Ask the Doctors

Ask the Doctors: Lung Nodules

When patients learn they have suspicious “spots” or nodules on their lungs, it is understandable that they may become concerned about their diagnosis. They may begin to contemplate serious questions about their health: “Are my lung nodules cancerous? Will I need surgery, chemotherapy or radiation? What should I do?”

“One of the most common problems I counsel patients about is the discovery of lung nodules on a screening CT scan,” says Bryan Meyers, MD, MPH, Chief of Thoracic Surgery. “The majority of lung nodules that get detected by a screening CT scan are not cancerous, so there is a lot of deliberation required to determine the next steps of what to do when a nodule is detected.”

A Washington University thoracic surgeon who specializes in traditional, minimally invasive and robotic surgical treatments for benign and malignant conditions of the lung and esophagus, Dr. Meyers answered some frequently asked question about lung nodules.

Lung Nodules: Frequently Asked Questions

What is a lung nodule?

Lung nodules—also referred to as pulmonary nodules, white spots, lesions, or masses—are small, abnormal areas in the lungs often found during a CT scan of the chest.

Are lung nodules serious? Are nodules always cancerous?

Most lung nodules are benign or noncancerous. Most noncancerous lung nodules are frequently the result of old infections, scar tissue, or other causes.

Smaller, rounded nodules that are less than a centimeter wide (pea-sized) are less likely to be cancerous. Additionally, your doctors will examine if the nodules appear calcified; nodules often calcify in response to infection and are most likely noncancerous.

Lung nodules are more likely to be cancerous if you are a former or current smoker, over 65 years old or have other risks of cancer (such as lung cancer in your family or handling asbestos in the past).

Further testing, such as a PET scan or biopsy, is needed to ensure lung nodules are not cancerous. Your care team will review your CT scan to determine whether further testing may be necessary.

Your physician may also review past CT scan results or request additional scans to observe any size differentiation over time. Cancerous nodules are more likely to grow over time. Sometimes, small nodules may be early, developing cancer. The cancer is easier to cure when it is discovered early and surgically removed.

When should I see a doctor about lung nodules?

If you have been told you have one or multiple lung nodules, you may be referred to a pulmonary specialist or thoracic surgeon with training and experience detecting and treating lung nodules or lung cancer.

In most cases, benign lung nodules do not require treatment or removal. Your physician may request repeated imaging scans over time to monitor any changes in nodule size or features.

What causes lung nodules?

When infection or illness causes your lung tissue to inflame, a small clump of cells (granuloma) can occur. As mentioned above, granulomas can calcify or harden in the lung, causing noncancerous lung nodules.

Abnormal noncancerous growths such as fibromas (fibrous connective tissues), hamartomas (abnormal groupings of normal tissues) and neurofibromas (nerve tissue) can also develop.

Some types of cancerous lung tumors include:

  • Non-small cell, small cell, and carcinoid lung cancer
  • Adenocarcinoma (abnormal growth of glandular cells)
  • Lymphoma (growth containing lymphoid tissue)
  • Carcinoid (small, slow-growing cancerous tumor)
  • Sarcoma (connective tissue tumor)
  • Metastatic tumors (tumors that have spread to the lungs from cancer in another part of the body)

Most lung nodules are not cancer but is important to see a doctor to make sure. Early treatment is the best cure for cancerous nodules.

Can lung nodules disappear on their own?

Compared to their cancerous counterparts, benign lung nodules will not spread to multiple parts of the body (metastasis) and are typically not life-threatening. Sometimes, these nodules may be inflammatory in nature and can shrink or spontaneously disappear by the time of your next scan.

Can you have multiple lung nodules?

Yes, you can have multiple lung nodules. Multiple nodules do not necessarily mean your nodules are cancerous and metastasized. As your team learns more about your nodules, they will carefully review the sizes, shapes and locations of the nodules and determine the next steps in your treatment.

How do you screen for lung nodules?

Most people find out they have lung nodules when they receive an imaging test, like a CT scan, in preparation for another procedure or when investigating other illnesses.

“Screening CT scans are very effective in identifying lung cancer early, but the majority of nodules that are detected in CT scans are not cancer,” says Meyers. “This often leads a patient to worry about their nodules and their risk of cancer.”

According to Dr. Meyers, there are four things that can be done upon the discovery of one or multiple lung nodules, from most to least invasive:

  • Remove the nodule. For a small lung nodule, our surgeons would take a minimally invasive approach and conduct a video-assisted or robot-assisted thoracoscopic removal. In general, a lung nodule can be removed very safely and using a minimally invasive surgical approach.
    • Your surgeon may want to perform a bronchoscopy to take a closer look at your nodules and take a biopsy. A biopsy involves removing a piece of your lung to look at it under a microscope.
    • Surgery is recommended if there is a high likelihood that the nodule may be cancerous.
  • Needle biopsy. A patient with a suspicious lesion or nodule who may not want surgery or has medical problems that make surgery especially risky, a needle biopsy can determine if the nodule is cancerous. If it is, we can offer them stereotactic  radiation therapy that has revolutionized therapy for lung cancer.
  • PET scan. These are a remarkable radiological tool but have limitations in the identification of lung cancer and noncancerous nodules. Noncancerous conditions such as granulomatous inflammation and fungal infections often light up on the PET scan just as brightly as a cancer.
    • Your surgeon may suggest a PET scan to show where possible cancer cells may be before deciding which type of biopsy to perform.
  • Observation. Factors such as a patient’s risk developing lung cancer, age, and smoking history decreases the likelihood that their nodules are cancerous.
    • Instead of subjecting these low-risk patients more in-depth scans or biopsies, thoracic surgeons choose to simply observe the patient’s health through additional CT scans in approximately 3-6 months following detection. If there has been little or no change to the nodules over time, the patient’s nodules are considered benign and no further testing is needed.  

How big are lung nodules?

A lung nodule refers to a small area of tissue within the lungs that are 30 millimeters (1.2 inches) in diameter or less. A nodule that is larger than 30 millimeters (1.2 inches) in diameter is called a mass.

I have been diagnosed with lung nodules. What should I do?

In most cases, benign lung nodules do not require treatment or removal. Your physician may request repeated imaging scans over time to monitor any changes in nodule size or features.

The board-certified, internationally recognized Washington University thoracic surgeons guide you through the monitoring, biopsy and removal of your lung nodules.

If the nodules are determined to be cancerous, your thoracic surgeon will collaborate directly with specialists at Siteman Cancer Center to ensure you receive the best patient care and the latest medical and technological advancements in your lung cancer treatment.

Washington University Thoracic Surgeons

The team of Washington University thoracic surgeons, including Dr. Meyers, are highly trained in the most advanced techniques for detecting, testing and removing lung nodules and managing other thoracic diseases.

For more information about lung nodule surgery or to make an appointment with Dr. Meyers at the Center for Advanced Medicine, please call (314) 362-6025.  

Follow the WashU Cardiothoracic Surgery on Twitter for news from our faculty, research insights and updates from the field of thoracic surgery.