Let's Talk About Lung Cancer Signs and Symptoms
Anytime you can spot cancer early, your odds of successful treatment go up—but in the case of lung cancer, that's a tall order. We asked the experts what red flags to look for when it comes to this disease.by Holly Pevzner Health Writer
Minds can race and worries mount once you start to wonder things like: Could this annoying, nagging cough be caused by something serious? Is my shortness of breath an indication of a bigger problem? Stop Googling. Quit panicking. We’re here for you. Our job here at HealthCentral is to offer you science-backed facts and expert-verified information to put your concerns in perspective. Here’s what some of the country’s top lung cancer doctors want you to know about the signs and symptoms of this challenging condition.
Our Pro Panel
We went to some of the nation's top experts in lung cancer to bring you the most up-to-date information possible.
Jorge Gomez, M.D.
Medical Director of the Thoracic Oncology Program and World Trade Center Oncology Clinic
Mount Sinai Hospital
New York, NY
Jacob Sands, M.D.
Thoracic Medical Oncologist and Instructor in Medicine
Dana-Farber Cancer Institute and Harvard Medical School
Elisabeth Dexter, M.D.
Thoracic Surgeon and Quality Assurance Officer for the Department of Thoracic Surgery
Roswell Park Comprehensive Cancer Center
It’s a pretty straightforward diagnosis for your doctor, but for the average person, it’s tough. That’s because early stages of the disease have almost no clear symptoms, so many people overlook possible warning signs until the cancer is pretty advanced. About 80% of lung cancers are not diagnosed until stage III or IV.
No, both smokers and nonsmokers have similar lung cancer symptoms. But because people who smoke often develop a chronic cough, it can be difficult for them to tell the difference between their usual hacking and a cough caused by the cancer.
In about 10% of lung cancer cases, people develop paraneoplastic syndromes. These are not caused by lung cancer itself, but rather by hormones, peptides, or cytokines produced by the cancer. Symptoms range from muscle weakness to fluid retention to abdominal pain.
When a tumor starts to grow in your lung, it cuts off the blood and oxygen supply to the remaining healthy lung tissue, making it harder for the lungs to do their job of passing that oxygen on to the rest of your body. This results in shortness of breath and fatigue.
What Is Lung Cancer, Exactly?
Let’s review. All cases of lung cancer begin with a small mutation in the DNA of a single cell or cells in your lungs. This mutation causes the cells to grow abnormally. As they multiply, they pass on the mutated DNA to new cells. Eventually, these abnormal cells cluster together to form a mass or tumor.
Over time, the tumor will grow, cutting off blood and oxygen to the remaining healthy lung tissue. In addition to making it difficult to breathe, lung cancer also limits the lungs’ ability to move oxygen throughout the body.
Every year, about 13% of all cancer cases diagnosed in the U.S. are for lung cancer. It affects more than 228,000 people annually in this country, making it the second-most common type cancer in both men and women. There are two types of lung cancer: the slower-growing non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), which tends to grow and spread more rapidly.
What Are the Most Common Lung Cancer Symptoms?
Lung cancer starts off as an oddly quiet disease, with few red flags early on. That’s partly because there are very few pain receptors inside your lungs, which means a tumor can develop and grow for a long while without causing any noticeable discomfort.
In fact, worrisome symptoms often don’t appear until the lung cancer tumor grows large enough to either irritate the airway or begin pressing against another organ, causing pain. Sometimes, symptoms don't set off alarm bells until the tumor has spread (metastatic lung cancer), creating problems in other areas of the body. Because of this, it can take about 8 years for certain non-small cell lung cancers to be diagnosed.
That said, there are common signs of lung cancer that you need to know about. And many individuals with lung cancer do experience these symptoms, but too often, they attribute them to something other than lung cancer. Smokers, for instance, may attribute a cough to their daily habit. Plus, there’s a fairly significant overlap of symptoms between lung cancer and other respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD). So people dealing with these chronic conditions may attribute lung cancer symptoms to the wrong disease, delaying diagnosis and treatment.
Despite their different growth trajectories, non-small cell lung cancer and small cell lung cancer share pretty similar symptoms. While signs vary from person to person, they may include the following:
Back pain. A growing tumor in the lungs can put pressure on the spine or impact the nerves around the spine, causing pain.
Chest pain. When this occurs, especially when breathing in deeply or laughing, it’s often due to enlarged lymph nodes or when cancer is in the chest wall.
Coughing up blood or bloody phlegm (hemoptysis). A bloody cough can occur when a lung cancer tumor begins to erode blood vessels.
Fatigue. It’s thought that cancer-related fatigue happens because of a shift in levels of certain proteins and hormones that are linked to the inflammatory process.
Finger clubbing. Lung cancer can cause fingers and nails look puffy because there is less oxygen in the blood due to the tumor.
Hoarseness. When lung cancer involves the laryngeal nerve, it can affect the vocal cords.
Lung infections. Frequent bouts of bronchitis or pneumonia can occur when lung cancer tumors obstruct the airways.
Painful swallowing (dysphagia). At times, a tumor can press against the esophagus or pharynx, making to difficult to swallow.
Persistent cough. A cough that worsens with time—or changes over time—is a red flag for lung cancer. This can be any type of cough, including a dry cough or a wet cough.
Shortness of breath. Wheezing or gasping for air happens when the airway is constricted or inflamed, or when fluid accumulates in the space between the lung and the chest wall.
Weight loss. Unexpected weight loss is a red flag for many types of cancer, including lung cancer, possibly as result of having a hard time swallowing. At the same time, cancer cells use up so much energy that it can alter the way the body processes calories from food.
Do These Symptoms Mean I Have Lung Cancer?
Nope, not necessarily. The thing is, it’s not possible to make a completely neat and clean list of signs and symptoms that—ding, ding, ding—automatically signal lung cancer. Plain and simple: There are any number of reasons you might experience one or all of the symptoms above, and lung cancer is just one possibility.
In short, you cannot diagnose lung cancer on your own. Rather, if any of the above symptoms persist, or you’re experiencing new, unexplained shortness of breath and an intractable cough, you need to see your doctor—even if you’re pretty sure it’s nothing.
Studies show the lag time between concern over symptoms and actual diagnosis can take approximately 4.5 months—precious time lost when it comes to tackling the disease. The delay in diagnosis happens on both sides: People are reluctant to take a cough or other indicators seriously, while doctors can sometimes initially mistreat with a prescription for antibiotics, inhalers, or cough medicine.
What Are Other Related Symptoms of Lung Cancer?
Along with the classic list above, there are some symptoms of lung cancer that may seem like real head-scratchers. These signs often go hand-in-hand with syndromes caused by lung cancer, not lung cancer itself. Keep a lookout for these syndromes and their warning signs.
Non-small cell lung cancer (NSCLC) can cause tumors to grow in the upper part of the lungs, invading certain nerves related to the eyes, face, and arms. This leads to a condition called Horner syndrome, which occurs in less than 5% of lung cancer patients. Signs include:
Droopy upper eyelids
Inability to perspire on one side of the face
Severe shoulder pain, numbness, and weakness
Sinking or retraction of the eyeballs
Superior Vena Cava Syndrome
This syndrome impacts approximately 3% to 4% of patients with lung cancer and it occurs when the superior vena cava—the large vein that passes next to the upper part of the right lung and carries blood to the heart—is compressed by a tumor. When restricted, blood can back up into the veins, leading to various symptoms, including:
Bluish-red skin color
Shortness of breath
Swelling in the face, neck, upper chest, breasts, and arms
Symptoms worsen when you bend forward or lie down
Paraneoplastic syndromes are not physically caused by lung cancer itself, but rather by hormones, peptides, or cytokines produced by the cancer that enter the bloodstream and wreak havoc on distant tissues and organs. (That doesn’t mean your lung cancer has spread, however.)
While paraneoplastic syndromes occur in about 10% of people with any type of lung cancer, they’re more common in individuals with small cell lung cancer. These are some of the most common syndromes and their symptoms.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH): Lung cancer cells produce a hormone that causes the kidneys to hold water, causing salt levels in the blood to drop. Some common symptoms are:
Loss of appetite
Muscle weakness or cramps
Nausea or vomiting
Ectopic Cushing Syndrome: Cancer cells make a hormone that spurs the adrenal glands to produce cortisol. Symptoms include:
Elevated blood sugar levels
High blood pressure
Hypercalcemia: People with squamous cell carcinoma, a non-small cell lung cancer, can develop high levels of calcium in their blood. This leads to:
Loss of appetite
Nausea or vomiting
Lambert-Eaton Myasthenic Syndrome (LEMS): Though scientists are still not sure of the exact reason, it is believed that this syndrome causes the body’s immune system to inadvertently attack nerve endings throughout the body. LEMS is the most common neurological paraneoplastic syndrome in small cell lung cancer. Symptoms include:
Difficulty rising from a seated position
Fatigued shoulder muscles
Weakened hip and upper leg muscles
What Are the Symptoms of Advanced Lung Cancer?
The truth is, lung cancer commonly spreads, and it does so stealthily, often before worrisome symptoms develop (or are noticed). In fact, 80% of people with lung cancer are diagnosed at stage III or IV of the disease, which often means that the cancer has metastasized to other places beyond the lungs. When lung cancer spreads, it typically does so to the liver, adrenal glands, bone, and the brain, leading to symptoms that include:
Abdominal or back pain
Bone pain or fractures
Loss of appetite
Where Can I Get More Info on Lung Cancer?
If you are concerned about possible symptoms of the disease, or you’ve just been diagnosed and are looking for more support, the Lung Cancer Research Foundation shares stories of people who have been in the exact spot where you are now. The American Lung Association created the Lung Force to raise lung cancer awareness and buoy research funding for effective treatments. And LungCancer.org offers tips on asking your medical team questions so you get clear answers.
Ultimately, the best thing you can do if any of these symptoms sound familiar and you have concerns about what might be going on with your lungs and your health, is to see your doctor. The subtleties and nuances of lung cancer can make it really tricky for the average person to identify the disease, but your physician will have the tools necessary to find out what’s happening with your health, and point you to the best path of treatment if it turns out to be cancer.
- Lung Cancer Diagnosis: Thorax. (2004). “Symptoms and the Early Diagnosis of Lung Cancer.” thorax.bmj.com/content/60/4/268
- Lung Cancer and Back Pain: Dana-Farber Cancer Institute. (2019). “Back Pain and Lung Cancer.” blog.dana-farber.org/insight/2018/07/back-pain-cancer-related/
- Lung Cancer and Fatigue: American Cancer Society. (2020). “What Is Fatigue or Weakness?” cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fatigue/what-is-cancer-related-fatigue.html
- Lung Cancer and Weight Loss: Dana-Farber Cancer Institute. (2019). “When Is Weight Loss a Sign of Cancer?” blog.dana-farber.org/insight/2017/06/when-is-weight-loss-a-sign-of-cancer/
- Lung Cancer Diagnosis Delay: Journal of Thoracic Disease. (2011). “Delays in the Diagnosis of Lung Cancer.” ncbi.nlm.nih.gov/pmc/articles/PMC3256519/
- Paraneoplastic Syndromes: World Journal of Clinical Oncology. (2014). “Paraneoplastic Syndromes Associated with Lung Cancer.” ncbi.nlm.nih.gov/pmc/articles/PMC4127595/#B1
- Lung Cancer and Patient Stories: Lung Cancer Research Foundation (n.d.). “Lung Cancer Journeys.” lungcancerresearchfoundation.org/for-patients/patient-stories