Pulmonary nodules / Patient information
Lung nodules - information for patients
Telling someone their scan found a spot that is probably nothing, without making it sound like nothing or like everything.
About the small spot found on your scan Your scan has shown a small spot in the lung, which doctors call a nodule. Lung nodules are common. They are found in a large proportion of people who have a CT scan of the chest for any reason, and the great majority are not cancer. Most are the scar of an old infection - something that happened years ago and healed - or a small collection of harmless tissue. Because a small number do turn out to be important, we do not simply ignore them. The safest and least invasive way to tell the difference is to look again after an interval and see whether the nodule has changed. Why we are watching rather than removing it An operation to remove a nodule this small is a bigger undertaking than the problem usually warrants. Most nodules of this size are harmless, and surgery carries real risks. Watching is not us doing nothing; it is the test. Nodules that are not cancer stay the same size. Nodules that are growing show it on a repeat scan, and if that happens we act on it. What happens now Your next scan is due in [] . It will be arranged by [] . If the scans stay unchanged until [] , we will stop scanning and discharge you, because a nodule that has not changed over that period is very unlikely to be anything to worry about. If a scan shows a change, we will contact you and arrange to see you in clinic. What you should do Please do keep the appointments, even if you feel completely well. Feeling well is expected, and it does not tell us anything about the nodule. If you smoke, stopping is the most useful thing you can do. It reduces the chance that this nodule, or another one, turns out to matter. We can arrange support and medication. Contact your GP or us if you develop a new or changing cough, cough up blood, lose weight without meaning to, or become breathless. These are not expected from a nodule of this size, and they should be looked at rather than waited out. It is normal to find this unsettling Being told that something has been found, and then being asked to wait, is uncomfortable. Most people find the first few weeks the hardest, and it settles. If it is preying on your mind, tell us - it is a reasonable thing to ring about.
How to use it
The temptation is to reassure so hard that the person stops attending, or to hedge so hard that they spend three years frightened. The block tries to hold both: the nodule is probably nothing, and the scans still matter. Naming surveillance as the test rather than as a delay is the sentence that does most of that work. The last paragraph is there because incidental findings cause measurable and persistent anxiety, and naming it makes it easier to raise.
Why it says that
None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.
- BTS guideline for the investigation and management of pulmonary nodules (2015) Surveillance with interval CT as the primary strategy for nodules above the size threshold, with explicit advice on communicating with patients.
- Fleischner Society 2017 guidelines for management of incidental pulmonary nodules The prevalence figures behind the statement that nodules are common.
Trials behind it
- NELSON 2020 Volume CT screening reduced lung cancer mortality with a 2.1% referral rate
- NLST 2011 Low-dose CT screening reduced lung cancer mortality — at the cost of a 96% false-positive rate
Records on respiratorytrials.org.