Pulmonary Nodule Clinic Frequently Asked Questions

Answers to FAQs about our Pulmonary Nodule Clinic, by the clinic's expert team of multidisciplinary specialists.

Why have I been referred to the Pulmonary Nodule Clinic?

You have been referred to the Pulmonary Nodule Clinic because a nodule was detected on a CT scan of your chest. The CT scan could have been either a:

• Lung Screening CT scan, which you would have had if your doctor thought you had a high chance of developing lung cancer, or a
• CT scan for another reason and a nodule was found. This is considered an “incidental finding”

The Pulmonary Nodule Clinic watches and evaluates nodules found from both types of scans.

Does this mean that I have cancer or will develop cancer?

Having a nodule does not mean that you have cancer or that you will develop cancer.

What are pulmonary nodules?

• A pulmonary nodule is a small irregularity within the lung tissue. It can be round or oval-shaped
• There are two types of pulmonary nodules: non-cancerous (benign) and cancerous (malignant)
• Often nodules are non-cancerous and may resolve over time
• Some causes for non-cancerous nodules include:
• Infection
• Inflammation (swelling)
• Growths that are not normal, such as:
• Fibroma (fibrous connective tissue)
• Hamartoma (abnormal grouping of normal tissues)
• Neurofibroma (nerve tissue)
• Sometimes, a small nodule may be an early, developing cancer. The cancer is easier to cure when caught early and when surgery is performed.
• Some types of cancerous tumors include:
• Lung cancer (non small cell, small cell and carcinoid are types of lung cancer)
• Adenocardinoma (abnormal growth of glandular cells)
• Lymphoma (a growth containing lymphoid tissue)
• Carcinoid (a small, slow growing cancerous tumor)
• Sarcoma (a tumor consisting of connective tissue)
• Metastatic tumors (tumors that have spread to the lungs from cancer in another part of the body)

What size nodules are seen in the Pulmonary Nodule Clinic?

The nodules seen in the pulmonary module clinic measure between 6 and 20 millimeters (mm).

6 mm is about the size of a pencil eraser.

20 mm is about the size of a penny from top to bottom.

What if the size of my nodule does not fit into this range?

• If your nodule is smaller than 6 mm: It does not need to be watched in the nodule clinic, but your primary care doctor may obtain another CT scan in 12 months, to see if the nodule grows over time. Your doctor should refer you to us if the nodule grows to be 6 mm or larger.
• If your nodule is larger than 20 mm: It is usually referred to as a “mass” and not a nodule. Patients with a mass are referred to a different clinic within the Thoracic Oncology department.

Why is it important to monitor pulmonary nodules?

Most pulmonary nodules are not cancerous. If a nodule is an early developing cancer, it has the best chance of being cured if it is detected and treated as early as possible.

How does my team of specialists in the Pulmonary Nodule Clinic prepare for my visit?

We bring a highly specialized team of thoracic physicians including oncologists, radiologists, surgeons, and pulmonologists together in a conference to review your imaging and history. We review your CT scan images and compare with any other CT scans you may have had. We look for any changes in development or resolution of irregularities seen on the scans. The team together identifies the best next step in monitoring or treating your nodule.

What is the benefit of having my team of specialists meet together in a conference?

Meeting in a conference reduces how many appointments you have because all specialists are together at one time. If your nodule needs to be treated, there will not be a delay in treatment.

How can I schedule an appointment in the Mass General Pulmonary Nodule Clinic?

Once we receive a referral from your doctor, our nurse navigator will contact you to complete an intake. The intake helps us to learn more about your history, the reason for your CT scan and any prior CT scans that you may have had. If you have been referred to the Pulmonary Nodule Clinic, but have not yet heard from our nurse, please call us at 617-643-8728.

I am not a patient at Mass General. Can I be seen in the Mass General Pulmonary Nodule Clinic?

Yes! If you have had a CT scan which reveals a nodule measuring 6 mm or more, please call our nurse navigator to complete an intake. We will ask that you send us your imaging and records for review. We will then schedule an appointment in the clinic. We do require that your CT scan be completed within the past year. If it was done more than one year ago, we suggest you follow up with your primary care doctor to obtain more current imaging.

If you are not yet registered as a patient at Mass General, please call 866-211-6588 to obtain a medical record number.

What happens during my first visit?

• Just before your visit, a team of physician specialists meet in a conference to review your scans. Your history is presented by the nurse navigator to the team. A thoracic radiologist will present the images and point out any irregular findings and compare them to any prior scans that you have had. Together, the team will review the location and characteristics of your nodule as well as how it has changed over time and then discuss a plan to either monitor or consider further diagnostic studies to provide more information. A specialist that is best suited to your needs will be assigned to see you for your appointment to share this information with you and make recommendations. They will also perform an exam and answer all of your questions. During this time, and with your input, the final plan will be determined. You will be scheduled for a follow up appointment or additional diagnostic tests or procedures.
• If your nodule is small or its features suggest a low likelihood that it represents cancer, we may recommend that imaging is repeated in an interval of weeks or months to monitor stability.
• Nodules may be monitored at intervals (for example 3, 6, or 12 month) for two years to assure stability.
• If your nodule shows more concerning characteristics, further diagnostic tests may be recommended such as a PET CT or perhaps a biopsy.

What happens next?

• At the end of your appointment, you will be scheduled either for a follow up appointment or additional diagnostic tests or procedures.
• Please call our nurse navigator at 617-643-8728 if you have any questions about follow up appointments, or if you need to make any changes to scheduled appointments.
• Let us know if you would like to be connected with a free smoking cessation counselor for additional support.