Lung nodules and lung cancer

1. Symptoms and when to seek help

Get a cough lasting more than three weeks, or a change in a longstanding cough, checked. Other symptoms include unexplained breathlessness, recurrent or persistent chest infections, chest or shoulder pain, loss of appetite, weight loss and persistent fatigue. Hoarseness, difficulty swallowing, finger clubbing or swelling of the face or neck also warrant assessment. These symptoms commonly have other causes, but should not be ignored.

Early lung cancer may cause no symptoms. It can occur in people who have never smoked. A normal chest X-ray does not always exclude lung cancer: persistent or worsening symptoms need review.

2. What type of lung cancer is it?

Non-small-cell lung cancer (NSCLC) includes adenocarcinoma and squamous-cell carcinoma. Small-cell lung cancer (SCLC) behaves differently and usually needs a different treatment approach. A pathologist examines a tissue or cell sample to identify the type. Cancer that has spread to the lung from another organ is a secondary cancer, rather than a new primary lung cancer. Mesothelioma arises from the lining around the lung and has its own investigation and treatment pathway.

3. The diagnostic pathway

Your respiratory consultant reviews symptoms, previous scans, smoking and exposure history, medicines and general health. A contrast-enhanced CT scan provides detail about the lungs, lymph nodes and other structures and helps choose the next test. Small lung nodules are often benign; some need interval scans rather than immediate biopsy.

Tests are chosen to obtain useful information with the least reasonable risk. A bronchoscopy looks inside the airways and can obtain samples. EBUS uses an ultrasound bronchoscope to sample chest lymph nodes; EUS approaches selected nodes from the food pipe. CT-guided needle biopsy may suit an abnormality near the edge of the lung. Pleural fluid sampling, a pleural biopsy or occasionally surgical biopsy may be appropriate. Sometimes a safely accessible abnormality outside the lung provides the most useful sample.

A single procedure may establish both the diagnosis and the stage. Bleeding, infection and, with some biopsies, a collapsed lung are among the risks discussed before consent. A negative or insufficient sample may require further investigation. Your clinician will explain the expected result times and who to contact while waiting.

4. Staging: how far has it spread?

Staging describes the extent of cancer, rather than how unwell you feel. TNM describes the primary tumour (T), involvement of regional lymph nodes (N) and spread to distant sites (M). These findings are grouped into numbered stages. Clinical staging uses scans and samples; pathological staging after surgery can add information and sometimes change the stage.

In broad terms, stage I NSCLC is localised without lymph-node spread. Stage II involves a larger or locally extending tumour and/or certain nearby nodes. Stage III is locally advanced disease involving particular chest structures or lymph-node groups. Stage IV includes distant spread, which may involve another organ, the opposite lung or malignant pleural disease. These are simplified descriptions; the exact TNM combination matters.

Small-cell cancer may also be described as limited-stage or extensive-stage. Your team will explain the classification used in your case.

PET-CT can help identify active areas requiring further assessment, especially when treatment with curative intent is being considered. Infection and inflammation can also light up, so PET findings sometimes need a biopsy. Brain MRI or other targeted imaging is arranged according to cancer type, stage and symptoms. Not everyone needs every scan.

5. Biomarkers and personalised treatment

For suitable cancers, particularly non-squamous NSCLC, the laboratory looks for changes that may guide treatment. Examples include EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, NTRK and HER2 alterations. PD-L1 is a separate marker that can help inform immunotherapy decisions. The relevant test panel and available treatments depend on the cancer type and current guidance.

These usually describe changes within the tumour; they do not automatically mean an inherited condition. Tissue is often needed, although a blood-based liquid biopsy can help in selected situations. Molecular results may take longer than the initial diagnosis and can change the best treatment choice. Ask which results are pending before the treatment plan is finalised.

6. Assessing fitness and discussing options

The multidisciplinary team brings together respiratory medicine, radiology, pathology, thoracic surgery, oncology and specialist nursing. The team considers the cancer alongside your lung and heart health, day-to-day function and preferences.

Lung function tests, including gas transfer, assess breathing reserve. Selected patients have walking tests, cardiac assessment or cardiopulmonary exercise testing (CPET) to help judge treatment risk. Fitness is individual: age alone does not decide whether treatment is suitable.

Our wider specialist team includes radiologist Dr Harmeet Chana, thoracic surgeon Mr Nizar Asadi and oncologist Dr Andreas Polychronis. Your respiratory consultant coordinates the appropriate specialist input and hospital pathway.

7. Treatment for non-small-cell lung cancer

For suitable early-stage cancers, surgery aims to remove the cancer with nearby lymph-node assessment. For people who cannot have surgery or choose not to, stereotactic ablative radiotherapy (SABR) can offer focused treatment with curative intent in selected early cancers. Some patients benefit from medicines before surgery, after surgery, or both. For locally advanced disease, options include combined chemotherapy and radiotherapy, sometimes followed by further systemic treatment.

For metastatic NSCLC, treatment usually aims to control the cancer, improve symptoms and prolong life. A matching tumour alteration may allow targeted treatment. Immunotherapy, alone or with chemotherapy, is another option for suitable patients. Treatment choice depends on molecular results, PD-L1, cancer type, other illnesses and your priorities.

8. Treatment for small-cell lung cancer

Small-cell cancer is often treated promptly with chemotherapy. Limited-stage disease may receive chemotherapy with chest radiotherapy; surgery is reserved for uncommon, carefully selected very early cases. Extensive-stage disease may be treated with chemotherapy plus immunotherapy when suitable.

9. Side effects, symptom control and follow-up

Side effects differ between treatments. Your oncology team provides written information and an urgent contact number; report new or worsening symptoms promptly. Supportive and palliative care can accompany active cancer treatment from an early stage, helping with breathlessness, cough, pain, fatigue, appetite, anxiety and family support.

10. Screening and useful questions

NHS lung cancer screening is being rolled out in England for eligible people aged 55–74 who currently smoke or have smoked. Screening is for people without symptoms: do not wait for an invitation if you develop symptoms.

Ask your team: What type and stage is my cancer? Are biomarker results complete? Is treatment intended to cure or control it? What are the expected benefits and side effects? Are there alternatives or clinical trials? Who is my specialist nurse and whom should I call if I become unwell?

Information checked September 2026.

Sources and further information

• NHS: Lung cancer
• NICE NG122: Lung cancer diagnosis and management
• Cancer Research UK: Lung cancer
• Macmillan: Lung cancer

This guide gives general information for adults and does not replace individual medical advice.