Understanding lung nodules

We know that when you are told you have a nodule in your lungs it can be confusing, and you may have questions. This information will help explain what it means to have a lung nodule, and to reassure you about what to expect. 

Finding a lung nodule on a chest X-ray or CT scan is common. A lung nodule is a small, more dense area of the lung which appears on the image.

Common features:

• often small, measuring less than 30mm wide
• don’t have any symptoms, and
• do not affect the function of the lungs or interfere with breathing.

Your doctor or specialist nurse may show you your scan to help you understand what we’re looking at. On an image of a CT scan of the chest (below), the areas in black are the lungs and the lung nodule shows up as a white spot within the lung

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It is very common that if you have a symptom related to your lungs or your breathing, the doctor may ask you to have a chest X-ray or CT scan to take pictures of your lungs.

In other cases, a scan may be done for other reasons (for example to assess your heart or kidneys). If so, any parts of the lungs that are seen on the scan will still be reviewed by the doctor.

Sometimes a lung nodule is also called a ‘pulmonary’ nodule and the two phrases mean the same thing.

The nodule can be due to lots of different causes. These can include:

• a small area of infection
• scarring
• normal glands within the lung
• previous tuberculosis (TB)

In a small number of cases, they can be the first signs of an early cancer in the lung. If this is the case, finding them early makes them much more treatable.

Up to 35% of people who have a CT scan which includes their lungs will have a nodule found.

Sometimes it is possible to find more than one nodule in your lungs. This is not necessarily more serious than having a single nodule.

Doctors and specialist nurses look at the size of the nodule and the characteristics of its appearance to help decide which nodules do require follow-up or assessment.

Not all lung nodules require more follow-up. We use national guidelines which have been written using evidence from clinical studies of thousands of people’s scans and their outcomes.

These guidelines and the features described help us to decide what to do next with each sort of nodule, and pick out any that might need follow up.

We also take into account lots of other factors like your age and other medical history.

It is not always possible to tell what a nodule represents on the very first scan. In these cases, we may offer you one or more further scans to see if the nodule changes or stays the same over a period of time.

Most lung nodules stay the same size, get smaller, or even disappear. If the nodule has not increased in size over several scans, no more follow-up is required. The majority of lung nodules do not change.

The process of repeated scans and reviewing results is sometimes called ‘nodule surveillance’ or active monitoring.

A small number of people may be asked to do more specialised tests after CT scans.

This is because we know a small number of nodules can develop into early lung cancer, and it is important to get follow-up of these nodules right.

If a nodule is cancerous, we aim to diagnose it early so we can offer more treatment options and aim for curative treatment if possible.

It is important to remember, though, that the general risk of a nodule being early lung cancer is small.

Your doctor or specialist nurse will talk to you about your individual risk and you can always ask any questions if you have them. We have also produced some Frequently Asked Questions if you would like further information.

If you have a scan which shows a lung nodule, a multidisciplinary team (MDT) works together to

look after you. The team might include consultant respiratory physicians, surgeons and specialist trainee doctors, a consultant radiologist, specialist nurses, and MDT coordinators.

Your appointments will normally be with a respiratory physician or specialist nurse to discuss results of your scans and next steps for you.

These might be face to face, over the telephone, via video clinics or through letters.

If you do have worries or anxieties, especially between appointments, it’s important to talk to them about this.

This leaflet was produced with support from RM Partners, the West London Cancer Alliance hosted by The Royal Marsden.