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Breathe Easier: The Ins and Outs of Lung Nodules

Are you at high risk of lung issues? Screenings and preventative care are easier than ever to help keep patients informed.

Each year, healthcare providers discover lung nodules—abnormal growths on the lung—in 1.5 million Americans. The good news: more than 90% of these lung nodules are benign. While the odds look good, screening and preventive care play essential roles in lung cancer prevention—especially among high-risk individuals. To learn more about lung nodule detection and management, we spoke with Dr. Julie Barta, a pulmonologist and critical care specialist, and Dr. Nathaniel Evans, a thoracic surgeon at Thomas Jefferson University Hospital. Dr. Barta and Dr. Evans lead the Korman Respiratory Institute’s lung cancer screening and nodules program.

What causes lung nodules?

 Dr. Barta: Lung nodules can occur because of a small infection in the lungs, inflammation of the lungs, scars from leftover infections or respiratory issues, and even as a reaction to environmental changes.

How are lung nodules found?

Dr. Barta: To understand how lung nodules are detected, it’s important to know two key terms: screen-detected nodules, which are nodules found through purposeful screening, and incidental nodules, nodules found during other regularly scheduled studies like CT scans of the chest. Of all CT scans of the chest, about 31% show an incidental lung nodule. If your doctor finds a lung nodule, know that it is fairly common.

Although lung nodules occur rather frequently, only a small minority turn out to be cancerous. Awareness is key when it comes to lung nodules, which is why we urge patients to learn more about screening and their eligibility. The sooner we discover a lung nodule, the sooner we can discuss the next steps in management.

What happens if a lung nodule is benign? What happens if it is cancerous?

Dr. Barta: After we find any lung nodule, we begin lung nodule management. That includes looking at the patient’s cancer baseline risk—which we obtain from their medical and family history—and monitoring the nodule characteristics during regular follow-up appointments. This also involves discussions with patients and their families about their preferences.

Whether or not a lung nodule is cancerous, we identify the patient’s options and best treatment pathways using a multidisciplinary consensus among nodule experts, including pulmonologists, radiologists, and thoracic surgeons. Every Tuesday morning, we look at all of our lung nodule patients’ cases during our internal nodule conference. One goal is to minimize any unnecessary procedures or testing. When we find nodules that are highly suspicious for lung cancer, we establish diagnosis and staging and then refer to our Sidney Kimmel Cancer Center Lung Tumor board. That way, we can hand off patients for surgery, chemotherapy, molecularly targeted therapy, or immunotherapy more smoothly, if necessary.

What treatments exist for lung cancer after a nodule has been found cancerous?

Dr. Evans: Fortunately, when we find cancer during screening, they are likely to be in an early stage. Jefferson is focused on minimally invasive and robotic techniques. Not only does this allow patients to go home just a day or two after surgery, but they’ll also recover and get back to feeling normal more quickly. Compared to just 5 to 10 years ago, treatment of lung cancer has come a long way.

Immunotherapy, stereotactic body radiation therapy, and robotic surgery have been game-changers in lung cancer treatment. Last year we finished a clinical trial giving patients immunotherapy and chemotherapy prior to surgery for more aggressive early-stage cancers. We’re seeing very promising results for many of the patients involved in that trial.

What else should patients know about lung nodules and lung cancer screening?

Dr. Evans: The vast majority of lung nodules are benign, so patients should not be afraid to be seen or get screened. However, just because most lung nodules are benign does not mean that patients can ignore them or let them fall to the wayside. It’s still important to continue with regular health management and monitoring.

Medicine and surgery have changed dramatically over the past few years. This is no longer your grandparent’s lung cancer treatment method. We have technologically advanced imaging studies (like CT and PET scans), as well as minimally invasive diagnostic and treatment techniques right at our fingertips.

Dr. Barta: Lung cancer screening is relatively new compared to other cancer screening modalities, but more patients are asking about it: “Am I high risk? What does that mean?” My advice for any patient worried about their risk profile for lung cancer would be to stay informed, read about screenings and eligibility requirements, ask questions and never hesitate to share concerns with your provider. We want to reach out to all communities in the Philadelphia area and especially provide equitable care for our vulnerable patients. Stay engaged in your health. Early detection can make all the difference.

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