A lung nodule on a CT: what does it mean?

Perhaps you had a CT for another reason and the report said ‘nodule’, or a doctor told you a spot was seen in the lung. The word is frightening, and the next answer may be days away. This article helps you understand what the finding means and what the next step usually is.

What does ‘nodule’ mean?

MedlinePlus describes a solitary pulmonary nodule as a round or oval spot seen on a chest X-ray or CT. It usually causes no symptoms and is often found by chance when imaging is done for another reason. ALA also writes that because lung cancer usually has no symptoms in its early stages, a nodule is often found this way.

Finding a nodule does not necessarily mean cancer, and ALA says so directly. MedlinePlus writes that more than half of solitary lung nodules are not cancer. Some are the scar of an infection that healed years ago, such as tuberculosis or certain fungal infections, which left a granuloma or scar in the lung. But the same source says primary lung cancer is the most common cause of a cancerous nodule. Both possibilities are real, which is why follow-up is needed.

All of this is about solitary nodules. If your report says ‘mass’, do not apply it to yourself, and talk to your doctor soon; ALA says a larger nodule may need more investigation.

How does the doctor know whether it is worrying?

The doctor weighs several things together:

• How the nodule looks. MedlinePlus says a small nodule with a smooth edge and a solid, even appearance is more likely to be benign.
• Change over time. ALA writes that lung cancers grow over time and any increase in size can be a sign. Comparison with old CT scans also shows whether the nodule is new or has stayed the same for years.
• Your situation. ALA says the look of the nodule is combined with smoking history, family history and environmental exposures to estimate the chance of cancer. MedlinePlus also counts other lung symptoms among the reasons for concern.

For this reason two patients whose reports describe similar nodules may have different plans.

What happens next?

Follow-up imaging. MedlinePlus says doctors usually watch a nodule with repeat X-rays or CT scans. The same source writes that if repeat images show the nodule has not changed in size after 2 years, it is very likely benign and a biopsy is not needed. For a small nodule in a person who does not smoke and has no family history, ALA mentions repeat CT scans every six months to a year. These are examples of what the sources say, not your plan, and they are not the same for every type of nodule. How often and how long each person is followed is set by their doctor, according to the type and size of the nodule.

More tests. ALA says a larger nodule, or a higher-risk person, may need more advanced imaging, bronchoscopy, a biopsy or even surgery. The NHS describes bronchoscopy as a thin, flexible tube with a tiny camera that passes through the throat into the lung. MedlinePlus names three ways to take a sample: a needle through the chest wall, bronchoscopy and mediastinoscopy. The sample is examined under a microscope for cancer cells (NCI). Tests for tuberculosis and other infections may be needed too (MedlinePlus).

A conversation about surgery. If the tests show cancer, or the concern is enough that the doctors want the nodule removed, a surgeon becomes involved. The NCI names four types of lung surgery: removing a piece of lung containing the tumour with a little tissue around it (wedge resection), removing a lobe, removing a whole lung, and removing part of a bronchus. Which one suits which patient depends on the disease, general health and your own wishes, and becomes clear in the discussion with the surgeon. The NCI says radiation therapy is also an option for people who cannot or do not want surgery.

Will I definitely have an operation?

Not necessarily. Being referred to a surgeon means their opinion is needed. Sometimes the result is continued follow-up with CT, and sometimes a biopsy or an operation is suggested. Any decision is made after the records are seen and you are examined.

What can you do until the answer comes?

• Collect all CT scans and reports, old and new. The first visit guide has the full list.
• If you smoke, ask your doctor for help to stop. Why stopping smoking before surgery matters
• If your doctor gave a date for the next CT, do not put it off, even if you feel well; a nodule rarely causes symptoms.
• Ask your doctor what the next step is, when it will happen and when you will get the result. ALA reminds us that waiting for results can be the hardest part; that feeling is normal.
• If you have symptoms, such as a lasting cough, coughing up blood or unexplained weight loss, tell your doctor; these should not wait for the next appointment.

When not to wait

Coughing up more than a few streaks of blood, sudden breathlessness or severe chest pain cannot wait for an appointment. In this situation call 115, Iran’s emergency number. The full list