August 07, 2024

Understanding lung nodules: when to worry

Lung nodules, small masses of dense tissue found in the lungs, often appear as white spots on a chest X-ray or CT scan. While the discovery of a lung nodule can be alarming, it is crucial to understand when they warrant concern and what steps to take next.

For high-risk individuals aged 50 − 80 with a significant smoking history (a pack per day for 20+ years), current smokers and those who quit within the last 15 years, regular lung cancer screenings with low-dose CT scans are critical for early detection and improved treatment outcomes.

Lung cancer is the leading cause of cancer death in the United States for both men and women—taking more lives than breast, colon and prostate cancers combined and accounting for nearly one quarter of all cancer deaths.

Are lung nodules cancerous?

A lung nodule, or pulmonary nodule, is an unusual growth in the lung, detectable through X-rays or CT scans—or, newer minimally invasive robotic bronchoscopies.

“Most are benign, but some can indicate lung cancer,” says IU Health Arnett oncologist Vijaya Kakani, MD.

Lung nodules can arise from various causes. Noncancerous nodules often form due to inflammation from infections, illnesses, air pollutants, autoimmune diseases or scar tissue. Malignant causes include lung cancer and carcinoid tumors.

What happens if you have a nodule on your lung? Symptoms and risk factors

Lung nodules typically do not cause any symptoms. In fact, outside of lung cancer screenings, most nodules are detected incidentally during unrelated imaging. Immediate medical attention is crucial if severe symptoms suggest lung cancer spread. These include:

Chest pain
Chronic cough
Shortness of breath
Coughing up blood
Hoarseness
Recurring pneumonia

Early detection is important for prompt diagnosis and treatment. Consulting a healthcare professional is critical for high-risk individuals with lung nodules. Regular screenings, like mammograms or colonoscopies, are vital for early detection, yet only 5.8% of eligible people in the U.S. get screened.

A patient's medical history and risk factors, such as being over age 50 – 80 with a significant smoking history (20+ pack per day years), are vital in assessing nodule malignancy risk. Current smokers or those who quit within 15 years also face higher risks.

Detection methods

ION Robotic Navigational Bronchoscopy. Historically, a computed tomography (CT) scan has been the tool of choice in identifying lung nodules. However, this new tool allows for minimally invasive detection and treatment of lung cancer at earlier stages than ever before, drastically improving outcomes for patients. “ION robotic navigation bronchoscopy allows us to diagnose and stage lung cancer in one procedure, thereby expediting care, with higher diagnosis rates and fewer complications compared to older tests,” says IU Health Arnett pulmonologist Mehboob Kalani, MD.
Imaging tests (CT scans, PET scans). Diagnosing a nodule in the lung often begins with CT scans, which reveal size, shape and location clues. Nodule size changes between scans may indicate cancer, prompting PET scans or biopsies for further evaluation.
Biopsy procedures. Confirming cancerous lung nodules often requires biopsy. Methods vary by size and location. Needle biopsy uses CT for tissue sampling with local anesthesia. Bronchoscopy, under general anesthesia, retrieves samples via throat tube with light sedation and video-assisted thoracoscopic surgery (VATS). Biopsy choice considers patient history and nodule details.
Role of pulmonary specialists. Pulmonary specialists collaborate with thoracic surgeons, radiologists and pulmonologists. They assess nodules by reviewing medical histories, analyzing CT images and using advanced technologies for biopsies. Regular follow-up appointments monitor nodules closely for early cancer detection.
Potential risks and benefits of diagnostic procedures. Diagnostic procedures for lung nodules provide early detection of potential lung cancer, enhancing treatment effectiveness with less invasive methods. High-risk individuals benefit from annual low-dose CT scans for detailed lung imaging with minimal radiation exposure, significantly improving treatment success rates. Despite risks such as false positives and biopsy complications, the benefits of timely detection and precise diagnosis generally outweigh concerns, especially for high-risk individuals.

Treatment Options

Monitoring and surveillance. Follow-up and monitoring are essential for managing lung nodules. Doctors may recommend periodic check-ups using CT scans every 3, 6 or 12 months to track changes in the nodule. These can confirm benign status or ensure early detection of potential lung cancer and optimize treatment effectiveness.
Surgical intervention. If a suspicious lung nodule is found, a biopsy may be needed. Early-stage cancers are often treated with surgery to remove small, localized tumors.
Radiation therapy. Radiation therapy uses high-energy radiation to target and eliminate cancer cells, often combined with other treatments. It is beneficial for patients who are ineligible for surgery due to health issues or cancer spread.
Chemotherapy and Immunotherapy. Treatments like chemotherapy and immunotherapy are helpful for advanced cancerous lung nodules. Chemotherapy kills cancer cells throughout the body and is often combined with radiation and immunotherapy. Immunotherapy boosts the immune system against cancer, while targeted therapy addresses genetic changes in cancer cells. This combined approach effectively manages the disease when surgery alone is insufficient.
Prevention and risk reduction
Importance of smoking cessation. Quitting smoking significantly reduces the risk of cancerous lung nodules and lung cancer. Ready to quit? Healthcare providers offer medications and counseling to help quit smoking and reduce these risks effectively.
Environmental factors and occupational hazards. Exposure to asbestos, radon and secondhand smoke increases lung nodule and lung cancer risk.
Promoting lung health through lifestyle changes. Maintaining lung health beyond avoiding smoke and occupational hazards includes eating a diet rich in fruits and vegetables and regular physical activity. Consulting healthcare professionals for personalized strategies is pivotal, especially for those with a history of lung disease or other risk factors.

Key takeaways

Understanding lung nodules and their risks is monumental for proactive lung health. Important actions include quitting smoking and high-risk individuals completing regular screenings.

Early detection of lung cancer greatly improves the odds of survival. Early screening matters, too, because patients with early-stage lung cancer typically don’t have any signs or symptoms, allowing the cancer to progress otherwise undetected until it’s at a more advanced stage.