Finding out you have a pulmonary nodule can be an unwelcome surprise – especially if you haven’t had any symptoms. The good news is that small nodules in people without risk factors for lung cancer are almost always non-cancerous. At the same time, for those at risk, nodules can be warning signs of cancer.
“With lung cancer screening, we can catch nodules early that could turn into lung cancer and dramatically improve survivability in this patient population,” says Dr. Luke Rogers, a pulmonary and critical care doctor at Health First in Melbourne. “If a person has been or is a smoker, I would encourage them to talk to their primary care provider to see if they are a candidate for screening.
“Lung nodules are abnormal growths that form within the lung tissue. They can be solid, partially solid, or nonsolid,” says Dr. Rogers, noting that nodules are very common: “It is estimated that 25 percent to 50 percent of all adults undergoing a chest CT will have an incidental pulmonary nodule found.
“In higher risk groups, such as patients with a strong smoking history who are older than 50 years of age, the chance of a pulmonary nodule being seen on low-dose screening CT scan is approximately 50 percent to 60 percent.”
More often than not, small nodules are the result of old infections, scar tissue or other causes, according to the American Cancer Society. But the organization cautions that tests are often needed to be sure a nodule is not cancer.
“People don’t usually know they have nodules from a symptomatic standpoint,” explains Dr. Rogers. “This is why the screening CT scans are so important, especially for those at high risk.
“If someone was to have a nodule that was cancerous, he or she typically wouldn’t show symptoms until the nodule had grown large enough to obstruct the airways or cause some other complication such as coughing up blood, shortness of breath or pneumonia.”
Cleveland Clinic says that although small lung nodules rarely cause symptoms, if the growth presses against your airway or is cancerous, you might experience chest pain, shortness of breath or wheezing, chronic cough, fatigue, hoarseness, loss of appetite, unexplained weight loss, and recurring respiratory infections such as bronchitis or pneumonia.
“The primary risk factor in developing lung nodules is a history of smoking and/or current smoking of anything – including nicotine, marijuana or vaping,” Dr. Rogers says, adding that other risk factors include age, family history of lung cancer, personal history of cancer, certain infections, and certain environmental/occupational exposures, such as asbestos.
Northwestern Medicine explains that treatment for lung nodules can 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.
If the nodule is malignant, your physician will perform more tests to determine if it has spread anywhere else in the body. If it is only in the lung, surgical removal is the usual treatment. This is why early detection is so helpful in treating malignancies. If caught early enough, before the cancer has spread, the prognosis is usually better and treatment less rigorous.
If the nodules have metastasized, then a more aggressive course of treatment is necessary, typically including radiation therapy, chemotherapy, or a combination of the two.
Dr. Rogers explains the number of cases is increasing, but not necessarily because there are more pulmonary nodules developing. “Our CT imaging continues to improve, and screening protocols are improving detection rates.”
Dr. Rogers summarizes the current recommended screening protocols. “The United States Preventative Task Force recommends that those with a 20-pack-a-year or greater smoking history (for example, half a pack a day for 40 years or one pack per day for 20 years or two packs per day for 10 years) who are older than age 50 and have either quit smoking within the past 15 years or who are actively smoking, undergo a low dose screening CT scan yearly if they smoke currently. The same applies for up to 15 years after they quit smoking or until age 80 (whichever comes first), or if their health status no longer permits curative lung cancer treatment if detected.”
In conclusion, Dr. Rogers says, “Overall, pulmonary nodules do not present with symptoms, and this is why screening patients with risk factors with low-dose screening CT scans is so important.
“Lung cancer is the third most common type of cancer found in the US. However, lung cancer is also the most lethal, and a large contributing factor to its lethality is that it is often found late.”
Luke Rogers, DO, is a pulmonary and critical care doctor at Health First Medical Group – Medico. He has a DO degree from the Alabama College of Osteopathic Medicine. He completed his internal medicine residency at HCA Healthcare USF Morsani College of Medicine at HCA Florida Largo Hospital, and a pulmonary and critical care fellowship at HCA Healthcare USF Morsani College of Medicine at HCA Florida Bayonet Point Hospital. Health First Medical Group – Medico is located at 2329 Medico Lane, Melbourne. Call 321-361-5565 for an appointment.
