Lung nodules aren’t usually what bring you to the doctor’s office. In fact, they rarely come with symptoms. However, if you are at an elevated risk for lung damage due to medical or lifestyle factors, it’s important to work with your healthcare provider on a screening plan.
Lung nodules aren’t usually what bring you to the doctor’s office. In fact, they rarely come with symptoms.
However, if you are at an elevated risk for lung damage due to medical or lifestyle factors, it’s important to work with your healthcare provider on a screening plan.
We spoke with pulmonologist Dr. Neveen Malik, about lung nodules, their diagnosis, and their treatment—here’s what you need to know.
What Are Lung Nodules?
Lung nodules are small growths or marks on the inside of the lungs. They can have a variety of causes and appearances but are only visible during an X-ray or CT scan. They are most commonly round or oval-shaped.
Lung nodules are the result of damage that can be caused by smoking, inflammation or infections like pneumonia. They can be tumorous and about 40% turn out to be cancerous.
Some patients may also develop lung nodules as a result of rare conditions like arteriovenous malformations (AVM), in which abnormal blood vessels may be found in the lung. These can be deadly if left unmonitored but do not always require removal.
The size, growth rate and shape of nodules are important tools in diagnosing their cause and treatment path. For example, small nodules that do not grow or change between scans are often left under review, while regular growth or a size larger than one centimeter should be investigated, and possibly even biopsied or removed.
“If the patient can tolerate surgery and the nodule is growing or causing concern, we will have it removed,” said Dr. Malik. “The procedure to biopsy lung nodules can be done while the patient is awake or under anesthesia.”
Most lung nodules are only a few millimeters in size, but some may continue to grow without proper diagnosis and treatment. If growth surpasses three centimeters, the nodule is then considered a pulmonary mass.
Symptoms are rarely present with lung nodules. If nodules grow into masses, they can be more difficult to easily treat and are more likely to be cancerous.
“Depending on the final diagnosis, symptoms might include a cough, coughing of blood, dramatic weight loss or lost appetite,” said Dr. Malik.
Screening Options and Knowing Your Risk
Early detection and monitoring are the keys to successful treatment, making an aggressive screening schedule is a must. However, not everyone should be receiving yearly chest X-rays.
“Patients between the ages of 55 and 77 who have more than 30 years of smoking should receive a CT scan annually as long as they are not exhibiting symptoms,” said Dr. Malik. If symptoms are present, they should be tested more frequently as recommended by a pulmonary specialist, as they may be a sign of a serious condition.
People who have at least 30 “pack years,” or years where they smoked at least one pack of cigarettes per day for 30 years, should also be tested annually—even after they’ve quit.
Those with a history of cancer, especially breast cancer, colon, kidney, prostate or bladder, may also qualify for scans under the national guidelines, depending on their medical history, since these types of cancers are more likely to spread to the lung.
Those with a low to average risk for lung nodules do not require regular scanning but should be aware of their risk profile.
“If you don’t qualify for low-dose CT screening but are concerned, your doctor may recommend you for an X-ray,” said Dr. Malik. “These aren’t exactly as effective, but can provide solid results.”
In the event a nodule appears, most patients are placed on a strict surveillance schedule, with follow-up appointments every six months or sooner if needed. This way, growth and change in shape can be carefully monitored.
Scheduling Your Scan
Regardless of your risk profile, knowing your personal and family health history is the first step toward a responsible screening schedule. Your primary care physician can order the low-dose CT scans of the chest and provide referrals to a pulmonary specialist to help you understand and analyze results.
“Lung cancer screening saves lives,” said Dr. Malik. “It’s important to be open with your doctor and self-advocate.”