Symptoms of Stage 1 Lung Cancer

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The symptoms of stage 1 lung cancer are often vague. They may include a persistent cough, coughing up blood, and shoulder pain, among other signs. Because symptoms may be mild, they can easily be dismissed as due to something else, or they may go unnoticed entirely.

While having an understanding of the common signs and symptoms is critical in finding these cancers early, it's important to note that many lung cancers at this stage are asymptomatic. For this reason, lung cancer screening is crucial for those who are candidates for the test.

This article will explain the early symptoms of lung cancer, as well as complications, who should be screened, and when to see your healthcare provider.

Woman coughing

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Frequent Symptoms

With stage 1 lung cancer, many people do not have symptoms. In fact, a 2020 review found that 59% of people diagnosed with stage 1 lung cancer had no symptoms. That said, it's important to be aware of symptoms that may occur in order to diagnose the disease as early as possible.

Common symptoms of stage 1 lung cancer may include the following:

Persistent Cough

The most common symptom of lung cancer overall is a persistent cough: one that lasts for several weeks. The cough may be dry (one that does not produce phlegm or mucus) or wet (one that does produce phlegm or mucus), mild or severe, and may be continuous or come and go. The cough may worsen over time, but it is usually relatively gradual and can go unnoticed.

For those who smoke, a cough related to lung cancer can be indistinguishable from a "smoker's cough," which can make recognition more challenging. For those who smoke, a change in your "normal" cough may be the most important sign.

In a large study from China, a persistent cough was the most common symptom that led to the diagnosis of stage 1 lung cancer.

Coughing Up Blood (Hemoptysis)

Even stage 1 lung cancers, if they grow near the large airways, can result in coughing up blood. Coughing up blood (hemoptypsis) can be subtle, and you may note only a tinge of pink or red on a tissue. Even if it is only a small amount, however, this symptom should always be checked out.

While lung cancer is not the most common cause for coughing up blood, it is the first sign of the disease for 7%–35% of people.

In one study, hemoptysis occurred in only 20% of people with lung cancer, but of possible lung cancer symptoms, it was the strongest predictor that cancer was present.

Shoulder and/or Chest Pain

Most people don't think of lung cancer if they experience shoulder pain or chest pain, but these types of pain can be a symptom of lung cancer.

Shoulder pain is very common in advanced lung cancer but can occur during stage 1 disease as well. One type of tumor, a pancoast tumor, grows near the top of the lungs (superior sulcus). Due to its location, it can place pressure on nearby nerves that lead to the shoulder and arm, causing shoulder pain, pain and swelling in the upper arm on the affected side, and weakness, numbness, or tingling of one hand. The pain is most severe in the shoulder, but it often radiates down the inside of the arm to the pinky finger on the affected side.

The pain due to a pancoast tumor may be severe and constant, and it frequently leads people (and healthcare providers) to initially think a bone or joint problem is present. These tumors are also often missed on a chest X-ray due to their location, which can further delay the diagnosis.

Chest pain may also occur early in the course of lung cancer if a tumor is located near the lining of the lungs (the pleura). Pain related to a tumor in this region is usually described as pain with a deep breath (pleuritic chest pain) and is often sharp and intermittent.

Lung adenocarcinomas are the type of lung cancer that often grows on the periphery of the lung near the pleura. They are the most common type in women and people who have never smoked.

Recurrent Respiratory Infections

Recurrent respiratory infections can also be a sign of stage 1 lung cancer, though less common than the above symptoms. If a lung cancer is growing near the airways, it may cause a partial obstruction. This obstruction, in turn, increases the risk of recurrent respiratory infections such as bronchitis or pneumonia.

While upper respiratory infections (such as colds) are common, and most adults experience three or four yearly, more than one episode of pneumonia in the span of a year is a reason to look further for an underlying cause.

Wheezing

Wheezing sounds like a squeal from the lungs that occurs with exhaling. Conditions such as asthma are a more common cause than lung cancer, but if a tumor is present in one of the airways it may lead to wheezing which may be heard primarily on one side of the chest. There is a saying in medicine that "not all that wheezes is asthma," and, even in people who ordinarily have asthma, a change in symptoms should be investigated.

Shortness of Breath

Shortness of breath is usually a sign of more advanced lung cancers, but it has been noted at times with stage 1 disease. When present, shortness of breath is usually relatively mild and may only be noticeable with exertion such as walking up and down stairs. At this stage, it's often easily dismissed as being related to age or being less active than usual.

Chest X-Rays and Lung Cancer Diagnosis

If you've seen your healthcare provider and been given the all-clear sign based on a chest X-ray, but continue to have symptoms, don't dismiss what you are feeling. Chest X-rays can be valuable in diagnosing lung cancer but miss up to 25% of tumors. A computed tomography (CT) scan may be needed.

In one study, one-third of people who were diagnosed with lung cancer had seen three or more doctors before the diagnosis was made. If your symptoms continue, make another appointment or get a second opinion.

Rare Symptoms

Since stage 1 lung cancer has not spread to distant regions of the body, symptoms of metastatic cancer (stage 4, in which the cancer has spread to distant parts of the body) are usually absent. These may include:

  • Unexplained weight loss
  • Loss of appetite
  • Hoarseness (often when a tumor spreads to lymph nodes)
  • Clubbing (a condition in which the fingers take on the appearance of upside down spoons)
  • Superior vena cava syndrome (a condition in which a tumor presses on the large blood vessel returning blood to the heart, resulting in swelling in the face and arms)
  • Symptoms related to spread to distant organs, such as headaches and seizures (brain metastases) or bone pain or weakness (bone metastases)

Some tumors, especially small cell lung cancers and squamous cell carcinomas, may release chemicals that act like hormones in the body. These paraneooplastic syndromes cause a wide variety of symptoms ranging from weakness and muscle cramping (hypercalcemia) to swelling of the face to weight gain (Cushing's syndrome), and more.

The important point is that the symptoms of lung cancer might not be readily attributable to the lungs.

Complications

Complications are less common with stage 1 lung cancer than with later stages of the disease but still may occur. In some cases, these complications may be the first signs of lung cancer. Potential complications may include:

Coughing up blood (hemoptysis): Coughing up more than 1 teaspoon of blood is considered a medical emergency and requires immediate care. Roughly 20% of people who have lung cancer will experience hemoptysis at some time.

Coughing up over 100 milliliters (ml) of blood (slightly less than half a cup) of blood is considered massive hemoptysis and has a high mortality rate. If this occurs, a person should call 911 rather than be driven to the hospital.

Blood clots: Blood clots are common with lung cancer, affecting roughly 15% of people with the disease. These clots can occur early in the disease and are sometimes the first symptom of lung cancer. Blood clots (deep venous thrombosis) most often begin in the legs and can cause redness, tenderness, and swelling.

If these blood clots break off and travel to the lungs (pulmonary emboli), people may experience severe shortness of breath, palpitations, and loss of consciousness.

Depression: Up to 25% of people with lung cancer will experience clinical depression. Symptoms of depression can include crying, but also anger and irritability. Some people may feel a sense of hopelessness. For most people, there will be a decreased interest in activities that were previously enjoyable. Fortunately, treatment can be very effective.

The risk of suicide is also very real with lung cancer, and highest early on after a diagnosis. In fact, suicide is most common during the first seven months after a diagnosis is received. It's thought that 6% of people overall with cancer (and more with lung cancer) think about or consider suicide at some time.

Help for Suicidal Thoughts

If you're concerned about a loved one with cancer who appears to be depressed, don't be afraid to ask. It's also important to seek help if you find yourself having thoughts of suicide. If you or a loved one are having suicidal ideation, talk to your doctor or call the National Suicide Hotline for immediate assistance. The number for the National Suicide Prevention Hotline is 800-273-TALK (8255) and is answered 24 hours a day 7 days a week.

When to See a Healthcare Provider/Go to the Hospital

Lung cancer is most treatable in the early stages of the disease, and when found at stage 1, many of these tumors may be cured.

Keep in mind that people who have never smoked can and do develop lung cancer. At the current time, roughly 20% of women who develop lung cancer in the United States have never smoked.

Symptoms that should prompt calling your healthcare provider for a checkup include:

  • If you have a persistent cough
  • If you cough up blood, even just a trace on a tissue
  • If you feel short of breath with activity
  • If you experience shoulder pain or chest pain
  • If you feel pain, swelling, or redness in one leg
  • If you feel you have more than one episode of pneumonia in a year
  • If you are feeling depressed or experience suicidal thoughts
  • Any symptom that is unexplained and is not normal for you

Emergencies are uncommon with stage 1 lung cancer but may occur. It's best to call 911 if you experience:

  • Severe chest pain
  • Severe or sudden onset shortness of breath
  • Coughing up more than 1 teaspoon of blood
  • Light-headedness or unconsciousness

Who Should Be Screened for Lung Cancer?

If you smoke or have smoked in the past, you may be a candidate for lung cancer screening. When done according to guidelines, screening can often detect lung cancer in the earliest, most treatable stages and can save lives. In fact, screening for lung cancer could save more lives than screening tests for all other cancers put together. You may be a candidate if:

  • You have a 20 pack-year history of smoking.
  • You are over the age of 50.
  • You currently smoke or have quit in the past 15 years.

In some cases, other risk factors may prompt your healthcare provider to recommend screening, such as a family history of lung cancer or radon exposure in the home.

Summary

The signs and symptoms of stage 1 lung cancer are often mild and vague. These may include a chronic cough, coughing up blood, wheezing, recurrent respiratory infections, or even the sudden urge to quit smoking. More than half the time, however, symptoms are absent, and lung cancer screening is the best guarantee (at least for people who have smoked) to find these cancers early.

A Word From Verywell

It's relatively uncommon to diagnose lung cancer at stage 1 of the disease, and for that reason, it's important to be aware of the symptoms. Since symptoms can be mild and vague and don't necessarily point to the lungs, it's important to talk to your healthcare provider about any symptoms that concern you. This is true even if you feel the symptom is relatively trivial.

Symptoms are our body's way of telling us that something is wrong. At the same time, similar to putting together a puzzle, telling your healthcare provider about a symptom that seems unrelated may be the last piece that's needed to put the picture together.

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