What are lung nodules. How are lung nodules diagnosed. What causes lung nodules. Are lung nodules cancerous. How are lung nodules treated. What symptoms do lung nodules cause. When should you be concerned about lung nodules.

Understanding Lung Nodules: Definition and Characteristics

A lung nodule, also known as a pulmonary nodule, is a small, round or oval-shaped growth in the lungs measuring up to 3 centimeters in diameter. Growths larger than 3 centimeters are classified as lung masses. These nodules are relatively common, particularly among smokers, and can be either benign (non-cancerous) or malignant (cancerous). Individuals may have a single nodule or multiple nodules in their lungs.

What makes lung nodules significant? While most are benign, they can sometimes indicate underlying health issues, including cancer. Therefore, proper diagnosis and monitoring are crucial for ensuring optimal health outcomes.

Key Characteristics of Lung Nodules:

• Size: Up to 3 centimeters in diameter
• Shape: Round or oval
• Occurrence: Can be solitary or multiple
• Nature: Typically benign, but can be malignant

Recognizing Symptoms: When Do Lung Nodules Cause Concern?

In most cases, lung nodules are asymptomatic and are often discovered incidentally during chest X-rays or CT scans performed for other reasons. However, in some instances, they may manifest symptoms that warrant medical attention.

Do lung nodules always cause symptoms? No, they typically don’t. However, when symptoms do occur, they may include:

• Persistent coughing
• Coughing up blood (hemoptysis)
• Wheezing
• Shortness of breath
• Respiratory infections

Is coughing up blood always a sign of lung cancer? While coughing up blood can be alarming and should always be evaluated by a healthcare professional, it’s not always indicative of lung cancer. It can be caused by various conditions, including benign lung nodules, infections, or other respiratory issues.

Unraveling the Causes: What Leads to Lung Nodule Formation?

Understanding the underlying causes of lung nodules is crucial for proper diagnosis and treatment. While the exact cause may vary from person to person, several factors have been identified as common contributors to lung nodule formation.

Common Causes of Benign Lung Nodules:

1. Inflammation: Granulomas formed due to infections or inflammatory conditions
2. Benign tumors: Such as hamartomas
3. Infections: Bacterial, fungal, or parasitic
4. Autoimmune conditions: Like sarcoidosis or rheumatoid arthritis

Potential Causes of Malignant Lung Nodules:

1. Primary lung cancer
2. Metastatic cancer from other parts of the body

Can environmental factors contribute to lung nodule formation? Yes, exposure to certain environmental toxins, such as asbestos or air pollution, may increase the risk of developing lung nodules. Additionally, smoking is a significant risk factor for both benign and malignant lung nodules.

Assessing Cancer Risk: When Should You Be Concerned?

While the majority of lung nodules are benign, it’s essential to assess the risk of malignancy. Certain factors can increase the likelihood that a lung nodule is cancerous.

Risk Factors for Malignant Lung Nodules:

• Age: Being over 50 years old
• Size: Nodules larger than 3 centimeters
• Smoking history: Current or former smokers are at higher risk
• Family history of lung cancer
• Presence of lung cancer symptoms
• Nodule characteristics: Irregular borders or rapid growth
• Multiple nodules: Having more than one nodule

Does the presence of these risk factors guarantee that a nodule is cancerous? No, these factors simply increase the likelihood of malignancy. A thorough evaluation by a healthcare professional is necessary to determine the nature of the nodule.

Diagnostic Approaches: Uncovering the Nature of Lung Nodules

Accurate diagnosis of lung nodules is crucial for determining the appropriate course of action. Pulmonologists employ a variety of diagnostic tools and techniques to assess the characteristics and potential risks associated with lung nodules.

Common Diagnostic Procedures:

1. Medical history review and physical examination
2. Imaging studies:
   • Chest X-ray
   • CT scan
   • Positron Emission Tomography (PET) scan
3. Biopsy:
   • Bronchoscopy
   • Needle biopsy
4. Blood tests
5. Additional tests to rule out specific conditions (e.g., tuberculosis)

How do imaging studies help in diagnosing lung nodules? Imaging studies provide detailed information about the size, shape, location, and characteristics of lung nodules. CT scans, in particular, can reveal calcium deposits and other features that help distinguish between benign and potentially malignant nodules.

Why is a PET scan sometimes recommended? PET scans can help differentiate between benign and malignant nodules by measuring metabolic activity. Cancerous cells typically show higher metabolic activity compared to benign tissue.

Treatment Strategies: Managing Lung Nodules Effectively

The approach to treating lung nodules depends on various factors, including the size, characteristics, and cancer risk associated with the nodule. Treatment strategies range from watchful waiting to surgical intervention.

Common Treatment Approaches:

1. Monitoring:
   • Regular follow-up imaging studies
   • Tracking growth and changes over time
2. Surgical removal:
   • For large nodules
   • When cancer is suspected or confirmed
   • If the nodule is causing symptoms
3. Treatment of underlying conditions:
   • Antibiotics for infectious causes
   • Management of inflammatory conditions

How is the decision made between monitoring and surgical removal? The decision is based on factors such as the size of the nodule, its growth rate, the patient’s cancer risk factors, and the presence of symptoms. Small, slow-growing nodules in low-risk individuals are often monitored, while larger, rapidly growing nodules or those in high-risk patients may require surgical intervention.

What does the monitoring process involve? Monitoring typically includes regular chest X-rays or CT scans to track the size and characteristics of the nodule over time. The frequency of these follow-up imaging studies depends on the initial assessment of the nodule and the patient’s risk factors.

Specialized Care: The Role of Pulmonologists in Lung Nodule Management

Pulmonologists play a crucial role in the diagnosis, treatment, and management of lung nodules. Their expertise in respiratory health allows for comprehensive care tailored to each patient’s unique needs.

Key Aspects of Pulmonologist Care for Lung Nodules:

• Expertise in interpreting imaging studies
• Skill in performing diagnostic procedures like bronchoscopies
• Knowledge of the latest treatment options and guidelines
• Ability to create personalized treatment plans
• Experience in long-term management and monitoring

How do pulmonologists determine the best course of action for each patient? Pulmonologists consider multiple factors, including the patient’s medical history, risk factors, nodule characteristics, and overall health status. They use this information to develop a tailored approach that balances the need for thorough evaluation with the goal of minimizing unnecessary interventions.

What should patients expect when consulting a pulmonologist for lung nodules? During the initial consultation, the pulmonologist will review the patient’s medical history, perform a physical examination, and discuss any existing imaging studies. They may order additional tests if needed and will explain the findings and recommended course of action in detail.

Living with Lung Nodules: Coping Strategies and Lifestyle Considerations

Receiving a diagnosis of lung nodules can be concerning for many patients. Understanding how to cope with the diagnosis and make appropriate lifestyle changes is crucial for maintaining overall health and well-being.

Coping Strategies:

1. Education: Learn about lung nodules from reliable sources
2. Communication: Maintain open dialogue with healthcare providers
3. Support: Seek emotional support from family, friends, or support groups
4. Stress management: Practice relaxation techniques or mindfulness

Lifestyle Considerations:

• Smoking cessation: Quit smoking to reduce risk factors
• Healthy diet: Maintain a balanced, nutritious diet
• Regular exercise: Engage in appropriate physical activity
• Follow-up care: Adhere to recommended monitoring schedules

How can patients manage anxiety between follow-up appointments? It’s normal to feel anxious about upcoming scans or appointments. Patients can manage this anxiety by staying informed, practicing relaxation techniques, and focusing on maintaining a healthy lifestyle. If anxiety becomes overwhelming, it’s important to discuss these feelings with a healthcare provider or mental health professional.

Are there any specific dietary recommendations for patients with lung nodules? While there’s no specific diet for lung nodules, maintaining a healthy, balanced diet rich in fruits, vegetables, and whole grains can support overall lung health. Some studies suggest that a diet high in antioxidants may have protective effects against lung cancer, but more research is needed in this area.

In conclusion, understanding lung nodules, their diagnosis, and management is crucial for patients and healthcare providers alike. While the discovery of a lung nodule can be concerning, it’s important to remember that most are benign. With proper evaluation, monitoring, and treatment when necessary, patients can effectively manage this condition and maintain their respiratory health. By working closely with pulmonologists and following recommended guidelines, individuals can navigate the challenges of lung nodules with confidence and peace of mind.

Lung Nodules – Diagnosis & Treatment | Conditions, Treatments & Specialty

Comprehensive care for lung nodules

Learn about COPD

Hearing that there’s a “spot on your lung” after a chest X-ray or CT scan can be concerning. The good news is that these “spots” are typically small, benign (non-cancerous) lung nodules. We’re here to diagnose, monitor and guide you through treatment.

What is a lung nodule?

A lung nodule (or pulmonary nodule) is a small, round or oval-shaped growth in the lungs that is up to 3 centimeters in diameter. A lung nodule larger than 3 centimeters is called a lung mass.

Lung nodules are common, mostly in those who smoke, and are typically benign (non-cancerous) but can also be malignant (cancerous). You may have a single lung nodule or several.

Symptoms of lung nodules

Most lung nodules don’t cause any symptoms and are often found on a chest X-ray or CT scan performed for another reason.

If symptoms are present, they may include:

• Coughing
• Coughing up blood
• Wheezing
• Shortness of breath
• Respiratory infection

What causes a lung nodule?

The most common causes of lung nodules are inflamed tissue due to an infection or inflammation (called granulomas) or benign lung tumors (such as hamartomas).

Less common, malignant lung nodules are typically caused by lung cancer or other cancers that have spread to the lungs (metastatic cancer).

Other causes may include:

• Infections: When your immune system acts against an infection, it will form a granuloma. Infections can be bacterial, fungal or parasitic.
• Inflammation: Inflammation from conditions like sarcoidosis and rheumatoid arthritis can also cause granulomas to form.

Is it cancer?

In most cases, a lung nodule does not mean cancer. However, certain risk factors can increase the likelihood that a lung nodule is malignant. These can include:

• Being over the age of 50
• A nodule larger than 3 centimeters
• Smoking
• Having a family history of lung cancer
• Having symptoms of lung cancer
• Growth or irregular borders
• Having multiple nodules

Diagnosing lung nodules

Once a lung nodule is identified, you’ll likely see a pulmonologist who can assess it to determine whether it’s a cause for concern.

To start, your doctor will discuss your medical history with you, perform a physical exam and a chest X-ray or CT scan. These scans can help your doctor see the size, shape and location of the lung nodule, as well as other characteristics, like calcium deposits. From there, they may recommend additional tests to rule out cancer or to determine another underlying cause. These can include:

• Positron emission tomography (PET) scan – A PET scan can help your doctor determine if a lung nodule is non-cancerous or cancerous, because it allows them to get a more detailed look.
• Biopsy – During a biopsy, your doctor removes a small amount of tissue from the nodule to examine closely under a microscope. The biopsy can be collected through a minimally invasive procedure called a bronchoscopy, which involves placing a thin, flexible tube through your mouth or nose to the nodule.
• Other tests – Your doctor may suggest blood testing or other tests to rule out other conditions, such as tuberculosis.

Treatment for lung nodules

Once the cause of your lung nodule is determined, your doctor and care team will discuss your next steps with you.

In most cases, if your lung nodule is small and your cancer risk is low, your doctor will suggest monitoring it through a series of X-rays over time to track its growth and any changes. Non-cancerous nodules grow slowly, if at all, while cancerous nodules grow quickly. If the nodule hasn’t grown or changed over a period of a few years, it can be left alone.

If your lung nodule is large, determined to be cancerous or causing you to have symptoms, your doctor may recommend having it removed it surgically. If surgery is recommended, your doctor will discuss all options with you.

Lung nodule care at Geisinger

Our pulmonology team is here to diagnose, monitor and provide treatment for lung nodules that’s right for you. We offer:

• Knowledge and experience – Your pulmonology team’s combined years of experience and research give them the expertise necessary to diagnose, treat and help you manage lung nodules. Learn more about our pulmonologists.
• Personalized care – When you need treatment for lung nodules, our pulmonology team will work one on one with you to create a treatment plan that’s tailored to your specific needs. With proper treatment and management of lung nodules, we can make sure that you stay healthy.
• Convenient locations and appointments – With pulmonologists available in Geisinger clinics and hospitals throughout Pennsylvania, you don’t have to travel far to get the care you need. We also offer extended clinic hours and minimal wait times to be seen, so you get care that’s convenient for you.

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Lung Nodules | Is a Lung Nodule Cancer?

• If you have a lung nodule
• After the biopsy

A lung nodule (or mass) is a small abnormal area that is sometimes found during a CT scan of the chest. These scans are done for many reasons, such as part of lung cancer screening, or to check the lungs if you have symptoms.

Most lung nodules seen on CT scans are not cancer. They are more often the result of old infections, scar tissue, or other causes. But tests are often needed to be sure a nodule is not cancer.

If you have a lung nodule

Most often the next step is to get a repeat CT scan to see if the nodule is growing over time. The time between scans might range anywhere from a few months to a year, depending on how likely your doctor thinks that the nodule could be cancer. This is based on the size, shape, and location of the nodule, as well as whether it appears to be solid or filled with fluid. If a repeat scan shows that the nodule has grown, your doctor might also want to get another type of imaging test called a positron emission tomography (PET) scan, which can often help tell if it is cancer.

If later scans show that the nodule has grown, or if the nodule has other concerning features, your doctor will want to get a sample of it to check it for cancer cells. This is called a biopsy. This can be done in different ways:

• The doctor might pass a long, thin tube (called a bronchoscope) down your throat and into the airways of your lung to reach the nodule. A small tweezer on the end of the bronchoscope can be used to get a sample of the nodule.
• If the nodule is in the outer part of the lung, the doctor might pass a thin, hollow needle through the skin of the chest wall (with the guidance of a CT scan) and into the nodule to get a sample.
• If there is a higher chance that the nodule is cancer (or if the nodule can’t be reached with a needle or bronchoscope), surgery might be done to remove the nodule and some surrounding lung tissue. Sometimes larger parts of the lung might be removed as well.

These types of tests, biopsies, and surgeries are described in more detail in Tests for Lung Cancer.

After the biopsy

After a biopsy is done, the tissue sample will be looked at closely in the lab by a doctor called a pathologist. The pathologist will check the biopsy for cancer, infection, scar tissue, and other lung problems. If cancer is found, then special tests will be done to find out what kind of cancer it is. If something other than cancer is found, the next step will depend on the diagnosis. Some nodules will be followed with a repeat CT scan in 6-12 months for a few years to make sure it does not change. If the lung nodule biopsy shows an infection, you might be sent to a specialist called an infectious disease doctor, for further testing. Your doctor will decide on the next step, depending on the results of the biopsy.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Araujo LH, Horn L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Ch. 69 – Cancer of the Lung: Non-small cell lung cancer and small cell lung cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020. 

Chiang A, Detterbeck FC, Stewart T, Decker RH, Tanoue L. Chapter 48: Non-small cell lung cancer. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Weinberger SE and McDermott S. UpToDate. Diagnostic evaluation of the incidental pulmonary nodule. This topic last updated: Jun 21, 2019. Accessed at https://www.uptodate.com/contents/diagnostic-evaluation-of-the-incidental-pulmonary-nodule on December 2, 2019. 

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Japanese classification of regional lymph nodes of the colon and rectum (JSCCR), numbering principles. — 24Radiology.ru

Japanese surgeons approached the problem of standardization of surgical technique in colon cancer in the most detailed and methodological way. Traditionally for the Japanese presentation, practical recommendations are formulated in the form of 2 parts: recommendations for classification and actual practical recommendations for treatment. A separate section is presented by the Japanese classification of lymph nodes.

In accordance with the “Japanese” classification, all lymph nodes are numbered with three digits.

• The first digit – belonging to the large intestine – is indicated as “2”.
• The second digit most often denotes the anatomical region corresponding to the vascular pedicle (iliac colic artery – 0, right colic artery – 1, middle colic artery – 2, left colic artery – 3, sigmoid – 4, rectal arteries – 5).
• The third number is the degree of distance from the intestine: 1 – epicolic and paracolic lymph nodes, 2 – mesocolic (intermedial) lymph nodes, 3 – apical, or main, lymph nodes.

Moreover, 1, 2 and 3 groups of lymph nodes correspond to the levels of lymph node dissection D1, D2, D3. When describing presacral lymph nodes, “0” (270, 280) is used as the last digit, and “2” (292) is used for inguinal lymph nodes. The principles of numbering of some other lymph nodes differ from the rule described above. The numbering of the lymph nodes in the Classification of Colorectal Cancer overlaps with that in the Classification of Gastric Cancer (JCGC): there is a match in the last digits. The lymph nodes of the superior mesenteric artery in colorectal surgery are designated as 214. In the Japanese Gastric Cancer Classification (JCGC), superior mesenteric nodes are designated as 14a and 14v for the base of the superior mesenteric artery and vein, respectively. Similar parallels can be drawn for lymph nodes number 216 – para-aortic (group 16 according to JCGC), 206 – infrapyloric (group 6 according to JCGC), 204 – gastroepiploic (group 4 according to JCGC), 210 – lymph nodes of the hilum of the spleen (group 10 according to JCG).

In accordance with the level of removed lymph nodes, the following volumes of lymph node dissection are distinguished: – D1 – removal of epicolic and paracolic lymph nodes; – D2 – D1 and removal of mesocolic lymph nodes; – D3 – D2 and removal of apical lymph nodes.

Preoperative TNM staging allows for a differentiated approach to choosing the volume of lymph node dissection. The main argument in favor of expanding lymph node dissection from category D2 to D3 is the data of radiation methods on the defeat of regional lymph nodes (cN+). In clinically N-negative stages, the volume of lymph node dissection is determined by the depth of tumor invasion (category cT). In cT1, D2 lymph node dissection is recommended. When the tumor invades the muscle layer, D3 lymph node dissection is recommended, since, according to Japanese registries, at the cT2 stage, there is a significant probability of damage to the apical lymph nodes. Diagnosis of cT3 and cT4 requires D3 lymph node dissection. Obviously, such a differentiated approach requires a specialized preoperative assessment of pathological changes detected during radiological and endoscopic studies.

What does CT show in pulmonary fibrosis

Fibrosis is the proliferation of connective tissue with the appearance of scars due to a violation of the mechanisms of healing of the wound surface.

When healing does not proceed properly, scarring may occur, leading to the fact that the organ cannot function fully.

Accordingly, pulmonary fibrosis is a scarring of lung tissue. The number of cells capable of saturating the blood with oxygen decreases. Consequently, respiratory efficiency decreases – respiratory failure develops, leading to intoxication, first with exercise, with aggravation of the course of the disease – at rest, and then – even in sleep. Scar tissue in the lungs not only has reduced functional properties, but also serves as an excellent environment for the development of associated infections, such as bacterial (pneumococcal or staphylococcal) pneumonia.

Pulmonary fibrosis is the outcome of tissue inflammation during interstitial (that is, with damage to the intercellular connective tissue) lung disease. The reasons for the development of such a disease may include lung injuries, high environmental pollution, smoking, inhalation of narcotic substances, mold, organic, asbestos, quartz and coal dust, infectious, autoimmune, viral diseases and their complications – bronchitis, tuberculosis, pneumonia, COVID- 19 and more.

Until recently, interstitial diseases themselves were synonymous with pneumofibrosis, but, fortunately, it was found that not all variants of such lung diseases are fibrosing.

The most complex and almost untreatable, primary or idiopathic pulmonary fibrosis is a rapidly progressive fibrosing lung disease of unknown cause.

Symptoms of pulmonary fibrosis

Pulmonary fibrosis is characterized by symptoms of shortness of breath and dry cough (rarely productive – with sputum) during exercise, persistent pain in the chest, fatigue due to shortness of breath, weight loss without changing diet. Auscultation of the lungs (listening with a phonendoscope) reveals early (in the inspiratory phase) inspiratory, that is, respiratory rales, most often localized in the lower posterior zones of the lungs.

Fibrosis can develop in one lung or both at the same time. Focal and total forms of fibrosis are also possible. With a total form, surgery is often required, since most of the lungs are affected. With a focal form, the changes are local in nature.

CT diagnosis of pulmonary fibrosis

The gold standard for diagnosing pulmonary fibrosis is high-resolution computed tomography. CT diagnostics of pulmonary fibrosis allows to reliably identify the degree of lung damage, to determine the localization of scar tissue. This diagnostic method is recognized as one of the most sensitive non-invasive methods for detecting pulmonary fibrosis. Thus, comparative studies conducted already in 1990 showed that pulmonary fibrosis using high-resolution computed tomography (HRCT) was detected in 91% of cases and only 39% using chest x-ray.

In the presence of pulmonary fibrosis in a serious stage, a pattern (a term adopted for pathological signs in medicine) is visible on CT scans of the so-called “honeycomb” lung – this condition is visible on scans as the same type of air-containing cysts located in several rows in the affected parts one or both lungs. In the early stages of pulmonary fibrosis, such a picture is not observed, so it was necessary to look for signs on CT that would allow to identify the disease at its onset. One of these signs was the presence of a “ground glass” pattern in the images – foci of slight compaction of the lung tissue. Also, specific signs of fibrosis in a patient can be detected when performing a CT scan of the lungs with functional tests. So, one of the signs – subpleural enhancement of the peripheral pulmonary interstitium – was previously considered a sign of the absence of pathology. Such changes are almost impossible to track using other methods of hardware diagnostics.

At the moment, the accuracy of CT diagnostic methods is increasing due to the introduction of new research protocols and careful study of the results of numerous studies. At the same time, the leading role in the diagnostic process is assigned to the radiologist, who interprets visible changes as pulmonary fibrosis or its absence. The search for early radiation signs of fibrosing lung disease is a key moment for the timely administration of antifibrotic therapy.

Also, it is multislice CT with the diagnosis made that is used to assess the rate of progression of the disease, identify favorable and unfavorable types of fibrotic changes, the success of treatment and the correct selection of therapeutic drugs.