Signs and Symptoms of Lung Cancer

The early signs and symptoms of lung cancer may be "typical" such as a persistent cough, shortness of breath, or coughing up blood, or less common such as back pain, shoulder pain, or even knee pain. The symptoms may also differ depending on whether a person is male or female, a smoker or nonsmoker, and even by age. Anyone who has lungs can get lung cancer, and without a screening test for everyone, an awareness of these symptoms is important in detecting the disease as early as possible.

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

A persistent cough is the most common symptom of lung cancer, found in around 50% of people at the time of diagnosis. The cough may be dry or wet, frequent or infrequent, and occur at any time of the day. Many people dismiss a persistent cough, attributing it to something else. Perhaps it is allergies, a leftover cough following a cold, or dry air during the winter months. Or perhaps it's thought to be a normal smoker's cough. But a cough that lasts more than a few weeks can be a sign of something more serious.

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 out-of-shape, or perhaps due to those few extra pounds you've gained. 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, make an appointment to talk to your doctor.

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 cause an obstruction which predisposes you to these infections. If you have recurrent chest infections talk to your doctor about a chest CT. Chest X-rays can miss lung cancer, up to 25% of the time.

Coughing up blood—termed "hemoptysis" in medical lingo—is a common symptom of lung cancer, and occurs in about a fifth of lung cancer patients, sometimes as the first symptom. While coughing up blood may sound dramatic, many people may notice only a small amount of blood-tinged sputum on a tissue. Hemoptysis is also a symptom which can become serious rapidly. Coughing up even 2 teaspoons of bloody sputum is considered a medical emergency.

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

Chest pain, which some people describe as "lung pain" or pain with a deep breath can occur with lung cancer, and is common even in early stage lung cancers. While the lungs themselves do not have pain fibers, the lung lining (the pleura) as well as structures surrounding the lungs have nerve endings, and the pain may feel as if it is coming from the lungs. Referred pain may also be felt in this region.

Certainly, there are causes of back pain that are more common but back pain is a common symptom of lung cancer, and 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 these small organs that sit on top of the kidneys. Back pain related to lung cancer often occurs in the mid to upper back, is present at rest as well as with activity, and tends to worsen at night and with a deep breath.

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

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

Lung cancer can cause a hoarse voice in a few ways. Tumors in the chest can directly cause pressure on the vocal cords (larynx), but hoarseness in people with lung cancer is sometimes caused by pressure on a nerve leading to the voice box called the recurrent laryngeal nerve. A symptom of hoarseness—especially if it is persistent—needs to be evaluated thoroughly.

It may seem like everyone experiences fatigue, but the "cancer fatigue" that is sometimes associated with lung cancer is different. 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 good cup of coffee.

There is a saying that goes, "all that wheezes is not asthma" and lung cancer is one of those possibilities. 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).

Some lung cancers release hormone-like substances, which in turn 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) and often arise before the symptoms of the lung cancer itself.

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 causing thirst, muscle weakness and confusion, and the 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 syndromes and this is one reason you should see your doctor if you just don't feel right.

Any abnormal symptoms or a decline in your general health should prompt a visit to your doctor. From knee pain to anemia, the list could go on in describing potential signs of lung cancer, but an important symptom that hasn't been granted a medical name is your 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.

Complications of lung cancer may produce the first symptoms that indicate the condition, or they can appear after diagnosis.

A complication of lung cancer called superior vena cava syndrome (SVC syndrome) may cause swelling of the face, neck, and arms, and well as dilated veins in the neck and chest. These symptoms can occur when tumors in the lungs press on the superior vena cava, the large blood vessel returning blood to the heart.

Lung cancer is frequently diagnosed after it has already spread 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 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 are common in people with lung cancer. Though cancer treatments such as surgery and chemotherapy are known to increase risk, these clots may occur even before lung cancer is diagnosed. Leg and calf pain and swelling are symptoms of a deep vein thrombosis. Chest pain (often sharp and sudden) along with shortness of breath may occur if the clots dislodge and travel to the lungs (pulmonary embolus).

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

The most common type of lung cancer in different groups plays a role in these differences. Lung cancers that are more strongly related to smoking, such as small cell lung cancer and squamous cell carcinoma (a type of non-small cell lung cancer) tend to grow near the large airways in the lungs. Due to this location, they often cause symptoms fairly early, such as coughing, coughing up blood, or recurrent lung infections due to airway obstruction.

Lung adenocarcinoma is now the most common type of lung cancer overall, and is the type of lung cancer most common in women, young adults, and people who do not smoke. These cancers usually occur in the outer regions (periphery) 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, and other non-specific symptoms such as fatigue, and loss of appetite.

Due to the often atypical symptoms, and the fact that lung cancer isn't high on a doctor's radar screen for these groups, lung cancer is more likely to be diagnosed in the later stages of the disease in women, never smokers, and young adults.

The treatment for lung cancer will often include surgery, radiation, or chemotherapy. People who are unable or unwilling to undergo those procedures may have a poorer prognosis.

If you have any of these symptoms, talk to your doctor. There is often a significant delay between the onset of symptoms and the diagnosis of lung cancer.

If you are a never smoker with these symptoms, don't dismiss the chance that it could be lung cancer. If your doctor dismisses the chance or believes a chest X-ray is sufficient to rule it out, get a second opinion. Lung cancer in never smokers is the sixth or seventh leading cause of cancer deaths in the United States.

If you are a smoker with these symptoms, don't hesitate to call your doctor. A 2016 study found that people who smoke are less likely to visit their doctors with warning signs of lung cancer than non-smokers. Even if you don't have any symptoms, talk to your doctor about lung cancer screening.

Lung cancer screening is now available for people who meet the following criteria:

• Are between the ages of 55 and 80
• Smoke or smoked for a total of 30 pack-years
• Continue to smoke or quit smoking in the past 15 years

Certainly there are risk factors for lung cancer that are as important as smoking, for example, radon exposure is the second leading cause of lung cancer (and leading cause in never smokers), occupational exposures play a role in up to 27% of lung cancers in men, and lung cancer can run in families. Talk to your doctor about your possible risk and whether lung cancer screening would be beneficial.

It's important to note once more that nearly any symptom could be a warning sign for lung cancer. If you have a symptom which is not explained—whether it is on this list or not—talk to your doctor. You are living in your body and only you know when something isn't right. There are also other conditions in addition to lung cancer which are serious.

Keep in mind—and remind your doctor if needed—that anyone with lungs can get lung cancer. Being your own advocate in your health care could save your life.