Do you have a small spot (pulmonary nodule) on your lung on your X-ray? Don't worry, let's talk about it!

Imagine that you have a chest X-ray or CT scan for some other reason, perhaps for chest tightness. When you get the report a few days later, you see that it says there is a 'pulmonary nodule'. It's normal to feel a sudden surge of fear. "Oh my God, is this cancer?" The question arises in the back of your mind. But is it really something to be afraid of? Most of the time, it's not. Let's talk about this simply and clearly.

What is a pulmonary nodule?

Simply put, a pulmonary nodule is a small round or oval-shaped mass inside your lung tissue that appears different from normal lung tissue on an X-ray or CT scan. These are often small in size.

It's understandable to be scared when you see something like this in a report. But the most important thing we need to remember is that more than 95% of these spots or lumps are not cancerous (`benign`). That means they are harmless and do not spread to other parts of the body.

You may have seen the term `ground glass opacity` in your report. Do you know what the doctor means by that? It means that the spots are so small that you can barely see the underlying lung tissue through them, like looking through a smoked glass. Some spots are completely solid, meaning you can't see anything underneath. Some spots can be a combination of both. This appearance helps the doctor get an idea of ​​the nature of the lump.

How common is this condition? And are there any symptoms?

This is a much more common condition than you might think. In fact, about one in three people who have a CT scan of their lungs will have this little spot on their report. So you can imagine how common this is.

When it comes to symptoms, most of the time these small lumps don't cause any symptoms. You may find out you have one during a scan for another reason. However, rarely, if the lump gets larger, or if it's near an airway and is pressing on it, or if it's cancerous, you may experience some symptoms.

Why do spots like this form on the lungs?

There could be many reasons for this. Let's look at the main ones.

• Scars from old infections: This is the most common cause. You may have a previous infection, such as a fungal infection or tuberculosis, that has healed and left behind a small scar-like lump (a granuloma) in your lungs. These are completely harmless. It's like a small scar left behind when a skin wound heals.
• Benign tumors: Non-cancerous, harmless tumors can also develop in the lungs. Examples include hamartomas and lipomas.
• Immune system diseases: These types of lumps can also occur due to diseases that alter the functioning of the body's own immune system, such as rheumatoid arthritis or sarcoidosis.
• Scarring of the lungs (`Fibrosis`): Causes such as smoking, inhalation of various chemicals, or dust can damage the lungs and cause scarring. This can also appear as lumps.
• Cancerous tumors: Yes, rarely, this lump can be the beginning of cancer. Lung cancers (non-small cell lung cancer, small cell lung cancer) can start this way. Also, lumps like this can be seen when cancer from another part of the body has spread to the lungs (metastasis).

What will the doctor do next?

When your doctor sees a lump like this on your report, he or she will consider a number of factors, including your complete medical history, your age, whether you smoke, and whether anyone in your family has had cancer. He or she will also pay special attention to the size, shape (smooth or rough edges), and appearance of the lump as seen on the scan.

Can you tell if this is cancer from a CT scan?

The straight answer to this is no. You can't tell with 100% certainty whether it's cancer or not just by looking at a CT scan. The only way to confirm whether it's cancer is with a biopsy, which is a small sample of the lump that is taken and examined.

However, the CT scan provides the doctor with a lot of valuable information.

• Size: Lumps smaller than 0.6 centimeters (6 millimeters) have a very low risk of being cancerous.
• Shape: Lumps with smooth, rounded edges are more likely to be noncancerous. Lumps with rough, jagged, irregular edges are a bit more concerning.

When is a biopsy needed?

Your doctor is more likely to recommend a biopsy in the following cases:

• If the lump is larger than 9 millimeters in size.
• If the lump gradually gets bigger on scans over time.
• If you have other risk factors for lung cancer.

There are several ways to do a biopsy. Bronchoscopy, VATS (Video-assisted thoracic surgery), or needle biopsy are some of them. Your doctor will decide which method is best for you.

What are the treatments?

Most of the time, small, noncancerous lumps don't need any treatment. Your doctor will often do what's called "active surveillance." That means waiting without worrying.

You will be asked to have another CT scan in 6 or 12 months. This will check to see if the size of the lump has changed. If the lump remains the same size or has shrunk in scans over a period of about two years, the chance that it is cancerous is almost zero.

• If it is due to an infection: If it is found that the lump is due to an infection, antibiotics or antifungal medications will be given.
• If the lump grows: If the lump grows during the observation period, if symptoms develop, or if a biopsy confirms that it is cancerous, the lump may need to be removed surgically.

When should you see a doctor?

If your scan reports a lung nodule, be sure to see your doctor to discuss any concerns you may have. Also, if you develop any of the symptoms we discussed earlier, such as chest pain, persistent cough, or difficulty breathing, you should also inform your doctor immediately.

When should you go to the Emergency Treatment Unit (ETU)?

If you suddenly develop severe symptoms like these, go to a hospital's Emergency Department (ETU) immediately or call 1990.

• Severe, unbearable chest pain
• It's very difficult to breathe.
• Excessive bleeding when coughing

Finally, don't hesitate to ask your doctor questions like these:

• What could be the reason why I have this lump?
• Do I need to do more tests?
• What symptoms should I be especially concerned about?

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