Spots on Lungs: When To Worry About Pulmonary Nodules | MyLungCancerTeam

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Spots on Lungs: When To Worry About Pulmonary Nodules

Medically reviewed by Todd Gersten, M.D.
Posted on April 4, 2022

What Are Pulmonary Nodules? | How Common Are They? | Causes | Symptoms | Cancer Risk Factors | Evaluation | Get Support

If your doctor discovers a spot on your lung during an imaging study, you may worry about what it means for your health. These spots are called pulmonary nodules. Though pulmonary nodules may be a sign of lung cancer, they are much more likely to be noncancerous, or benign. This article will review pulmonary nodules, why they occur, and what happens if you have one.

What Are Pulmonary Nodules?

A pulmonary nodule is an area of tissue that is more dense than normal lung tissue. Nodules can look like a white spot or a shadow on X-rays or CT scans of the chest. Nodules are often round, and although they can be any size, most are between 0.2 centimeter and 1.2 centimeters. They are often found incidentally when evaluating symptoms such as cough or shortness of breath. They are also found during CT scans for lung cancer screening.

How Common Are Pulmonary Nodules?

Pulmonary nodules are incredibly common. It is estimated that about half of people who get a chest X-ray or CT scan of the chest will have a pulmonary nodule.

What Causes Pulmonary Nodules?

Pulmonary nodules can be caused by many things. Though nodules can potentially be cancerous, about 95 percent of nodules are caused by something other than cancer. For example, lung infections can lead to small areas of inflammation (granulomas) in lung tissue. Over time, these granulomas can harden and become lung nodules.

Some other causes of pulmonary nodules may include:

  • Air pollution
  • Autoimmune diseases
  • Fungal infections
  • Tuberculosis or other lung infections, such as histoplasmosis
  • Scar tissue

Do Pulmonary Nodules Cause Symptoms?

Many pulmonary nodules, especially if they are small, do not cause any symptoms.

If nodules are large, or if they indicate early stage lung cancer, they may cause some symptoms. Some symptoms of lung cancer can include:

  • Coughing
  • Shortness of breath
  • Coughing up blood
  • Chest pain
  • Wheezing
  • Unintentional weight loss

What Makes Nodules More Likely To Be Cancerous?

After your doctor finds a lung nodule, they may ask you to follow up every six months to a year with repeat CT scans. This type of follow-up allows your doctor to compare the nodule’s size over time to help determine if it may be cancerous. If a nodule doesn’t grow over a period of about two years, it is typically thought to be benign.

Risk factors that increase the likelihood that a nodule may be cancerous include:

  • History of smoking
  • Age older than 65 years
  • Family history of cancer
  • Previous exposure to radiation or asbestos

What Can Be Done To Evaluate a Suspicious Nodule?

If a lung nodule looks suspicious on a CT scan, your doctor can order more tests to help determine whether it is cancerous or benign.

PET Scan

Your doctor may want to do an imaging study called a positron emission tomography (PET) scan. PET scans use a radioactive tracer to show metabolic activity in your body. During a PET scan, you’ll be given the tracer through a vein in your arm or hand. The tracer is attached to sugar molecules, so any cells that take up the sugar will also take up the tracer. Cells that are metabolically active, such as cancer cells, would then light up on the images taken. Cells in benign nodules would not take up the tracer, so they would not light up on the images.

Lung Biopsy

A lung biopsy can help your doctor make the ultimate determination of whether a pulmonary nodule indicates lung cancer. During a biopsy, a piece of tissue is removed from the lesion (nodule) and then tested to determine whether cancer cells are present.

A biopsy can be done by bronchoscopy or with CT guidance.

During a bronchoscopy, a bronchoscope (a thin tube with a camera) is guided down through the mouth and into the lung. Tissue is then removed from the nodule by a needle or small surgical instrument. This procedure is typically done by a pulmonologist. Sedation is given for this procedure.

A CT-guided needle biopsy is done using a CT machine to locate the nodule. Then, a needle is placed through the outside of the chest and into the suspicious nodule to get a tissue sample.

Talk With Others Who Understand

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Are you living with pulmonary nodules? Share your experience in the comments below, or start a conversation by posting on MyLungCancerTeam.

Posted on April 4, 2022
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Julie Scott, ANP-BC, AOCNP is an adult nurse practitioner with advanced practice oncology certification, based in St. Louis, Missouri. Learn more about her here.

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