Lung Cancer Symptoms

This article describes typical symptoms that occur with lung cancer.  This is an important topic because lung cancer continues to be the most common cause of death due to cancer in the United States for both men and women.  Although breast cancer is the most common cancer diagnosed in women (and prostate cancer for men) and receives a lot of media attention, lung cancer is a much bigger threat to women’s health.  The biggest modifiable risk factor for lung cancer is cigarette smoking.  Some cancers as ovarian cancer are notorious for not having many symptoms for most of the disease course.  In contrast, most people with lung cancer will have some type of complaint or symptom that should prompt an investigation and ultimately lead to the diagnosis.  The difficulty arises in that many symptoms that occur with lung cancer are very common complaints and can occur with other diseases or without a particular disease.  For example, cough is extremely common and is a symptom of lung cancer but also may signify asthma, seasonal allergies, sinus infection or no particular diagnosis at all.

Although many people with lung cancer will have some type of symptom, the non-specific nature of these symptoms may lead to a delay in diagnosis.  A delayed diagnosis means that the cancer will be discovered after it has been there for some time and thus have a higher risk of having already grown into neighboring structures or spread elsewhere in the body before any treatment is possible.

The most common symptoms that occur with lung cancer include:

  • Cough
  • Weight loss
  • Dyspnea (shortness of breath)
  • Hemoptysis (coughing up blood)
  • Chest pain
  • Hoarseness

These symptoms occur in varying degrees and combinations of those with lung cancer depending upon how big the cancer is and what the cancer involves.  About 45-75% of patients with lung cancer will have cough at diagnosis.  Weight loss is found between 10-70%.  A bigger tumor or one that has spread will tend to cause more severe weight loss.  Shortness of breath (dyspnea) is found in 35-60% at diagnosis also.  Chest pain or discomfort is found in about 30-50% of people at diagnosis.  Hoarseness is found in about 2-20% of those with lung cancer at diagnosis also.

Coughing up blood (hemoptysis) is a very concerning symptom.  There are many alternative reasons besides lung cancer why someone may cough up blood:

  • tuberculosis
  • pneumonia
  • “thin blood” or coagulopathy
  • Bronchitis
  • Many others (including lung cancer)

The amount of blood coughed up can be classified as minor or massive; with massive being about more than a cup full.  Hemoptysis from a lung cancer is caused by the tumor erosion in surfaces that can bleed or erosion directly into blood vessels of the lung.  When the latter occurs, the bleeding can be massive even life threatening as this will make breathing difficult.

If someone has these typical symptoms and has smoked heavily for many years, this makes lung cancer more concerning.  There are several different common types of lung cancer.  It is also possible to have tumor spread from other areas of the body to the lung.

A partial list of common cancers that spread to the lung include:

  • Colon cancer
  • Prostate cancer
  • Breast cancer
  • Renal cancer
  • Many others are possible 

Tumors that are found to be in the lung that have spread from another area such as colon cancer, will cause similar problems as a tumor that grows primarily in the lung.

What if someone has the above symptoms and has smoked for many years?  This person needs to see a doctor to investigate the cause of these symptoms; usually this will begin with a chest x-ray.  A simple chest x-ray can help look for alternative causes of these symptoms as well as a lung cancer.  What if the chest x-ray is completely normal?  Up to 5% of people in this situation may still have lung cancer and different types of testing may be required.

The above symptoms can occur with a small or large lung tumor.  Certain types of lung cancers can cause unique symptoms in addition to the ones that commonly occur as listed above.

When these other symptoms occur, it usually signifies a worse disease and poorer prognosis.  Some of these rarer symptoms include:

  • Superior vena cava syndrome
  • Chest wall invasion
  • Vocal cord paralysis
  • Paraneoplastic syndromes

Superior vena cava syndrome – This is swelling of the upper chest, head and neck that occurs as a tumor or very large lymph nodes with tumor cells cause blockage of the main vein that drains the head and neck.  The veins of the head and neck drain toward the heart through the superior vena cava.  When compression of this vein occurs from cancer, this indicates a very poor prognosis.

Chest wall invasion – This occurs when a tumor grows from the lung into the muscle, ribs and possibly skin of the chest wall.  This also indicates a poor prognosis.

Vocal cord paralysis – This may occur when a lung tumor grows into the nerves that supply the vocal cords that help normal breathing and speech.  This may create hoarseness.  This is also indicative of an advanced cancer.

Paraneoplastic syndromes – These are a collection of unusual disorders that are caused by a lung cancer that secretes hormones or antibodies that cause disorders in other areas of the body.  Some of these disorders include severe sodium imbalance or total body muscle weakness (i.e. SIADH or lambert-Eaton syndromes, respectively).

REFERENCES:

  1. www.cdc.gov/cancer/lung/
  2. www.cancer.gov/cancertopics/types/lung
  3. Mason RJ, et al.; Mason: Murray and Nadel’s Textbook of Respiratory Medicine, 5th ed. (2010) Chapter 47. Saunders.
  4. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18thed.  Chapter 59.  New York, NY: Saunders.
  5. Goldman L, Schafer, AI;  (2011) Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 85. New York, NY: Elsevier
  6. Colice GL: Detecting lung cancer as a cause of hemoptysis in a patient with a normal radiograph.  Chest  1997; 111:877-884.
  7. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.