Lung Nodules & Spots
There are many reasons your doctor may order a chest x-ray or CT scan, including looking for signs of infection, inflammation or with recent advances, even lung cancer.
Finding out you have a lung nodule is likely unanticipated and can be a stressful event.
As part of a new effort underway at EvergreenHealth, Dr. Lindy Klaff and her colleagues are partnering with patients to provide a greater understanding of the nodule and what it means for their health.
What are we referring to when we use the term lung nodule?
Dr. Lindy Klaff: A nodule is a “spot” seen in the lung on an x-ray or CT scan. Sometimes there is just one nodule and sometimes there may be many.
In most situations, the spot is found by chance when a chest x-ray or CT scan is done for other reasons.
Many things can cause a nodule and most nodules are found in people over age 45.
Just like your skin can have old scars, freckles and discolorations, the inside of the lungs can have a variety of things that cause spots when we image your chest.
Nodules may include scars from prior infection or inflammation or non-cancerous tumors. Nodules may also be cancer.
If I have a nodule, how concerned should I be that it’s cancer?
Dr. Klaff: Generally, less than 10 percent of pulmonary nodules are cancer.
If the nodule has been present and unchanged for more than two to three years, there is a less than one percent chance the nodule is cancerous.
If the nodule is newly discovered, you may need a lung specialist to assess the risk of cancer in the nodule.
At EvergreenHealth, our team of radiologists, chest surgeons, cancer specialists, respiratory therapists, nurses and a nurse navigator carefully evaluate the nodule and the patient’s health history to help determine whether there is a low, medium or high risk of lung cancer. This includes:
- The size, shape, location and density of the nodule
- Person’s age
- Smoking, cancer and family history
- Exposure to asbestos or other environmental factors
- Places lived and traveled to
What happens after determining whether someone is at low, medium or high risk of lung cancer?
Dr. Klaff: If the risk of cancer is low, we may recommend follow-up low-dose CT scans to make sure the nodule does not change. Depending on the size and features of the nodule, it might need to be followed for one to three years.
If the risk of cancer is intermediate or high, a pulmonologist may recommend a PET scan, lung function testing and/or biopsy to learn more.
- PET scans are special scanners where a dye is injected through an IV and tells us if there are metabolically active cells in the lungs and other parts of the body, which helps determine if cancer is present.
- Lung function testing is done to assess the impact of smoking on the lungs and assesses the safety of several options for biopsy or even surgery.
- A biopsy can be performed several different ways. Each involves a physician obtaining a piece of the nodule, lymph node or body fluid so that a pathologist can look at it with a microscope and determine what it is.
Why is it important to monitor a nodule even if it’s not cancer?
Dr. Klaff: In almost all cases, benign nodules require no treatment. However, most doctors will recommend monitoring them for up to three years to note any changes that may indicate the presence of cancer.
- A biopsy or surgical removal of a benign nodule may be needed if:
- The patient is a smoker
- The patient has difficulty breathing, or other troubling symptoms
- Tests show that cancer could be present
- The nodule continues to grow