Lung Cancer: Signs and Symptoms

Lungs have a lot of room. A tumor can grow for a while inside them. It may not press on anything or block enough airway to cause a clear symptom. This is a major reason lung cancer is often found late. Cancers in smaller organs tend to cause symptoms sooner. New, lasting breathing symptoms deserve real attention. This matters most for anyone who has smoked.

The most common early symptoms come from the tumor growing in or near the airway:

• A cough that does not go away, or one that changes or worsens
• Coughing up blood, or sputum tinged rust-colored or red
• Chest pain, often worse with deep breathing, coughing, or laughing
• Hoarseness
• Shortness of breath
• Wheezing that is new
• Repeated bouts of bronchitis or pneumonia
• Loss of appetite, unexplained weight loss, and fatigue

Any one of these can have a harmless explanation. A cold or seasonal allergies can cause several of them. Duration is what separates a warning sign from an everyday illness. A cough lasting more than a few weeks, or one that keeps coming back, should not be waited out.

Lung cancer that has spread beyond the lung causes different symptoms. They depend on wherever it has gone. Spread to bone can cause bone pain, often in the back or hips. Spread to the brain can cause headaches. It can also cause weakness or numbness in an arm or leg, dizziness, trouble with balance, or seizures. Spread to the liver can cause jaundice, a yellowing of the skin and eyes. Lymph nodes in the neck or above the collarbone can become noticeably swollen.

These are not appointment symptoms. Call 911 or go to an emergency department.

Superior vena cava syndrome happens when a tumor presses on the large vein that carries blood back to the heart. It causes swelling in the face, neck, or arms. It can also cause breathing trouble, headaches, and sometimes confusion. It can be life-threatening, and it is worse lying flat. Go to an emergency department rather than waiting for a clinic slot.

New neurological symptoms can mean the cancer has reached the brain or spinal cord. These include sudden weakness, numbness, a seizure, or a sharp change in balance or thinking. Call 911. Sudden loss of feeling or movement in the legs, or new trouble controlling your bladder or bowels, is also an emergency, because the spinal cord may be under pressure.

Coughing up blood in any quantity more than a few streaks, or coughing blood along with breathlessness, dizziness or chest pain, needs emergency assessment now. Small streaks in sputum still need a prompt appointment, but heavy bleeding from the airway cannot wait.

Sometimes lung cancer triggers symptoms far from the lung itself. Substances the tumor releases cause these, not the tumor's location. These are called paraneoplastic syndromes. Examples include a drooping eyelid and constricted pupil on one side of the face. Muscle weakness is another. High blood calcium can cause excessive thirst and constipation. Abnormal sodium levels can cause confusion. These are less common. They are easy to blame on something else. That is part of why they can delay diagnosis.

Finding lung cancer when you first notice symptoms gives treatment the best chance of working. Waiting reduces that chance. That is true at every stage, not just early ones. Anyone with a lasting cough, chest pain, or unexplained weight loss should be evaluated. Anyone with sudden facial swelling, breathing trouble, coughing up blood, or new neurological symptoms should go straight to an emergency department.

Because lung cancer often stays quiet until it has grown or spread, waiting for symptoms is not the safest approach for people at high risk. The U.S. Preventive Services Task Force recommends yearly low-dose CT screening for adults aged 50 to 80 who have a 20 pack-year smoking history — roughly a pack a day for 20 years, or two packs a day for 10 — and who currently smoke or quit within the past 15 years. If that describes you, ask about screening even if you feel completely well. It is designed to catch cancer before any symptom would.

• Given my symptoms and smoking history, do I need imaging or other tests?
• Could these symptoms have a cause other than lung cancer, and how would we find out?
• If I've had lung cancer before, which symptoms would suggest it has returned or spread?
• What symptoms should send me to an emergency room rather than wait for an appointment?

• American Cancer Society — Signs and Symptoms of Lung Cancer
• U.S. Preventive Services Task Force — Lung Cancer: Screening