Written by Dr. Jonathan Kiev, a cardiothoracic surgeon at UK HealthCare.
Your doctor tells you that a chest X-ray shows a spot on your lung. It might sound scary at first, but these spots, or lung nodules, are not an uncommon occurrence.
What are lung nodules and what causes them?
Lung nodules are small masses of tissue in the lung that can be cancerous, although the majority are non-cancerous.
Dust and chemical exposure, infection or other tumors can all cause a lung nodule to form. Most people have no symptoms at all and lung nodules are accidentally discovered during the evaluation of something else.
Conversely, people who smoke or who have smoked in the past may also have nodules, which sometimes progress to an invasive cancer. That’s why it’s so important for a specialist to look at your X-rays for further evaluation.
Do lung nodules cause pain?
Pain is rare, especially if the nodule is very small. A CT scan will reveal even the tiniest of nodules, and your doctor can then correlate it with your symptoms. Rarely, if the nodule is near a rib, there could be associated pain.
Why does my doctor want me to get my old records?
An X-ray or CT scan is a snapshot in time; it shows what is happening now.
For comparison, a doctor may ask you to get old hospital records or X-rays to see if your nodule was there in the past, if it’s grown or if it’s stayed the same size. Benign nodules usually don’t change in size, while nodules that are associated with cancer can grow or spread.
If I have a family history of lung cancer, should I be concerned?
Secondhand smoke increases the risk of lung cancer, so most physicians will screen family members of lung cancer patients more frequently. Cancerous nodules that are discovered earlier are more easily treated.
Unfortunately, that the vast majority of lung cancer patients have no symptoms at all, which is why only 15 percent of people who have lung cancer are diagnosed early.
My radiology report said that my nodule was suspicious. What does this mean?
Nodules that are deemed suspicious have certain characteristics, and your care team may want to do additional testing to find out whether your nodule is cancerous.
If your nodule is large enough, your doctor can do a needle biopsy, which involves placing a small needle in the nodule to remove some of the tissue for further testing. In some cases, a surgeon will need to do a surgical biopsy, which involves making a tiny incision to remove the questionable tissue for testing.
Why was I referred to a pulmonologist?
Pulmonologists specialize in lung disease. Through a procedure called a bronchoscopy, they are able to access different areas of the lung and perform biopsies of abnormal areas.
Additionally, they can assess your breathing function and make useful recommendations for inhalers and other medicines as well. They work in close collaboration with thoracic surgeons to form a multidisciplinary lung care team.
Should I consider lung cancer screening?
Lung cancer screening was developed several years ago to detect lung cancer in people who are at a higher risk of developing the disease.
Lung cancer screening is recommended for patients who are at high risk for lung cancer. Low-dose CT screenings are recommended for patients who:
- Are ages 55-80.
- Currently smoke or have quit within the past 15 years.
- Have a 30 pack-year smoking history, meaning the patient smokes one pack of cigarettes per day for 30 years, or two packs per day for 15 years.
- Have no current symptoms of lung cancer.
The low-dose CT scan takes about 30 seconds to perform, and there is very little radiation exposure to be concerned about. Most insurances will pay for the scan, and many hospitals have programs to help offset the cost as well.