Signs and Symptoms of Lung Cancer

The early signs and symptoms of lung cancer may be "typical" (persistent cough, shortness of breath, or coughing up blood) or less common (back pain, shoulder pain, or even knee pain). Symptoms may also differ depending on whether a person is male or female, a smoker or nonsmoker, and even by age.

Anyone 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.

Symptoms you shouldn't ignore include:

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

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, 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. Or perhaps it's thought to be a 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 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.

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 (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 dramatic, many people may notice only a small amount of blood-tinged sputum on a tissue.

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; it is common even in early-stage disease. While the lungs themselves do not have pain fibers, the lung lining (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 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 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.

Less common symptoms of lung cancer can include:

• Hoarseness
• Face and neck swelling
• Fatigue
• Wheezing
• Blood clots
• Paraneoplastic syndromes
• Symptoms from metastases
• A feeling that something is wrong

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 the recurrent laryngeal nerve, which leads to the voice box. Hoarseness—especially if it is persistent—needs to be evaluated thoroughly.

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 good cup of coffee.

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).

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; 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 of potential signs of lung cancer could go on, 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.

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 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 on, such as coughing, coughing up blood, or recurrent lung infections due to airway obstruction.

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 people in these groups, lung cancer is more likely to be diagnosed in the later stages of the disease in these individuals.

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, as 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 (DVT). Chest pain (often sharp and sudden) along with shortness of breath may occur if the clots dislodge and travel to the lungs (pulmonary embolus).

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.

Screening may also be beneficial for individuals with other risk factors for lung cancer, such as radon exposure (the second leading cause of lung cancer and leading cause in never-smokers), occupational exposures, and a family history of the disease.

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 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.