Lung Cancer

Signs & Symptoms of Lung Cancer

Early Signs of Lung Cancer

What are the early symptoms of lung cancer—the  first signs that will tell you something is wrong? This is an important question for everyone, whether you have ever smoked or not. Lung cancer is an equal opportunity disease. It occurs in non-smokers, it occurs in women almost as frequently as men, and it occurs in young adults. In fact, lung cancer is increasing in young, never-smoking women.

Importance of Knowing the Symptoms of Lung Cancer

Even though lung cancer is so common—it's the leading cause of cancer deaths in both men and women in the United States—a  recent study found that only a small percent of the population was familiar with the most common symptoms.

And since there isn't a screening test for lung cancer available for everyone, understanding the signs is often the only way to find it as early as possible, before it has spread.

We know that the survival rate from lung cancer is better the earlier it is caught. The five-year survival rate for people with early stage lung cancer is approximately 50 percent, which drops to single digits in the advanced stages.

Unfortunately, nearly half of people are already in the advanced stages of lung cancer at the time of diagnosis.

Lung cancer can cause symptoms in several ways. It can cause symptoms by growing and pressing on airways and structures in and near the lungs. It can cause general symptoms related to cancer growth, such as fatigue and weight loss. And it can cause symptoms when it spreads to other regions of the body, such as the bones or the brain.

Common Signs and Symptoms of Lung Cancer

Roughly 90 percent of people have symptoms at the time a lung cancer is diagnosed. The other 5 to 10 percent may be diagnosed after a cancer is found on screening or is discovered incidentally when a test is ordered to evaluate an unrelated problem.

So why is the diagnosis often missed or delayed?

In addition to a lack of public awareness of the common signs and symptoms, it's important to note that the early symptoms of lung cancer may be subtle or vague. Instead of noting disabling hoarseness, a person may simply notice that he is clearing his throat more often than usual. Instead of being alarmed by shortness of breath, another may simply think she is out of shape or a has gained a few pounds when she becomes winded walking up a flight of stairs.

As you read through these signs and symptoms, place them in your memory, both for yourself and for your loved ones. It's not uncommon for people to see their doctor only after a loved one comments about one of these signs. Common symptoms may include:

A Cough That Doesn’t Go Away

A  persistent cough is the most common symptom of lung cancer. This 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 you think your cough is a normal smoker's cough. But a cough that lasts more than a few weeks can be a sign of something more serious.

A chronic cough as an early symptom of lung cancer is even easier to miss if you have a condition that predisposes you to a cough, such as asthma, COPD, allergies, or gastroesophageal reflux. If you are experiencing a persistent cough, talk to your doctor. Lung cancer is only one of the causes of a persistent cough, but a very important one. While lung cancer is found in only 2 percent of people with a chronic cough, 50 percent of people with lung cancer have a chronic cough at the time of diagnosis.

Shortness of Breath With Activity

Another common early symptom of lung cancer is shortness of breath that is present only with activity. This can 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.

Repeated Infections Such as Bronchitis and Pneumonia

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, especially if you don't have other typical chest infection symptoms such as a fever. Repeated chest infections could be related to smoking, a condition such as COPD, but could also be an early symptom of lung cancer. 

Coughing up Blood

Coughing up blood—termed "hemoptysis" in medical lingo—is a common symptom of lung cancer, and is the only symptom for 7 percent of people at the time of diagnosis. 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 and Arm Pain 

Tumors occurring in the upper portions of the lungs known as Pancoast tumors often lack "typical symptoms" of lung cancer. Instead, these tumors may cause pain in the shoulder (frequently severe), which radiates down the arm towards the pinky finger. Other symptoms of Pancoast syndrome may include weakness and tingling of the hands, and "Horner's syndrome"—a constellation of symptoms which may include a droopy eyelid, and flushing, and sweating of one side of the face. 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

Chest pain, which some people describe as "lung pain," 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 this pain may be felt as if it is coming from the lungs. Referred pain may also be felt in this region. Up to 50 percent of people with lung cancer have some chest or shoulder pain at the time of diagnosis.

Back Pain

Certainly, there are causes of back pain which are more common than lung cancer, but back pain is a relatively common first symptom of lung cancer. This may be caused by pressure from a tumor, irritation of nerve roots, spread to bones in the spine, or adrenal metastases—the adrenal glands are small organs set on top of the kidneys to which lung cancer commonly spreads. 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.

Unexplained Weight Loss

Unintentional weight loss is defined as the loss of 5 percent 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 20 percent to 70 percent of people with lung cancer prior to its diagnosis.

Less Common Signs and Symptoms of Lung Cancer

In addition to the symptoms mentioned above, there are several other symptoms that are not uncommonly associated with lung cancer. These can include:

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), but hoarseness in people with lung cancer is most commonly 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.

Face and Neck Swelling

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. 

Fatigue

It may seem like everyone experiences fatigue, but the 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.

Wheezing

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).

Blood Clots (Deep Vein Thrombosis and Pulmonary Embolism)

Blood clots are unfortunately common in people with lung cancer, even at the time of diagnosis. 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 common symptoms of a deep vein thrombosis, with symptoms of chest pain (often sharp and sudden) along with shortness of breath occurring if these clots dislodge and travel to the lungs (pulmonary embolus.)

Paraneoplastic Syndromes

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 percent to 20 percent 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 include hypercalcemia, in which the tumors (most commonly squamous cell carcinoma) secrete a substance which raises blood calcium levels causing thirst, muscle weakness and confusion, and the syndrome of inappropriate ADH (SIADH) in which the tumors secrete a substance lowering the blood sodium level causing headaches, weakness, and memory loss.

Symptoms of Lung Cancer Metastases

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 (due to brain metastases), back pain (due to bone metastases), and upper abdominal pain, nausea, and vomiting (due to liver metastases).

Any Abnormal Symptoms or a General Decline in Health—Your 'Gut' Feeling

From knee pain to anemia, this list could go on describing many more symptoms which could mean lung cancer. But an important symptom that hasn't been granted a medical name is your intuition. Your "gut feeling." What is your body telling you? Many people remark that prior to their diagnosis of lung cancer, they just weren't feeling right or were wondering if something was wrong. Heed that warning if your body declares it, and talk to your doctor.

Symptoms of Lung Cancer in Non-Smokers and Women

In recent years we've heard a lot about how the symptoms of heart attacks in women differ from those in men. We are now learning that the symptoms of lung cancer in women are often different than those in men. In addition, the symptoms of lung cancer in non-smokers can differ from those in people who smoke. Since lung cancer is not high on doctor's radar screens for women, and especially non-smokers, it may not be diagnosed until the later stages of the disease. And a later diagnosis means less chance for a cure. 

In the past, lung cancers such as small cell lung cancer and squamous cell carcinoma were more common. These cancers, which are linked more strongly to smoking, tend to occur in the central areas of the lung, near the airways. Due to this location, they often cause symptoms fairly early; recurrent lung infections due to airway obstruction, or coughing up blood as they grow into the airways.

Now, lung adenocarcinoma is the most common cause of lung cancer and is the type of lung cancer most common in women and people who do not smoke. These cancers instead 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.

Diseases and Condition That Are Similar to Lung Cancer

In reviewing the signs and symptoms of lung cancer you'll notice that there are many other conditions which have similar signs and symptoms, In fact, a large number of people with lung cancer are first misdiagnosed with these other conditions, delaying treatment.

A chronic cough can be due to lung cancer, but may also be related to allergies, recurrent viral infections, or a multitude of other conditions. Both COPD and lung cancer may have similar symptoms. Tuberculosis not only raises the risk of developing lung cancer, but the two are not uncommonly misdiagnosed as the other. Since there is so much overlap between different diagnoses, it's important to talk to your doctor about all of your symptoms, even if any of those symptoms seem mild. The combination of symptoms you experience may be more important than individual symptoms.

When to See Your Doctor

If you have any of these symptoms, talk to your doctor. A study in the U.K. found that the median time between the onset of symptoms and the time when people sought medical attention for lung cancer was 12 months.

If you are a never smoker with these symptoms, don't dismiss the chance that it could be lung cancer, and get a second opinion if your doctor dismisses it. Lung cancer in non-smokers is the sixth 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. If you feel guilty about smoking, erase that guilt and make the appointment. Everyone—whether you have never smoked or have chain smoked throughout your life—deserves the best of care and treatment in facing lung cancer.

If you have a history of smoking, talk to your doctor about lung cancer screening before you have any symptoms. Screening is recommended for people who:

  • 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

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 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. If you aren't getting answers, get a second opinion.

Keep in mind—and remind your doctor if needed—that anyone with lungs can get lung cancer. As noted earlier, the diagnosis of lung cancer is often delayed in people who don't smoke. The message we consistently hear from lung cancer survivors is that you need to speak up. Being your own advocate in your health care could save your life. 

Sources:

American Cancer Society. Cancer Facts and Figures 2016. Atlanta: American Cancer Society; 2016. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2016/

Friedemann Smith C, Whitaker K, Winstanley K, and Wardle J. Smokers are Less Likely Than Non-Smokers to Seek Help for a Lung Cancer ‘Alarm’ Symptom. Thorax. Published online 21 Feb 2016.

Pass J, Carbone D, Johnson D, et al. Principles and Practice of Lung Cancer. 4th Edition. Williams and Wilkins: 2010.

Thomas K. Patient information: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics). UpToDate. 04/29/16. http://www.uptodate.com/contents/lung-cancer-risks-symptoms-and-diagnosis-beyond-the-basics

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