Signs and Symptoms of Lung Cancer

Signs and symptoms of lung cancer range from what may immediately come to mind when you think of the disease (e.g., persistent cough, shortness of breath, coughing up blood) to perhaps more surprising symptoms like hoarseness, back pain, and shoulder pain.

This varies from patient to patient. Symptoms can differ depending on whether a person is male or female, a smoker or nonsmoker, and even by age.

Anyone can get this disease. And since screening is not done on everyone, an awareness of lung cancer symptoms is important to detecting the disease as early as possible.

Frequent Symptoms

There are several signs of lung cancer that are relatively common, although they can be subtle and easily attributed to something else.

Symptoms you shouldn't ignore include:

• A cough that doesn't go away
• Shortness of breath with activity
• Repeated respiratory infections (e.g., bronchitis, pneumonia)
• Coughing up blood
• Shoulder, arm, chest, or back pain
• Unexplained weight loss

Persistent Cough

A persistent cough is the most common symptom of lung cancer and is found in around 50% of people at the time of diagnosis. The cough may be dry or wet (producing mucus), frequent or infrequent, and occur at any time of the day.

Many people dismiss a persistent cough, attributing it to something else like allergies or dry air during the winter months. Smokers may think it's smoker's cough.

But a cough that lasts more than a few weeks can be a sign of something more serious.

Shortness of Breath With Activity

Another common early symptom of lung cancer (especially in never-smokers) is shortness of breath that is present only with activity. This can easily be overlooked and blamed on getting older, being sedentary, or being overweight.

If you notice that you are hesitant to take that hike, become winded with sexual activity, or blame the humidity for making it more difficult to breathe (or something similar), make an appointment to talk to your doctor.

Repeated Infections

It’s common for someone to discover that they have lung cancer after being treated for repeated episodes of bronchitis or pneumonia. If a tumor is located near an airway, it can block it, which makes these infections more likely.

If you have recurrent chest infections, talk to your doctor about chest computed tomography, otherwise known as a chest CT scan. This is preferred to a chest X-ray, which can miss lung cancer up to 25% of the time.

Coughing Up Blood

Coughing up blood (hemoptysis) is a common symptom of lung cancer. It occurs in about a fifth of lung cancer patients, sometimes as the first symptom.

While coughing up blood may sound like something that would be hard to miss, many people may notice only a small amount of blood-tinged sputum on a tissue.

Shoulder and Arm Pain

Shoulder pain can be a symptom of lung cancer and is sometimes the first symptom.

Tumors occurring in the upper portions of the lungs known as Pancoast tumors may cause pain in the shoulder (frequently severe) that can radiate down the arm toward the pinky finger.

In addition to lacking "typical" lung cancer symptoms, these tumors can be hard to detect on imaging studies. The diagnosis is often delayed.

Chest Pain

Chest pain, which some people describe as lung pain or pain with a deep breath, can occur with lung cancer. It is common even in early-stage disease.

While the lungs themselves do not have pain fibers, the lung lining (pleura) and structures surrounding the lungs have nerve endings. Because of this, the pain may feel as if it is coming from the lungs.

Referred pain, which is pain stemming from a completely different area of the body, may also be felt in this region.

Back Pain

Certainly, there are causes of back pain that are more common, but back pain is a common symptom of lung cancer and is often the first symptom.

This may be caused by pressure from a tumor, irritation of nerve roots, spread to bones in the spine, or adrenal metastases—the spread of cancer to the small organs that sit on top of the kidneys.

Back pain related to lung cancer is often:

• In the mid- to upper-back
• Present at rest as well as with activity
• Worse at night and with a deep breath

Unexplained Weight Loss

Unintentional weight loss is the loss of 5% of body weight or more than 10 pounds during a six to 12-month period. It occurs in 35% to 75% of people with lung cancer prior to diagnosis.

There are several ways in which cancer can cause weight loss, ranging from a loss of appetite to changes in metabolism related to a tumor.

Less Common Symptoms

In addition to the symptoms mentioned above, there are several others that can be associated with lung cancer.

Less common symptoms of lung cancer can include:

• Hoarseness
• Fatigue
• Wheezing
• Paraneoplastic syndromes
• A feeling that something is wrong

Hoarseness

Lung cancer can cause a hoarse voice in a few ways.

Tumors in the chest can directly cause pressure on the vocal cords (larynx). Hoarseness in people with lung cancer can also sometimes be caused by pressure on the recurrent laryngeal nerve, which leads to the voice box.

Hoarseness—especially if it is persistent—needs to be evaluated thoroughly.

Fatigue

The so-called "cancer fatigue" sometimes associated with lung cancer is different than regular tiredness.

Some people describe this fatigue as whole-body fatigue or even exhaustion. It is the kind of fatigue that isn't easily remedied with a good night of sleep or a cup of coffee.

Wheezing

There is a saying that "all that wheezes is not asthma." Lung cancer is one such possibility.

Of note is that wheezing related to lung cancer tends not to be generalized as it is with asthma. In fact, people are often able to describe where the wheezing originates in their lungs (localized wheezing).

Paraneoplastic Syndromes

Some lung cancers release hormone-like substances that can cause a unique group of symptoms.

These symptoms, known as paraneoplastic syndromes, occur in around 10% to 20% of people with lung cancer (most commonly small cell lung cancer). They often arise before symptoms of the disease themselves.

Two of the more common paraneoplastic syndromes are characterized by hypercalcemia, in which the tumors (most commonly squamous cell carcinoma) secrete a substance that raises blood calcium levels. This causes thirst, muscle weakness, and confusion.

It also causes syndrome of inappropriate ADH (SIADH), in which the tumors secrete a substance that lowers the blood sodium level, causing headaches, weakness, and memory loss.

There are many different paraneoplastic syndromes, and they can cause a variety of symptoms. This is another reason you should see your doctor if you just don't feel right.

A Gut Feeling

From knee pain to fatigue, the list of potential signs of lung cancer is lengthy. But an important one that hasn't been granted a medical name is your own intuition.

Many people remark that prior to their diagnosis they had a "gut feeling" that something was wrong.

Heed that warning if your body declares it and talk to your doctor.

Complication-Related Symptoms

Complications of lung cancer can appear after diagnosis. But in some cases, they may occur before that and actually be what tips you off that something is wrong.

Face and Neck Swelling

Lung cancer tumors can press on the superior vena cava, the large blood vessel that returns blood to the heart from the upper part of the body.

This can cause blood flow through that vein to become fully or partially blocked—a complication known as superior vena cava (SVC) syndrome.

When this occurs, blood flow is impended and pressure builds up in the areas the vein usually drains blood away from. This can cause swelling of the face, neck, and arms, as well as dilated veins in the neck and chest.

Symptoms Related to Cancer Spread

Lung cancer is frequently diagnosed after it has already spread (metastasized) to other regions of the body.

The most common regions to which lung cancer spreads include the brain, the bones, the liver, and the adrenal glands.

Some possible related symptoms include:

• Headaches, weakness, or seizures (with brain metastases)
• Back pain, weakness, or changes in urinary and bowel control (with bone metastases)
• Upper abdominal pain, nausea, jaundice, and itching (with liver metastases)

Blood Clots

Blood clots are common in people with lung cancer. Though cancer treatments such as surgery and chemotherapy are known to increase this risk, these clots may occur even before lung cancer is diagnosed.

Leg/calf pain and swelling are symptoms of a deep vein thrombosis (DVT).

Chest pain (often sharp and sudden) along with shortness of breath may occur if the clots dislodge and travel to the lungs—what's called a pulmonary embolus.

Sub-Groups

Just as the symptoms of heart disease in women differ from those in men, so too can the symptoms of lung cancer. Similarly, the symptoms in never-smokers and young adults are not always typical.

The most common type of lung cancer in these different groups is the main reason for these differences.

Take squamous cell carcinoma, for example. This type of lung cancer grows in the large airways, rather than the outer edges of the lungs. Due to its location, this cancer often causes symptoms fairly early on, such as coughing, coughing up blood, or recurrent lung infections due to airway obstruction.

As men are more likely to develop squamous cell carcinoma than women, they may experience more prominent symptoms early on.

These cancers usually occur in the outer regions of the lungs and can grow quite large before causing any symptoms. The first symptom with adenocarcinoma may be a vague sense of shortness of breath as the tumor takes over lung tissue or another non-specific symptom, such as fatigue or loss of appetite.

Due to the often atypical symptoms and the fact that lung cancer isn't usually on a doctor's radar for people in these groups, lung cancer is more likely to be diagnosed in the later stages of the disease in these individuals.

When to See a Doctor or Go to the Hospital

There is often a significant delay between the start of symptoms and the diagnosis of lung cancer.

Make an appointment to get checked out. If your doctor discounts the possibility of lung cancer or believes a chest X-ray is sufficient to rule it out, get a second opinion.

If you are a smoker with one or more of these symptoms, don't hesitate to call your doctor—even if you feel sure that "it's nothing" or "just a smoker's cough."

A 2016 study found that people who smoke are less likely to visit their doctors with warning signs of lung cancer than non-smokers. But the sooner a diagnosis is made, the greater the chance treatment will be successful.

Candidates for Lung Cancer Screening

Even if you don't have symptoms, you may be a candidate for lung cancer screening.

Screening using chest CT is recommended for people who:

• Are 50 to 80 years old
• Have a 20 pack-year history of smoking
• Currently smoke or have quit within the past 15 years
• Are healthy enough overall to tolerate and benefit from treatment if lung cancer is diagnosed

Screening may also be beneficial for individuals with other risk factors for lung cancer, such as radon exposure, occupational exposures, and a family history of the disease.

Frequently Asked Questions

Where would I feel back pain with lung cancer?

Back pain related to lung cancer is usually felt in the middle to upper back. Tumors may spread to the thoracic spine or other bones, or irritate nerves in the back. It's possible, though, that pain may be felt in the lower (lumbar) region of the back, depending on how tumors press on the spine.

What are early symptoms of lung cancer in women?

In women, symptoms are usually related to lung adenocarcinoma. They include:

• Fatigue
• Back or shoulder pain
• Shortness of breath

Does early-stage lung cancer cause a lot of pain?

No. As lung cancer tumors grow, they can put pressure on the spine and chest. But initially, there is little pain because there are very few nerve endings in the lungs themselves. If lung cancer spreads to bones, it can cause increased pain.

A Word From Verywell

It's important to note once more that nearly any symptom could be a warning sign for lung cancer.

If you have a symptom that is not confidently explained—whether it is on this list or not—talk to your doctor. Even if it's not lung cancer, it could be a sign of another serious condition.

Being your own advocate in your health care could save your life.