NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

NCCN Guidelines for Patients® | Lung Cancer - Non-Small Cell Lung Cancer

16 NCCN Guidelines for Patients ® : Lung Cancer – Non-Small Cell, 2018 2 Assessing lung nodules Repeat testing Repeat testing This section is for lung nodules found by chance with CT. If a nodule is found during routine lung cancer screening, read the NCCN Guidelines for Patients ® : Lung Cancer Screening . The next steps of care for cancer screening are covered in these guidelines. Nodules found by chance Nodules found by chance with CT include solid and subsolid nodules. Subsolid nodules include both non- solid and part-solid nodules. Non-solid nodules are also called GGOs ( g round- g lass o pacities) or GGNs ( g round- g lass n odules). Options for follow-up care are grouped by whether a nodule is solid or subsolid. LDCT vs. diagnostic CT Often, the use of one imaging test doesn’t clearly reveal whether the nodule is cancer. Thus, tests need to be repeated to look for increases in nodule size or density over time. Such changes are likely signs of cancer. Most often, CT is used for follow-up imaging. It may be an LDCT ( l ow- d ose CT ) or a diagnostic CT. LDCT uses much less radiation than a standard scan. It also does not require contrast. Contrast is a dye that is injected into the body to make clearer pictures. It is used for a diagnostic CT. LDCT is preferred by NCCN experts for cancer screening unless a clearer picture is needed. Solid nodules Guide 2 lists the options for follow-up care for solid nodules. Options are partly based on whether you are at low or high risk for lung cancer. They are also based on the nodule size at baseline. If you get a second CT, your doctor will look for increases in nodule size and density. Low risk for lung cancer Your risk is low if you have none or minor risk factors. You must not have smoked or smoked very little. Other risk factors are absent or minor. <6 mm . Routine follow-up care is not needed for nodules smaller than 6 mm. They are likely not cancer among people at low risk. 6–8 mm . Between 6 and 12 months, re-assess nodules between 6 mm and 8 mm in size. If there’s no increase, think about getting CT between 18 and 24 months. >8 mm . There are three options for nodules larger than 8 mm. One option is CT at 3 months. If cancer is present, an increase in size or density may be seen by this point. A second option is to think about getting PET with CT. When used together, they are called a PET/CT scan. Your whole body or from the base of your skull to your knees can be scanned. PET/CT may detect cancer quicker than CTs repeated over a period of time. It may also show signs of cancer spreading in the body. The presence of cancer needs to be confirmed before starting treatment. Read the next section, Confirming cancer . A third option is to think about getting a biopsy. Instead of waiting for a scan, you could be tested for cancer now. However, sometimes a biopsy is not possible. Also, your doctor may think it’s better

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