Understanding lung nodules

An explanation for patients 

We know that when you are told you have a nodule in your lungs it can be confusing, and you may have questions. This information explains what it means to have a lung nodule, and to reassure you about what to expect.

What does ‘lung nodule’ mean? 

Finding a lung nodule on a chest X-ray or CT scan is common. The phrase ‘lung nodule’ describes a small, more dense area of the lung which appears on the image. 

Common features: 

  • Often small, measuring less than 30mm wide 
  • Don’t have any symptoms
  • Do not affect the function of the lungs or interfere with breathing

Your doctor or specialist nurse may show you your scan to help you understand what we’re looking at. On an image of a CT scan of the chest (below), the areas in black are the lungs and the lung nodule shows up as a white spot within the lung.

How common is it to have a lung nodule? 

Up to 35% of people who have a CT scan which includes their lungs will have a nodule found. Sometimes it is possible to find more than one nodule in your lungs. This is not necessarily more serious than having a single nodule.

How did you find my lung nodule? 

If you have a symptom related to your lungs or your breathing, it is very common that the doctor will ask you to have a chest X-ray or CT scan to take pictures of your lungs. 

In other cases, a scan may be done for other reasons (for example to assess your heart or kidneys). If so, any parts of the lungs that are seen on the scan will still be reviewed by the doctor. 

Sometimes a lung nodule is also called a ‘pulmonary’ nodule and the two phrases mean the same thing. 

What might have caused my lung nodule? 

The nodule can be due to lots of different causes. These can include: 

  • a small area of infection 
  • scarring 
  • normal glands within the lung 
  • previous tuberculosis (TB)  

In a small number of cases, they can be the first signs of an early cancer in the lung. If this is the case, finding them early makes them much more treatable.

What do you look for when you review my scans? 

Doctors and specialist nurses look at the size of the nodule and the characteristics of its appearance to help decide which nodules do require follow-up or assessment. 

Not all lung nodules require more follow-up. We use national guidelines which have been written using evidence from clinical studies of thousands of people’s scans and their outcomes. 

These guidelines and the features described help us to decide what to do next with each sort of nodule, and pick out any that might need follow up. 

We also take into account lots of other factors like your age and other medical history. 

How will my lung nodule be followed up? 

It is not always possible to tell what a nodule represents on the very first scan. In these cases, we may offer you one or more further scans to see if the nodule changes or stays the same over a period of time. 

Most lung nodules stay the same size, get smaller, or even disappear. If the nodule has not increased in size over several scans, no more follow-up is required. The majority of lung nodules do not change.

The process of repeated scans and reviewing results is sometimes called ‘nodule surveillance’ or ‘active monitoring’. 

What happens if my doctor or specialist nurse tells me I need other tests? 

A small number of people may be asked to do more specialised tests after CT scans. 

This is because we know a small number of nodules can develop into early lung cancer, and it is important to get follow-up of these nodules right. 

If a nodule is cancerous, we aim to diagnose it early so we can offer more treatment options and aim for curative treatment if possible.

It is important to remember, though, that the general risk of a nodule being early lung cancer is small. 

Your doctor or specialist nurse will talk to you about your individual risk and you can always ask any questions if you have them. 

Support for you and your family 

If you have a scan which shows a lung nodule, a multidisciplinary team (MDT) works together to look after you. The team might include consultant respiratory physicians, surgeons and specialist trainee doctors, a consultant radiologist, specialist nurses, and MDT coordinators. 

Your appointments will normally be with a respiratory physician or specialist nurse to discuss results of your scans and next steps for you. 

These might be face to face, over the telephone, via video clinics or through letters. 

If you do have worries or anxieties, especially between appointments, it’s important to talk to them about this.

Summary

Lung nodules are very common findings, and your team is there to support and work with you and to answer any questions you have.

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