Importance: Pulmonary nodules are identified in approximately 1.6 million patients per year in the US and are detected on approximately 30% of computed tomographic (CT) images of the chest.
How common are lung nodules? Lung nodules are very common. Up to half of adults who get chest X-rays or CT scans have them.
They're very common. Most lung nodules are scar tissue from past lung infections. Lung nodules usually don't cause symptoms. They're often found by accident on a chest X-ray or CT scan done for some other reason.
How common are benign lung nodules? Pulmonary nodules are fairly common. They are seen in about one of every 500 chest X-rays and in about one out of every 100 chest CT scans. At least 60% of pulmonary nodules seen on chest X-rays turn out to be benign, and 99% of those on chest CT are benign.
Age: Rare in people under 35 years of age. Half of lung nodules in people over age 50 are malignant.
Most lung nodules are benign, or non-cancerous. In fact, only 3 or 4 out of 100 lung nodules end up being cancerous, or less than five percent. But, lung nodules should always be further evaluated for cancer, even if they're small.
Half of all patients treated for a cancerous pulmonary nodule live at least five years past the diagnosis. But if the nodule is one centimeter across or smaller, survival after five years rises to 80 percent. That's why early detection is critical.
The most common causes of lung nodules are inflamed tissue due to an infection or inflammation (called granulomas) or benign lung tumors (such as hamartomas). Less common, malignant lung nodules are typically caused by lung cancer or other cancers that have spread to the lungs (metastatic cancer).
Nodules between 6 mm and 10 mm need to be carefully assessed. Nodules greater than 10 mm in diameter should be biopsied or removed due to the 80 percent probability that they are malignant. Nodules greater than 3 cm are referred to as lung masses.
In the vast majority of cases, lung nodules turn out to be small benign scars, indicating the site of a previous small area of infection. These nodules may be permanent or may even spontaneously disappear by the time of the next scan. Most are of absolutely no consequence.
The location of the lung nodule may guide the care team in evaluating possible risk, and studies indicate that nodules in the upper lobe may be more indicative of cancer. However, not all nodules in the upper region of the lung are cancerous, and not all nodules located elsewhere are benign.
If lung nodules are large or malignant, they may cause symptoms, including: Chronic cough.
The five-year survival rate for lung cancer is 56 percent for cases detected when the disease is still localized (within the lungs). However, only 16 percent of lung cancer cases are diagnosed at an early stage. For distant tumors (spread to other organs) the five-year survival rate is only 5 percent.
Lung nodules are usually 5 mm to 25 mm in size, but the larger nodules (larger than 25 mm) are more likely to be cancerous than the smaller ones.
Benign (noncancerous) pulmonary lung nodules require no treatment. Cancerous lung nodules, however, usually are surgically removed. The procedures used depend on the size, condition and location of the nodule. Observation with repeat CT scans in three to six months may be recommended.
While the overall survival of the participants was 80 percent, the survival rate for the 139 participants with nonsolid cancerous lung nodules and the 155 participants with nodules that had a partly solid consistency was 100 percent. For the 991 participants with solid nodules, the survival rate was 73 percent.
Any nodule that is 4 cm or larger should be removed with thyroid nodule surgery. Thyroid surgery is also very frequently needed for nodules that have atypical or suspicious cells on biopsy. This allows for a definitive diagnosis and cure. Many thyroid nodules that are benign on biopsy may be observed.
Treatment for lung nodules may range from a “watchful waiting” approach for benign nodules, to surgery, chemotherapy and radiation therapy for malignant nodules. If the nodule is benign, your physician will monitor the nodule periodically with CT scans, to determine if any changes in size or shape have occurred.
Malignant pulmonary nodules indicate cancer and will require medical attention and surgery. There are many ways to reduce the likelihood of malignant lung nodules and improve overall lung health: Stop Smoking/Don't start. Engage in exercises that promote lung health like running, yoga, hiking, etc.
Varicella pneumonia sometimes causes multiple lung nodules, so differentiation from a metastatic pulmonary tumor is necessary in patients with malignant disease.
These are often referred to as nodules on x-ray. Surgery with this limited extent of disease can result in 80-90% cure rates. As the tumor spreads into the lymph nodes of the lung, then the chest, and then to other parts of the body, the staging number increases. The higher the stage, the less the chance for cure.
If >6 mm, the repeat CT at 3 to 6 months, if nodule continues to grow or has persistent solid component >6 mm, the patient is deemed high risk, and resection should be considered. A CT should be performed annually for 5 years if the nodule is unchanged from a prior and solid component <6 mm.
Treatment for a cancerous nodule
A doctor may request a thoracotomy to remove a cancerous nodule. This surgical procedure involves removing the nodule through an incision in the chest wall. Additional treatments for cancerous lung nodules may include chemotherapy, radiation therapy, and other surgical interventions.
Lung biopsy procedures are not usually painful and have few risks that doctors associate with them. A doctor will only recommend a lung biopsy procedure to support their diagnosis. For example, if a person has smaller lung nodules, a biopsy may be too risky and difficult to justify.
You may need to take it easy at home for a day or two after the procedure. For 1 week, try to avoid heavy lifting and strenuous activities. These activities could cause bleeding from the biopsy site. It can take several days to get the results of the biopsy.