Lung nodules and masses

What does this finding mean?

MedlinePlus describes a lung nodule as a round or oval spot in the lung seen on a plain X-ray or CT scan. It usually causes no symptoms. Most of the time it is found by chance when imaging was done for another reason. ALA also writes that early-stage lung cancer usually has no symptoms, so having no symptoms does not mean a nodule is unimportant.

MedlinePlus also names the harmless explanations: more than half of solitary lung nodules are not cancer, and old infections such as tuberculosis and some fungal infections can leave a scar or granuloma in the lung. On the other side, the same source says primary lung cancer is the most common cause of cancerous nodules. So both possibilities are real, which is why follow-up is needed.

A radiology report sometimes uses the word ‘mass’. What it means exactly in your report is made clear by the report itself and your doctor; this page gives no size cut-off, because the sources we read give no such figure. The statement ‘more than half are not cancer’ is about solitary nodules, so do not apply it to a mass. ALA says a larger nodule may need more investigation, so if your report says ‘mass’, do not put off follow-up.

Who comes to a surgeon?

Someone sent by another doctor with findings such as:

• A nodule that has grown, or changed its look, over successive CT scans. MedlinePlus counts growth and change among the reasons for concern.
• A nodule that looks suspicious or was found in a person with risk factors. ALA says that for a larger nodule or a higher-risk person the doctor may move to more advanced imaging, bronchoscopy, a biopsy or even surgery.
• A biopsy or pathology result that showed cancer.

Referral to a surgeon means the surgeon’s opinion is needed, not that an operation has been decided. Some patients simply continue follow-up with CT after the visit.

How is it investigated?

• Comparison with old images. ALA writes that if earlier CT scans are available, it becomes clear whether the nodule is new or has been there and stayed the same.
• Repeat CT or X-ray. 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 low-risk person, ALA mentions repeat CT scans every six months to a year. These are examples of what the sources say and they are not the same for every type of nodule; how often and how long you are followed is set by your doctor according to the type and size of the nodule and your own situation.
• How the nodule looks. MedlinePlus says a small nodule with a smooth edge and an even, solid look is more likely benign. ALA says the doctor weighs the look of the nodule together with smoking history, family history and work or environmental exposures to estimate the chance of cancer.
• Other tests. Sometimes a PET scan (ALA), and for infections such as tuberculosis a specific test (MedlinePlus), are needed too.
• Biopsy. MedlinePlus names three ways: a needle through the chest wall, bronchoscopy and mediastinoscopy. The NHS describes bronchoscopy as a thin, flexible tube with a tiny camera that passes through the throat into the lung. The sample is examined under a microscope for cancer cells (NCI). The NHS says some test results arrive the same day and some after days or weeks.

How is it treated in general?

MedlinePlus says treatment depends on the result of the biopsy and other tests. If the nodule is benign and does not grow, follow-up alone may be enough.

If cancer is confirmed, the NHS and the NCI count several factors in choosing treatment: the type, size and place of the tumour, how far the disease has spread, the patient’s general health and their own wishes. Surgery is one of the options. The NCI names four types of surgery:

• Wedge resection: removing the tumour with a little healthy tissue around it; when more is removed it is called segmental resection.
• Lobectomy: removing a whole lobe of the lung.
• Pneumonectomy: removing a whole lung.
• Sleeve resection: removing part of a bronchus.

Which method suits which patient, and with what technique, is for the surgeon and becomes clear at the visit. The NCI says radiation therapy is also an option for people who cannot or do not want to have surgery. Before deciding, the care team usually checks how well the lungs work.

What can you do?

• Gather all images and reports, new and old. Bring every CT with its disc.
• Write down your medicine list and earlier operations. Do not stop or reduce any medicine yourself, especially a blood thinner; that decision is for your doctor.
• If you smoke, ask for help to stop from now on. Why stopping smoking before surgery matters
• Ask when the tests will be done and when the results will come. ALA also reminds us that waiting for results can be the hardest part; this feeling is normal.
• Ask your doctor what the least invasive way is to get the information needed.

For a fuller review, see the article A lung nodule on a CT: what does it mean?

When to get urgent help

• Coughing up blood. The NHS says if you have seen only a few spots or small streaks of blood, get an urgent appointment with a doctor; in practice, call a doctor the same day. If you cough up more than a few streaks of blood, or have breathlessness, a very fast heartbeat or pain in the chest or upper back with it, call 115, Iran’s emergency number, at once; the NHS says this combination may be a sign of a blood clot in the lung.
• Severe breathlessness. If breathing has become very hard, you cannot say a sentence, your chest feels heavy, or your lips and skin have turned blue or grey, call 115, Iran’s emergency number (NHS).

Do not drive yourself. See the full list in the guide When should I call urgently?