Signs and Symptoms of Lung Cancer

The signs and symptoms of lung cancer include a cough that won't go away, shortness of breath, and coughing up blood. Lung cancer can also cause a hoarse voice, back pain, and other less common symptoms.

Each patient with lung cancer is different. The symptoms that a person has can vary depending on a person's sex, age, and smoking status.

Anyone can get lung cancer, but since not everyone gets checked for it, knowing the signs of the disease can help you get diagnosed and start treatment sooner.

This article covers the signs and symptoms of lung cancer. It also discusses complications of lung cancer.

Frequent Symptoms

Some of the signs and symptoms of lung cancer are not obvious at first. You might think that they are being caused by a more common condition.

However, if you have these symptoms, you should not ignore them:

• A cough that does not go away
• Shortness of breath
• Repeated infections
• Coughing up blood
• Shoulder and arm pain
• Chest or back pain
• Fatigue
• Unexplained weight loss

Persistent Cough

A cough that does not go away (persistent cough) is the most common symptom of lung cancer. It usually lasts longer than a few weeks. Around 50% of people have a persistent cough when they are diagnosed with lung cancer.

The cough can:

• Manifest as dry or wet (makes mucus)
• Happen a lot or only sometimes
• Happen at any time of day

Many people assume the nagging cough is caused by something like allergies or dry air during the winter months. People who use tobacco might just think it's "smoker's cough."

Shortness of Breath

Shortness of breath, also called dyspnea, can vary with some people experiencing it with physical activity and others experiencing it while resting. Shortness of breath is often described as a feeling of being "hungry for air." 

Feeling short of breath during activity can easily be chalked up to getting older, being out of shape, or being overweight.

You might not recognize that you're short of breath at first. You might just notice that doing things like going up several flights of stairs or having sex leaves you winded. You might also find yourself blaming the humidity or other factors for your shortness of breath.

Repeated Infections

It’s common for someone to discover that they have lung cancer after being treated for repeated bouts of bronchitis or pneumonia. If a tumor is located near an airway, it blocks it and makes these infections more likely.

If you have recurrent chest infections, your provider can run some tests. One test, called chest computed tomography (chest CT scan) can help spot lung cancer. It's better than a chest X-ray, which can miss lung cancer up to 25% of the time.

Coughing Up Blood

Coughing up blood (hemoptysis) is a common symptom of lung cancer. It occurs in about a fifth of lung cancer patients. In some cases, it's the first symptom a person has.

Coughing up blood might sound like something that would be hard to miss, but it isn't always extreme. A person could easily miss or ignore a small spot of blood on a tissue.

Even if it starts out mild, coughing up blood can quickly get serious. If you've coughed up a few teaspoons of blood, you need medical care right away.

Shoulder and Arm Pain

Shoulder pain can be a symptom of lung cancer. Shoulder pain may occur if a lung tumor exerts pressure on a nearby nerve or if lung cancer spreads to the bones in or around the shoulder.

Tumors in the upper parts of the lungs are called Pancoast tumors. They can cause pain in the shoulder that spreads down the arm toward the pinky finger. Pancoast tumors often don't come with typical lung cancer symptoms. Instead, symptoms may include muscle weakness, tingling, loss of sensation, facial flushing, and excessive facial sweating.

Pancoast tumors are also hard to see on imaging tests, which means the diagnosis usually takes a long time.

Chest Pain

Chest pain can feel different to different people. Some people say it feels more like lung pain, while others say they have pain when taking a deep breath. This symptom is common even in the early stage of lung cancer.

The lungs do not have pain fibers, but the lung lining (pleura) and structures around the lungs do have nerve endings. That's why the pain feels like it's coming from the lungs even though it's not.

"Referred pain" is the term used to describe pain that starts in one part of the body but is felt somewhere else. You may have referred pain in your lungs from another organ.

Back Pain

Back pain is easy to miss because there are many more common reasons for back pain.

In someone with lung cancer, back pain can be caused by pressure from a tumor, irritation of nerve roots, cancer that's spread to bones in the spine, or cancer that's spread to the small organs that sit on top of the kidneys (adrenal metastases).

Back pain from lung cancer is usually:

• Felt in the mid-to-upper-back
• Present at rest and with activity
• Worse at night and when taking a deep breath
• Not responsive to physical therapy or other treatment

Fatigue

Feeling tired all of the time is a frequent complaint of people with lung cancer. So-called "cancer fatigue" is different from feeling tired. Some people describe it as whole-body fatigue or even exhaustion. This kind of tiredness doesn't get better after a good night's sleep or a cup of coffee.

Cancer-related fatigue is difficult to treat, but some research indicates alternative remedies and physical exercise may be some of the most effective ways to improve fatigue at any stage of lung cancer.

Unexplained Weight Loss

Losing weight without trying and without a clear reason is defined as losing 5% of your body weight or more than 10 pounds in six to 12 months. Unintentional weight loss happens to 35% to 75% of people with lung cancer before they get diagnosed.

Cancer causes weight loss in a few ways, such as causing loss of appetite and changing the body's metabolism.

Less Common Symptoms

There are also some symptoms of lung cancer that are not very common, such as:

• Hoarseness
• Wheezing
• Paraneoplastic syndromes (an immune system reaction to a cancerous tumor)
• A feeling that "something is wrong"

Hoarseness

Lung cancer can cause you to have a hoarse-sounding voice. There are a couple of reasons why this can happen.

One reason is that tumors in the chest can put pressure on the vocal cords (larynx). Hoarseness in people with lung cancer can also be caused by pressure on the recurrent laryngeal nerve that leads to the voice box.

Wheezing

There is a saying that "all that wheezes is not asthma." It's good to keep that in mind, as lung cancer can also cause wheezing.

Wheezing related to lung cancer tends not to be generalized like it is with asthma. In fact, people are often able to describe where the wheezing starts in their lungs (localized wheezing).

Paraneoplastic Syndromes

Some lung cancers release hormone-like substances that can cause certain symptoms. When this group of symptoms happens, it's called paraneoplastic syndrome.

Paraneoplastic syndromes occur in around 10% to 20% of people with lung cancer. It's most common in people with small cell lung cancer. The syndrome can start before the symptoms of the disease do.

There are many paraneoplastic syndromes and each can cause a variety of symptoms. Two common paraneoplastic syndromes include:

• Hypercalcemia, in which the tumors (most commonly squamous cell carcinoma) put out a substance that raises blood calcium levels. A person may feel thirsty, have muscle weakness, and become confused.
• Inappropriate ADH (SIADH), in which the tumors put out a substance that lowers the level of salt (sodium) in the blood. A person may have headaches, weakness, and memory loss.

A "Gut Feeling"

From knee pain to fatigue, the list of potential signs of lung cancer is long. However, an important one that doesn't have a medical name is your intuition.

Many people recall that before their diagnosis they had a "gut feeling" that something was wrong.

If you feel "off" or "wrong" about your health and wellbeing, don't ignore it. Talk to your healthcare provider—even if it's just for reassurance and peace of mind.

Complication-Related Symptoms

Complications of lung cancer usually happen after a person is diagnosed. However, they can also pop up before a diagnosis is made and might even be the first clue that cancer is present.

Face and Neck Swelling

Lung cancer tumors can press on the large blood vessel that returns blood to the heart from the upper part of the body (superior vena cava).

When this happens, it causes the blood flow to that vein to become fully or partially blocked. This is called superior vena cava (SVC) syndrome.

If the blood flow is blocked, pressure builds up in the areas the vein is supposed to drain blood away from. This can cause swelling of the face, neck, and arms. A person may also have veins in the neck and chest that look bigger than normal (dilated).

Symptoms Related to Cancer Spread

Lung cancer is often diagnosed after it has already spread to other parts of the body. The most common places where lung cancer spreads are the brain, the bones, the liver, and the adrenal glands.

When cancer has spread, a person might have symptoms such as:

• 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

Blood clots are common in people with lung cancer. Though cancer treatments such as surgery and chemotherapy are known to increase this risk, these clots can happen before lung cancer is diagnosed.

Possible signs of a blood clot include:

• Leg/calf pain and swelling with deep vein thrombosis (DVT)
• Sharp, sudden chest pain and shortness of breath when a clot breaks free and travels to the lungs (pulmonary embolus)

Sub-Groups

Just as the symptoms of heart disease in women differ from those in men, the symptoms of lung cancer can also differ. Similarly, the symptoms of lung cancer in never-smokers and young adults can be different.

The most common type of lung cancer in these groups is the main reason that they have different symptoms.

Squamous Cell Carcinoma

One example is squamous cell carcinoma. This type of lung cancer grows in the large airways instead of at the outer edges of the lungs.

People with cancer in this spot often have early symptoms like coughing, coughing up blood, or recurrent lung infections caused by a blocked airway.

Men are more likely to develop squamous cell carcinoma than women. They may experience more obvious prominent symptoms early on in the disease.

Lung Adenocarcinoma

Another example is lung adenocarcinoma. It is the most common type of lung cancer overall. It's also most common in women, young adults, and people who do not smoke.

These cancers usually happen in the outer regions of the lungs. They can grow very big before causing symptoms.

The first symptom of adenocarcinoma is often shortness of breath because the tumor takes over lung tissue. People may also have symptoms like fatigue or loss of appetite that don't seem to have a clear cause.

Lung cancers in these groups are diagnosed at later stages for a couple of reasons:

• They don't always come with "typical" lung cancer symptoms,
• Healthcare providers might not consider a lung cancer diagnosis in these groups at first

When to Get Medical Care

There is often a long delay between when a person starts having symptoms and when they get diagnosed with lung cancer.

If you have risk factors for lung cancer, knowing the signs and symptoms is important. Tell your healthcare provider about them right away if they appear.

If you have symptoms but have never smoked before, you might not think you're at risk for lung cancer. However, 10% to 20% of people who develop lung cancer have never smoked. Lung cancer in never-smokers is the 7th-leading cause of cancer deaths in men and women worldwide.

Candidates for Lung Cancer Screening

If you have lung cancer symptoms, your provider will want to check to see if you have it. That said, you might be able to have a lung cancer screening even if you don't have any symptoms.

The U.S. Preventive Services Task Force recommends annual screening with a chest CT for people who:

• Are 50 to 80 years old
• Have a 20-pack-year history of smoking
• Currently smoke or have quit within the past 15 years
• Are healthy enough to get through and benefit from treatment if lung cancer is diagnosed

Some guidelines vary. The American Cancer Society, for example, recommends screening even if it's been more than 15 years since you quit smoking. So talk with your healthcare provider about whether screening is the right option for you.

Screening is also beneficial for people with risk factors for lung cancer, such as radon exposure, occupational exposure, and a family history of the disease.

Summary

The signs and symptoms of lung cancer can be related to the lungs or other organs. Some of the early symptoms are common and can have other causes that are not cancer. People may not realize that something is wrong because they assume that a cough that won't go away or back pain is from allergies or a pulled muscle.

If the cancer has spread, symptoms that come from different body symptoms can show up. For example, a person with lung cancer that's spread to the brain might have headaches.

Complications of lung cancer usually happen after a person finds out they have cancer. Sometimes, complications happen sooner and might be what leads to a diagnosis of lung cancer.