Lung Nodule

What is a lung Nodule?

A small round or oval-shaped growth in the lung, sometimes called a “spot on the lung”. Most pulmonary nodules are smaller than 3 cm in size. Larger nodules are more likely to represent a malignancy.


How common is a lung nodule?

Lung nodules are quite common and can be found in up to a half of CT scans of the chest. Risk factors for malignant lung nodule are history of smoking and old age.


What causes Lung nodule?

There are two main types of lung nodules: benign (non-cancerous) and malignant (cancerous). Majority (over 90%) of lung nodules are benign and could be due to infections, inflammation, or benign tumours. Malignant nodules are less common (<10% of all nodules) and could be due to lung cancer, lymphoma or secondary cancers that may have spread into the lungs from other primary sites.


What are the symptoms of Lung nodule?

Most lung nodules do not give any symptoms and are incidentally discovered on XRays or CT scans. If present, symptoms would be related to the condition that led to the nodule developing. Common symptoms of malignant nodule are cough or cough up blood.


What tests are performed to investigate lung nodule?

Chest X-Rays and CT scans: Usually, the first sign that a pulmonary nodule is present is a spot on the lung that shows up on a chest X-ray or a CT scan. These tests are usually done when you see your doctor with respiratory symptoms. Often, a lung nodule is incidentally discovered on the scan performed for some other reason in patients with no respiratory symptoms.

PET scan: A PET scan can help to differentiate a malignant nodule from a benign. The PET scan uses a radiolabeled glucose that is absorbed by the nodule, and provides a picture of the nodule’s metabolic activity level. Malignant cells have faster metabolic rates and thus absorb more of the radiolabeled substance. Nodules can light up on PET imaging if they are malignant or if there is active inflammation. Nodules smaller than 8-10 mm are usually not seen well by PET imaging.

Biopsy: A biopsy is a procedure in which a small tissue sample is removed from the nodule so it can be examined under a microscope. It may be performed when other tests are inconclusive to rule out the chance that a growth is malignant.

Brochoscopy/EBUS: This procedure is used if it appears the nodule can be reached through the windpipe. It uses a bronchoscope, which is a thin, lighted flexible tube that can be inserted into the mouth or nose and through the windpipe (trachea) into the bronchus (airway) of the lung. The bronchoscope has a very small camera at its end. Biopsy tools can be passed through the camera to reach the nodule.

Needle biopsy: A needle is inserted through the chest wall and into the nodule, under local anaesthesia and under the guidance of a CT scan. This procedure most successful if the nodule is more towards the edge of the lung.

Sometimes it may not be possible to obtain and needle biopsy due to the location of the nodule in the lung. In those cases, if the nodule has suspicious features on imaging, then the best option could be to surgically remove the nodule.


How are lung nodules treated?

Benign nodules usually do not require treatment. For nodules due to infection or inflammation, the treatment would be based on the condition identified and the symptoms that are present.

If the nodule is malignant, there does not appear to be any spread of the cancer, and the patient is fit, then the cancer should be surgically removed. If the surgery is not feasible then targeted radiotherapy could be a better option.

Prevention: the best way to avoid getting malignant lung nodule is to quit/avoid smoking.


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