Lung cancer continues to be the #1 cancer killer in the U.S., but only 16% of people eligible for lung cancer screening are getting the lifesaving scan. When caught early, lung cancer can often be treated with surgery alone, and the likelihood of surviving five years or more improves to 65%. Once lung cancer is suspected on a scan, minimally invasive diagnostic procedures and comprehensive biomarker testing are critical to identify next steps and treatment options upon diagnosis.
“Unfortunately, most lung cancers are discovered incidentally or when they have progressed to an advanced stage. Early-stage lung cancer typically has no symptoms so a nodule may be found when someone gets a chest X-ray for an unrelated problem,” explained Amit "Bobby" Mahajan MD, FCCP, DAABIP, Section Chief, Interventional Pulmonology Inova Medical System, Department of Surgery.
Lung cancer screening is the only sure way to catch cancer early for high-risk groups, before it metastasizes. But what happens if you find a nodule on your scan?
What to Do if a Nodule Is Found
Just because a nodule is found, doesn’t mean that it is cancerous. In fact, when your lung tissue encounters irritants, it is common for the body to create a barrier around the annoyance, or “create a nodule.” This is why you need to work closely with your healthcare provider after you receive the results of a scan.
If the lung nodule is small and present in a low-risk individual (someone without smoking history or family history of lung cancer) the nodule can be observed with repeat CT scans every 6 months to a year. If nodules are larger or are present in a high-risk individual, additional advanced scanning or procedures like a bronchoscopy, lung biopsy or even surgery may be needed. “I explain to patients that further understanding of what is causing a nodule is dependent on data. Lung cancers tend to grow over time, so any increase in size may indicate cancer,” said Dr. Mahajan. “To determine if a lung nodule is malignant, a healthcare provider will need to order a follow-up PET or CT scan to see if there is any growth.”
Old CT scans are very helpful in showing if the nodule is new or has been present for many years without change. Besides the appearance of your nodule, your healthcare provider will decide next steps based on individual risk factors like smoking, family and exposure history. “These aspects are taken together to develop a pre-test probability of cancer which can be calculated to determine if we should keep watching or biopsy.”
Getting Answers During Times of Uncertainty
Regardless of your smoking and medical history, it can be difficult not to spiral and worry after something is found on your scan. Dr. Mahajan suggests trying to find a skilled physician who can quickly perform diagnostic testing as waiting for results can be the worst part. He also thinks it is essential for patients to be educated about the process and advocate for themselves by asking questions. “When it comes to a patient’s health, they should have time and availability of the team to answer all questions,” he said. “If there are language or cultural barriers, it is our job to make sure that resources are available, such as interpreters, to ensure that everything being said is clearly understood.”
When it comes to care, a patient should ask about the least invasive but most effective way to get data about their condition. Additionally, patients should ask about the plan for genetic testing if cancer is present.
Next Steps and Moving Forward
“The most important thing to remember is that with advancements in medicine, even if diagnosed at a late stage, our ability to treat cancers with significantly fewer side effects and better outcomes has greatly improved,” Dr. Mahajan said.
Over the last 10 years, the world of cancer therapy has evolved dramatically. Precision oncology and targeted therapies have changed the game when it comes to treatment of advanced cancer. Previously, the most effective therapy for late-stage cancer was chemotherapy, which unfortunately has many side effects because it attacks both cancerous and normal cells alike. Fortunately, new technologies can determine the exact genetic abnormality causing the growth of cancer cells and target them. These targeted therapies can be used with significantly fewer side effects. “Patients need to advocate for themselves and ask to have their care performed quickly and with empathy.”
To learn more about Lung Cancer Screening next steps, visit SavedByThe Scan.org.
Blog last updated: November 7, 2025
