’t panic! Our board-certified pulmonologists can help you get answers. Schedule a visit at your nearest Fivestar Pulmonary Associates office in Allen, McKinney, or Plano, Texas, today.