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The diagnosis of a lung or pulmonary nodule comes as a surprise to many people. Often, it is found incidentally as part of another test. Sometimes, though, it can be part of a regular chest xray or CT scan. Lung nodules and their management can be confusing and frustrating. It is natural to have many questions about these nodules. You have come to the right place for insight and information. Take your time and look over all the information.

What is a lung nodule?

A lung nodule is simply a description of a finding on a chest x-ray, or most commonly, a CT scan of the chest. It is not a disease by itself. The term “nodule” refers to a region or spot within the lung tissue which appears more dense than the surrounding lung. Since this area is more dense, it appears whiter than normal lung. Nodules can have a vast number of causes, and the majority of nodules are benign and of no serious consequence. Some nodules may be scars from long ago, and some may represent more recent events. The list of benign causes is long and can include infectious processes or inflammatory processes. The most serious concern when considering a lung nodule is whether it may represent a cancer. Making that determination is critical.

What do I do first?

The first thing to do is to stop and collect your thoughts. You may feel surprised to learn that you have a lung nodule, and feel blindsided. This is normal. Take some time to make sure you have understood everything you have been told so far. Write down all the information you have been given. It will come in handy as you move along. Make sure you know some specific things like the size of the nodule, which side it is on and where it is. Talk to the doctor who ordered the test and be certain you understand everything you have been told. The next step is choosing the right doctor to evaluate the nodule. This is critical. It can make all the difference.

How do I choose the right type of doctor?

Choosing the correct type of doctor or specialist to evaluate and manage a lung nodule is critical. If the nodule is malignant, time is extremely important. Unnecessary delays and unnecessary tests must be avoided. Decisions must be made efficiently and correctly, but not every specialist can make every decision. In the case of a lung cancer, surgery must always be considered for the best long term survival. There is no question that survival is best when a lung cancer can be removed. That decision can only be made by an experienced thoracic surgeon. If surgery cannot be performed safely, then chemotherapy or radiation may be needed. Chemotherapy is the administration of cancer drugs, and this is done by oncologists. Radiation is the use of high energy radiation directed at the cancer, and this is done by Radiation oncologists. Pulmonologists are lung medicine doctors. They do not and cannot treat lung cancer. They do not operate and cannot make surgical decisions. Pulmonologists do not do chemotherapy or radiation.

How do I know if it is benign or malignant?

This is the most important and difficult part of lung nodule management. Every individual must be evaluated separately and there are no perfect rules that can always predict a correct diagnosis based simply on a scan or x ray. In broad terms, individuals can be categorized as being at high risk for a cancer diagnosis based on certain criteria such as:

  • Age
  • Sex
  • Smoking History
  • Family History of Lung Cancer
  • Previous Cancer History
  • Size of the Nodule
Based on these and other aspects of your history your personal risk may be determined to be high or low. Individuals at high risk or with multiple risk factors must be considered for aggressive and complete evaluation. Evaluation may require simply a repeat scan in a short time, or it might mean additional testing with PET scan. PET scan is a test using a radioactive sugar to look at the activity of cells. It is not a perfect test. It may miss some cancers, and it may incorrectly pick up noncancers. But the PET scan is the only test that does what it does, so it is used as part of the complete picture. Biopsy is also incompletely reliable and may be wrong in a significant number of cases. It is used occasionally for diagnosis.

In the vast majority of high risk nodules, surgical removal is the treatment of choice. It is the standard of care.

Are You Concerned?


There are many new treatments for lung cancer these days that were not available a few years ago. If you are concerned about a lung nodule or if you believe you might be at high risk because of smoking, age, previous cancer diagnosis, or if the pulmonary nodule is large, proper follow up on your part is critical. We can help guide you through proper and complete care. Please click the button below if you would like more information on lung nodules, lung cancer and treatment for lung cancer, or for a consultation with a specialist.