Pulmonary Node
"Many people think that quitting smoking completely eliminates the possibility of getting this cancer. However, the risk does not decrease until many years have passed, so it is necessary to follow up".
DR. LUIS SEIJO
DIRECTOR. PNEUMOLOGY DEPARTMENT
What is a pulmonary nodule?
A pulmonary nodule is a small lesion in the lung, often round or oval in shape, usually detected on a chest X-ray or computed tomography (CT) scan. Pulmonary nodules can be solid, partially solid, or subsolid, and by consensus measure no more than 30 mm.
Most pulmonary nodules discovered incidentally or during a screening program turn out to be benign, non-tumorous lesions. However, some nodules may be malignant. The risk of malignancy increases depending on the size, shape, and location of the nodule, as well as the patient’s medical history.
Pulmonary nodules are often detected incidentally and usually only require radiologic follow-up. The frequency of follow-up depends on the size of the nodule and the patient’s medical history. In patients with certain risk factors—especially current or former smokers over the age of 50—it is advisable to have periodic check-ups with a Pulmonology specialist as part of a screening program.
Early detection of pulmonary nodules in high-risk individuals enrolled in a screening program increases the chances of diagnosing lung cancer at an early stage. This cancer is mainly caused by tobacco use. However, it can also occur in non-smokers, which is why every detected pulmonary nodule should be monitored. In some cases, pulmonary nodules require a biopsy or additional tests such as a PET-CT scan.
Not all smokers have the same risk, but currently it is not possible to know in advance which smokers are at higher risk. Certain respiratory diseases, such as COPD or emphysema, significantly increase the risk.
Symptoms of pulmonary nodule
Pulmonary nodules are most often asymptomatic. The appearance of symptoms is usually associated with other respiratory conditions such as chronic obstructive pulmonary disease (COPD), bronchiectasis, or smoking.
However, some benign pulmonary nodules may cause symptoms typical of respiratory infections, such as fever or cough, and some cancerous nodules may produce symptoms in the context of a paraneoplastic syndrome or metastatic disease.
What risk factors make a pulmonary nodule suspicious?
Risk factors that increase the likelihood of a pulmonary nodule being malignant include:
- The size, shape, and location of the nodule.
- Smoking is a key risk factor.
- A personal or family history of cancer can increase the risk of a nodule being malignant.
- Occupational risk factors exist (for example, asbestos exposure).
- Environmental risk factors such as pollution or radon gas exposure. Age is also a contributing factor.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
How is a pulmonary nodule diagnosed?
Most pulmonary nodules do not require a specific diagnosis, as their stability during follow-up is sufficient to confirm their benign nature.
Pulmonary nodules are often diagnosed incidentally, but also through early detection programs. The Early Detection Program at the Cancer Center of the Clínica Universidad de Navarra has over 20 years of experience in this field and has evaluated more than 5,500 patients.
In addition to a medical consultation, the tests included in the program are:
- Low-dose chest CT scan: the radiation dose is significantly lower than that of a standard CT scan and less than the amount of environmental radiation a person receives in one year.
- Pulmonary function tests.
- A blood sample.
- Health questionnaires.
- Smoking assessment, if applicable.
- Depending on the results of the above tests, additional testing may be required.
Occasionally, complementary tests are needed to further characterize a nodule. These may include taking a blood sample, characterizing one or more nodules through PET-CT (an imaging test that measures the metabolic activity of the finding and assesses its risk), and, in rare cases, a biopsy. A lung biopsy can be performed via needle aspiration, bronchoscopy, or surgery, depending on the size and location of the pulmonary nodule.
Treatment of pulmonary nodule
Most pulmonary nodules do not require treatment, as they are benign.
How is a malignant pulmonary nodule treated?
Occasionally, a pulmonary nodule detected incidentally or during screening is malignant. These nodules must be biopsied or surgically removed.
In cases where a biopsy is feasible and a cancer diagnosis is confirmed, it is necessary to determine the extent of the disease in order to choose the most appropriate and personalized treatment. The staging process varies among centers, depending on the diagnostic techniques available.
At the Cancer Center of the Clínica Universidad de Navarra, PET-CT is frequently performed to assess the metabolic activity—and therefore the aggressiveness—of a nodule, as well as to detect locoregional or distant spread if the nodule is cancerous. Endobronchial ultrasound is also commonly used in this context to confirm or rule out lymph node involvement in the mediastinum, and in some cases, mediastinoscopy is performed for the same purpose before removing a malignant nodule.
Surgery is indicated for patients with malignant nodules or for those whose nodules are not accessible through a minimally invasive biopsy but whose high risk of malignancy requires removal.
Early Detection Program for Lung Cancer (iELCAP)
Since the year 2000, researchers at the Clinica—led by the Pulmonology, Radiology, and Cima Universidad de Navarra departments—have participated in an international multicenter cohort study that has demonstrated that performing an annual low-dose chest CT scan detects lung cancer at its earliest stage (81% in Stage I), which is the stage with the best prognosis.
Eighty-one percent of diagnosed cancers were cured, and up to 95% of those found at the earliest stage (IA) were successfully cured with surgery.
Where do we treat it?
IN NAVARRA AND MADRID
The Department of Pneumology
of the Clínica Universidad de Navarra
Specializing in smoking and tobacco-related diseases, the Department has over 15 years of experience in smoking cessation and lung cancer early detection programs.
The department's specialists have received training at leading centers around the world, including centers in the United States, and have extensive experience in the diagnosis and treatment of all respiratory diseases, both common and rare.
Diseases we treat
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Why at the Clínica?
- Leading clinical assistance with great work in research and teaching.
- Specialized nursing team.
- We work together with the Sleep Unit and the Lung Cancer Area.
Our expert lung nodule team
