If your doctor has told you that you have a lung mass, it can be terrifying. What do physicians mean when they say “lung mass,” what are possible causes, and what tests might be recommended to determine the cause?
Definition of a Lung MassA "lung mass" is defined as an abnormal spot in the lungs that is more than 3 cm (1 ½ inches) in size. If a spot (or spots) is less than 3 cm in diameter, it is called a "lung nodule."
Possible CausesUnfortunately, the most common cause of a mass in the lungs is one of the types of lung cancer. Lung cancer is the leading cause of cancer deaths in men and women in the United States and can occur even in people who have never smoked. In fact, the majority of people who develop lung cancer at this time do not smoke. The are either former smokers or never smoked -- twenty percent of women who develop lung cancer have never smoked a cigarette. That said, there are benign (non-cancerous) causes of lung masses. Some causes of a lung mass include:
- Lung cancer.
- Other cancers – Other cancers that may appear as a mass in the lungs include lymphomas and sarcomas.
- Benign (non-cancerous) lung tumors – Such as hamartomas.
- Metastases (spread) of cancers from other regions of the body to the lung. The most common of these are breast cancer, colon cancer, bladder cancer, and prostate cancer.
- Lung abscesses.
- AV Malformations - An abnormal connection between arteries and veins that is usually present from birth.
- Lipoid pneumonia.
- Infections - Fungal infections such as
coccidiomycosis and blastomycosis, and parasitic infections such as echinococcus (hydatid cysts).
- Pulmonary artery aneurysms – An outpouching in the arteries that travel from the heart to the lungs.
- Amyloidosis - A build up of abnormal proteins that forms a mass.
What Are the Chances That My Lung Mass Is Cancer?Sadly, the most likely diagnosis if you have a lung mass is lung cancer. Yet there are many non-cancerous causes, as noted above. A lung mass is more likely to be cancerous if it is described as “ground glass” on an imaging report, whereas the finding of “calcifications” is more common in benign tumors. If a tumor is described as “cavitary” it is also more likely to be benign. A history of smoking, or working in occupations with exposures to cancer causing substances raises the chances that a tumor is cancer.
What Tests Are Done?The first thing your doctor will want to do is perform a careful history and physical. Some of the questions she might ask include:
- Have you ever smoked?
- Have you traveled recently?
- What other medical conditions do you have?
- Do you have a family history of any medical problems including lung conditions?
- Are you having any symptoms such as a persistent cough, coughing up blood, shortness of breath, pain in the area of your lung, shoulder, or back, or unexplained weight loss?
Depending on the results of a careful history and physical exam, further tests might include:
- A CT scan - If your doctor noted a lung mass on a chest x-ray, one of the first things she may recommend is a CT scan to look at the mass more closely. This can help define the size and location of the mass, and sometimes make sure that the mass wasn’t an “artifact” on the x-ray – that is, something that looked like a mass but wasn’t, such as an overlap of tissues.
- MRI studies.
- A PET Scan – A PET scan is an imaging study that looks for active growth in an area that is suspicious. For example, a suspicious area that does not light up on a PET scan may be old scar tissue, whereas an area that lights up (shows sign of active growth) is more likely to be a cancerous tumor.
- A Bronchoscopy – If the mass is located in the central area of the lungs near the large airways, a bronchoscopy may be recommended. During a bronchoscopy, doctors can look for abnormalities in and near the large airways and take a biopsy if needed.
- A fine needle biopsy – If your lung mass is in the outer regions of the lungs, your doctor may recommend a biopsy with a needle that is placed through the chest wall and into the mass to get a tissue sample.
- Lung surgery – Sometimes it may be difficult to get a sample of the cells in your lung mass with either a needle biopsy or via a bronchoscopy. If this is the case, thoracic surgery may be recommended to get a sample of tissue.
TreatmentThe treatment of your lung mass will depend upon the underlying cause. If it is a cancerous tumor of the lung or from the spread of a cancer from another region of the body to the lung, treatment options may include surgery, chemotherapy, or radiation therapy. Other less common causes of lung masses, such as infections, will be treated based on the diagnosis you and your doctor determine after testing.
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