Lung Nodules (Pulmonary Nodules)

What are lung nodules?

A lung nodule is a small mass of dense tissue on the lung. On a chest X-ray or CT scan, it looks like a white spot.  

How are lung nodules found?

Lung nodules are discovered on scans through three different scenarios: 

1. Following screening with a low-dose CT scan for patients at high risk for lung cancer 
2. Through imaging tests like an X-ray or CT scan when a patient has symptoms, and the physician is trying to find the cause 
3. Through imaging tests like an X-ray or CT scan while a patient is being seen for something else (like after a car accident). This can be called an incidental or “surprise” finding.  

What causes lung nodules?  

A variety of factors can cause a lung nodule to form, including: 

• Scar tissue 
• Lung irritants or air pollution 
• Inflammatory conditions from diseases like rheumatoid arthritis and sarcoidosis 
• Current or past infections like histoplasmosis and tuberculosis
• Cancer. The most common risk factors for lung cancer are exposure to tobacco smoke and radon gas.

Sometimes the cause of the nodule is unknown. 

Are all lung nodules cancerous?  

Most lung nodules are benign, meaning not cancerous. Your doctor uses results from additional tests and your overall health and risk factors for lung diseases to determine the next step in treating your lung nodule(s).  

What are the signs that a lung nodule is cancer?

Benign and cancerous lung nodules often look different on CT scan images. Physicians use the information below, plus the patient’s overall health, to judge if the nodule(s) might be cancerous and determine next steps.  

Can you have more than one lung nodule? 

It is possible to have several lung nodules. This doesn’t always mean the nodules are cancerous. Each nodule will be examined on the CT scan images, and your doctor will discuss the most appropriate next steps for determining what the nodule is and how to treat it. In many cases, a biopsy of the lung nodule may be suggested. Lung cancer often spreads to lymph nodes in the lung and chest. It’s important for your care team to know which lymph nodes are cancerous because it informs your treatment plan. In particular, it informs if you are eligible for surgery, which provides the greatest chance of cure. 

What happens after my doctor finds a lung nodule?

Physicians look at the size and shape of the nodule(s) as well as the patient’s health history to determine next steps. Sometimes, the most appropriate next step is to re-scan the lungs in several months to see if there are changes.  

If the nodule looks cancerous (malignant) or your health history suggests a higher risk for cancer, physicians will order tests to learn more about your nodule(s). These tests often include a combination of imaging scans, nodule and lymph node biopsies, and sometimes blood tests. The results from these tests can confirm the cancer and its type, size, location, and possible spread. Based on this information, the lung cancer is diagnosed and assigned a stage. 

Which procedures will I get if my doctor finds a lung nodule?

Physicians who are experts in lung disease use special guidelines to determine next steps. Patients with benign or slow growing nodules may get a CT scan every few months to monitor the growth of the nodule(s). 

If the nodule looks suspicious, your care team may recommend several different procedures to diagnose and stage your lung cancer. For some lung cancer patients, it is recommended their cancer be diagnosed and staged at the same time using one procedure called EBUS-TBNA (endobronchial ultrasound transbronchial needle aspiration). EBUS-TBNA combines a device called a bronchoscope with a needle inserted to remove tissue or fluid samples from the lung nodule and lymph nodes.  

The results from these procedures help your care team gather as much information about your cancer as possible before you begin treatment.  

Your care team might recommend other procedures when diagnosing and staging your lung cancer depending on the results from your imaging tests and your overall health history. 

Learn more about the common diagnostic and staging procedures for lung cancer. 

Do I have to wait for all of my test results before I start treatment?

It is common to feel urgency to start treatment when you know you have any type of lung nodule. However, for many patients, it is important to wait until your care team has a complete picture of your lung disease before you begin treatment. After the complete diagnostic and staging process, your care team will look at all your test results, your final stage and your overall health and preferences, and make treatment recommendations specific to your results and the individual characteristics of your disease.  

Learn more about the staging process and the importance of knowing your full cancer stage before starting treatment. 

How are lung nodules treated?

After the diagnostic and staging process, your care team will look at all your test results, your final stage and your overall health and preferences, and make treatment recommendations. 

Cancerous lung nodules are often treated with surgery when they are caught in an early stage when they are small and have not spread to other parts of the body. Lung nodules found in later stages may be treated with a combination of surgery, chemotherapy, radiation, immunotherapy and targeted therapy.

 This resource has been made possible with support from Olympus.