When To Worry About Lung Nodules

Finding out you have a spot on your lung can feel unsettling. Whether your doctor mentions it after a routine X-ray or an annual lung cancer screening, it’s normal to wonder what it means — and to fear the worst. But most of the time, those small spots, called lung nodules, aren’t cancerous.

“It’s a human reaction to feel concerned after you learn you have a lung nodule,” said Govind Jha, MD, an internal medicine physician specializing in pulmonary and critical care medicine at Franciscan Physician Network Pulmonary, Critical Care & Sleep Medicine in Lafayette, Indiana. “But the first thing you should know is that 90 percent of lung nodules are benign, which means they’re not cancer.”

Key takeaways

• Lung nodules are abnormal spots found on the lungs during an imaging test. Most aren’t cancerous.
• Doctors evaluate lung nodules based on their size, your health history and whether you have risk factors like a history of smoking or a prior cancer.
• Low-dose CT scans can help detect lung nodules early, especially for people with a high risk of lung cancer.
• Even if a lung nodule turns out to be cancerous, early diagnosis and new treatment options greatly improve outcomes.

What is a lung nodule?

A lung nodule is a spot on the lungs found by an imaging test. By definition, Dr. Jha notes, it must be less than 3 centimeters in size. Anything greater is considered a lung mass.

How Are Lung Nodules Found?

Doctors often discover most lung nodules by chance during an imaging test ordered for another reason. For example, your primary care doctor may tell you that you have a lung nodule after noticing one on your chest X-ray, which they originally ordered because you have pneumonia.

There are also times when low-dose CT scans for lung cancer screening reveal lung nodules, Dr. Jha said. The U.S. Preventive Services Task Force recommends these scans annually for people who:

• Are between 50 and 80 years old
• Are in overall good health
• Have a 20 pack-year smoking history (e.g., have smoked one pack a day for 20 years or two packs a day for 10 years)
• Either currently smoke or have quit smoking within the past 15 years

What Do Doctors Consider With Lung Nodules?

If you have a lung nodule, you’ll likely meet with a pulmonologist — a doctor who specializes in the diagnosis and treatment of diseases of the respiratory system.

When determining next steps, your doctor will consider several factors, such as:

• Past imaging tests, if available
• The size of the lung nodule(s)
• Your age
• Your health history, including whether you have a history of smoking or cancer
• Your overall health and whether you have symptoms like a cough, shortness of breath or unexplained weight loss

Accounting for your whole health picture helps your doctor calculate how high the risk is that your lung nodule is cancerous.

Treatment Plans Based On Risk

Low-risk lung nodules

If your lung nodule is low risk, it likely means your overall health is good, you don’t have concerning symptoms, or a history of smoking or cancer, Dr. Jha said. Typically, it also means that your lung nodule isn’t very large. In this case, your doctor will likely recommend conservative management — known as active surveillance or “watchful waiting” — with follow-up imaging tests to ensure the lung nodule doesn’t grow or change.

The frequency of follow-up imaging generally depends on the size of the nodule — and we don’t recommend it for a nodule smaller than 6 millimeters in a patient with no other risk factors.

Intermediate-risk lung nodules

If your lung nodule is intermediate risk, your doctor may recommend a blood test to measure biomarkers in your blood, which helps further classify your nodule’s cancer risk. If the blood test determines your risk is low, your doctor will usually advise conservative management. If the test determines your risk is high, your doctor will follow a high-risk lung nodule management pathway.

High-risk lung nodules

In most instances, we biopsy lung nodules deemed high risk for cancer, Dr. Jha said. A biopsy removes a sample of the nodule for testing.

“The nodule may not be cancerous, but if it is, we want to diagnose it when it’s early,” he said. “The more quickly we diagnose and stage cancer, the sooner we can start treatment and the better the patient’s outcome.”

What Causes Benign Lung Nodules?

Benign lung modules can have a multitude of causes, such as:

• Conditions that cause lung inflammation, such as pneumonia and autoimmune disorders like rheumatoid arthritis
• Developmental abnormalities
• Environmental exposures, like smoking and air pollution
• Infections (bacterial, viral or fungal)

“Most lung nodules are caused by pneumonia or another past infection your body has contained in the lungs, causing scar tissue,” Dr. Jha said. “However, even in those cases and depending on risk factors, we still repeat imaging to ensure the nodules don’t grow or change.”

Although it’s uncommon, benign lung nodules can become cancerous.

“That’s where risk factors come into play,” Dr. Jha said. “If someone has a smoking history and a lung nodule, for example, there’s a chance that the nodule can become cancerous down the road. That’s why it’s very important to take everything into consideration when we determine management and treatment.”

If you have a nodule on your lung that’s larger than 3 centimeters, it can still be benign, Dr. Jha said, but it’s more likely to be cancerous and considered a lung mass.

“I tell patients straight up that it’s too big and it concerns me enough that I’m not comfortable with just repeating imaging down the line,” he said, “but I always discuss patients’ options with them and weigh the pros and cons.”

Find Peace Of Mind At Franciscan Health

It may scare you to learn you have a lung nodule, and that’s understandable, Dr. Jha said. But don’t let fear stop you from taking action.

“We want patients to know that most of these nodules are benign, so you shouldn’t worry and should instead talk to your doctor,” he said. “Talk about your health history and your risk factors. Learn about your options. And even if your nodule is cancerous, the therapies for lung cancer have improved tremendously over the past few years. There are many good treatment options available today.”

Pulmonary and respiratory medicine specialists at Franciscan Health offer the latest in screening, treatment, disease management and pulmonary rehabilitation. They also help patients manage chronic illnesses and diseases like asthma, bronchitis and emphysema.

Advanced Technology For Early Diagnosis

Franciscan Health offers advanced diagnostic technology with robotic bronchoscopy to help find and diagnose lung cancer in its earliest stages. If a high-risk nodule is found during your lung scan, our interventional pulmonologists use a robotic bronchoscope to reach and sample tissue from even the smallest or hardest-to-reach areas of the lung. This minimally invasive procedure provides highly accurate results, meaning patients have more treatment options and better outcomes when cancer is found early.

Franciscan Health was the first healthcare system in Indiana to use this robotic bronchoscopy technology, which is still available at only a few hospitals statewide. The procedure is available at several Franciscan Health locations, including Indianapolis, Lafayette, Mooresville, Michigan City and Crown Point.

To learn more about robotic bronchoscopy, visit our robotic-assisted surgery page.

Ask your doctor whether you’re a candidate for annual low-dose CT scan screenings for lung cancer. You can also call (833) 238-0688 or request an appointment.