A Persistent Cough Might Be More Than a Cold: Know the Early Signs of Lung Cancer

When you're diagnosed with lung cancer at an early stage before it spreads to other areas of the body, you have a much better chance of successful treatment. Another advantage is that early detection can make it possible to fight lung cancer with less aggressive treatments, improving quality of life. Plus, there are often more treatment options than with late-stage lung cancer. The problem is that early lung cancer warning signs can be non-existent or so subtle they go unnoticed.

Here, we'll delve into the early warning signs of lung cancer, shedding light on the subtle hints that often go undetected. We'll provide insights into the various stages of lung cancer, emphasizing the symptoms associated with each. Given the elusive nature of early symptoms, understanding the risk factors associated with lung cancer becomes imperative.

We'll also briefly touch on the different types of lung cancer, stressing the need for vigilance in the face of this formidable foe. You'll learn why regular screenings like low-dose chest CT scans to detect lung cancer are so important for high-risk patients.

How Common Is Lung Cancer?

Lung cancer is the second most common cancer in both men and women in the United States and the leading cause of cancer death for both men and women.

It's expected that 238,340 new lung cancer cases will be diagnosed in the U.S. in 2023, and 127,070 people will die from the disease¹.

Smoking is the main cause of lung cancer, but exposure to secondhand smoke, radon gas, and air pollution can also increase the risk.

A man's lifetime chance of developing lung cancer is approximately 1 in 15, while a woman's risk is about 1 in 17². And the disease mainly develops in the elderly: most individuals diagnosed with lung cancer are at least 65, with the average age of diagnosis sitting at 70.

What Is Lung Cancer?

Lung cancer is a type of cancer that starts in the lung tissue. The lungs are responsible for taking in oxygen and releasing carbon dioxide from our system, which is an essential function for living. Cancer cells can develop in the lungs after repeated exposure to certain chemicals that are breathed in. This is a reason why smoking is associated with increased lung cancer risk.

Primary lung cancer, or cancer that starts in the lungs, most commonly begins as a small tumor or nodule in one lung. Conversely, secondary lung cancer, or cancer that has spread from another part of the body (also known as metastases), is more commonly seen as multiple tumors in both lungs.

What Are Some Early Lung Cancer Warning Signs?

Recognizing subtle symptoms of lung cancer can be pivotal in early diagnosis and better outcomes. But remember — oftentimes people may have no symptoms when lung cancer is in the earliest stages.

Some signs and symptoms to watch for include the following³:

1. Persistent cough: A chronic cough or bronchitis, especially coughing up blood, is a common lung cancer symptom.
2. Unexplained weight loss: Sudden, unexplained weight loss, despite no changes in diet or physical activity, could indicate underlying health issues, including lung cancer.
3. Loss of appetite: This is common in patients with all cancers and undergoing cancer treatment. Changes in the sense of taste and smell may cause loss of appetite.
4. Chest pain: Persistent chest pain, especially while breathing deeply or coughing, warrants immediate medical attention.
5. Shortness of breath: If you experience persistent shortness of breath, even during routine activities, it might be a sign of lung cancer, particularly if there's no other apparent cause.
6. Hoarseness: Scratchy throat that lingers for weeks, unrelated to respiratory infections, should raise concerns.
7. Phlegm with blood: Coughing up sputum or phlegm tinged with blood, even in small amounts, necessitates medical investigation.
8. Blood clots: Developing blood clots in the legs, arms, or lungs is more common in lung cancer patients.
9. Finger clubbing: This sign occurs when your fingers become more curved or longer due to a lack of oxygen.
10. Unexplained fatigue: Constant fatigue, unrelated to physical or mental exertion, might indicate an underlying health issue, potentially lung cancer.

When someone first develops symptoms of lung cancer, it may be difficult to tell because these symptoms can be vague and nonspecific. Many people first develop a cough that doesn't get better and may have multiple health care visits before getting an answer. Some people are diagnosed with other illnesses first such as bronchitis or pneumonia before discovering lung cancer.

It's important to note that symptoms vary significantly across individuals. A large study from China found only 17.9 percent of lung cancer patients experienced chest pain and just 4.8 percent experienced fatigue⁴. Many early-stage lung cancers are completely asymptomatic.

What Are the Hidden Signs of Lung Cancer?

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While many symptoms of lung cancer may not seem surprising, there are some symptoms that on first look may seem unrelated to the lungs. Due to this, these signs can initially be ignored or overlooked.

Some of these hidden symptoms and signs can include:

1. Shoulder pain: People with lung cancer can develop shoulder pain if they have a tumor that's located in the upper lung, otherwise called a Pancoast tumor.
2. Superior vena cava syndrome: This is a condition that can happen when a lung tumor in the upper lobes presses on the superior vena cava, a large blood vessel returning blood back to the heart. This can lead to symptoms including facial and arm swelling and redness.
3. Horner's syndrome: This can happen when a tumor is pressing on certain nerves that can lead to drooping of the eyelid, constriction of the pupil, and inability to sweat on the affected side of the face.
4. Hoarseness: Some lung tumors can press on the nerves supplying the vocal cords, leading to hoarseness.

Some other surprising symptoms can happen if the cancer cells secrete different types of hormones or chemicals, a condition called paraneoplastic syndrome, which is not uncommon in lung cancer. When certain lung cancer cells grow, they can release hormones that can lead to symptoms affecting different systems of the body. This can present in different ways depending on the type of lung cancer.

Small cell carcinoma can secrete chemicals that lead to weight gain and excessive thirst while squamous cell carcinoma can lead to hypercalcemia, or elevated calcium levels. Hypercalcemia can lead to symptoms including constipation, bone pain, and confusion.

A Warning About Pancoast Tumors

Pancoast tumors, named after radiologist Dr. Henry Pancoast, are rare, affecting only 3% to 5% of lung cancer patients⁵. These tumors develop at the apex, or top, of the lung, near the spine. Oftentimes, symptoms of Pancoast tumors — such as arm and shoulder pain, muscle weakness, numbness, tingling, drooping eyelids, and loss of coordination — are initially missed because they are subtle or easily explained by other causes.

However, it's imperative to consult a healthcare professional if any of the aforementioned symptoms arise, especially when they persist or worsen over time. Recognizing the symptoms associated with Pancoast tumors is crucial for early detection and intervention.

Stages of Lung Cancer

In the early stages of lung cancer, you may not have any noticeable symptoms, making it crucial to understand risk factors and make lifestyle changes. Tumors often progress to more advanced stages before symptoms become apparent. Understanding what is happening with the tumor growth as lung cancer progresses can help you make sense of the symptoms⁶.

Stage I lung cancer: The tumor is localized within the lungs and has not spread to nearby tissues or lymph nodes. Symptoms are often absent or mild.

Stage II lung cancer: The tumor has grown and may have started to invade nearby tissues or lymph nodes within the lung. Coughing discomfort, shortness of breath, and chest pain may be symptoms of this condition.

Stage III lung: In this stage, the cancer has spread extensively within the lung and to nearby lymph nodes. Symptoms may include worsening cough, shortness of breath, chest pain, hoarseness, difficulty swallowing, and bone pain.

Stage IV lung cancer: Advanced lung cancer has spread (metastasized) to other parts of the body. Symptoms may include fatigue, unexplained weight loss, bone pain, neurological symptoms, and breathing difficulties.

Different Types of Lung Cancer

According to the American Cancer Society, about 84% of all lung cancers are non-small cell lung cancer (NSCLC)⁷. Large cell carcinoma may show up anywhere in your lung. It grows and spreads quickly, making it challenging to treat.

About 10-15% of lung cancers are small-cell lung cancers (SCLC)⁸. Smokers tend to develop this type of cancer much more frequently.

The two types of SCLC are small cell carcinoma (or oat cell cancer) and combined small cell lung cancer (a mix of large and small cells). They're named for how the cells look under a microscope. You may also hear types of cancer described as squamous cell carcinoma, adenocarcinomas, lymphoma, and sarcomas^9,10.

Lung adenocarcinoma is a subtype of NSCLC and is the most common type of lung cancer in the United States. It's usually associated with smoking, but it's also the most common type of lung cancer diagnosed in non-smokers. A less common subtype of NSCLC is squamous cell carcinoma, which makes up to one-third of all lung cancer cases.

Lung carcinoid tumors are responsible for less than 5% of lung cancer cases. These are also called lung neuroendocrine tumors, and tend to grow at a slow pace and rarely metastasize.

Lung Cancer in Women

As the leading cause of cancer death in the United States, lung cancer is a serious diagnosis. While it's more commonly seen in men, lung cancer cases in women have recently been on the rise. Symptoms of lung cancer in women tend to be similar to those in men, but some differences exist and can depend on many factors.

Women also tend to be diagnosed earlier compared to men, which can improve their outcomes. According to the American Cancer Society, the lifetime risk of a woman developing lung cancer is 1 in 17, which is a sobering statistic. It's estimated that over 200,000 new lung cancer cases will be diagnosed in 2023, approximately half of them being women.

While the majority of lung cancer cases used to occur in mostly older men who smoked, cases are now occurring much more often in younger women who have never smoked. It's not completely clear why this is happening, and some researchers are calling this an epidemic that requires urgent attention and further study¹¹.

When it comes to women and lung cancer risks, up to half of women diagnosed have never smoked¹². Furthermore, research shows that younger women who have never smoked are likelier to develop lung cancer than their male counterparts. It's unclear if this is due to secondhand smoke exposure or some other environmental exposure. Differences in hormones like estrogen could also be a risk factor, but research on this point is currently inconclusive.

What Could Put You At Risk For Lung Cancer?

Because lung cancer often develops without early symptoms, understanding and acting on your risk factors is critical. Let's take a closer look at each of these risk factors.

Smoking

According to the CDC, smoking tobacco is the leading risk factor for getting lung cancer, accounting for up to 90% of all cases. Tobacco smoke contains 7,000+ chemicals, including at least 70 known to cause cancer. When you smoke, these chemicals are inhaled into the lungs and may cause damage to the DNA of lung cells. This can lead to the development of cancer tumors.

The more cigarettes you smoke and the longer you smoke, the higher your risks are. But even smoking a few cigarettes a day or occasionally increases your risks. Ask your healthcare provider for help quitting smoking.

Family History of Lung Cancer

If you have family members with lung cancer, you're at an elevated risk of developing the disease. This is because you may be more likely to inherit genetic mutations that increase your risk.

If you have a family history of lung cancer, talk to your doctor about ways to screen for cancer early and reduce your risks.

Radiation Therapy to the Chest

Radiation treatment to your chest can damage the DNA of lung cells and increase the risk of developing lung cancer. The risk is highest in people exposed to higher radiation doses, which is not the same as radiation from routine chest X-rays.

Carcinogen Exposure

Carcinogens are substances that can cause cancer. Some common carcinogens that can increase the risk of lung cancer include:

• Radon: Colorless, odorless, radioactive gas found in soil and rocks
• Asbestos: A mineral fiber once widely used in construction materials, such as insulation and roofing
• Other carcinogens (cancer-causing substances): Workplace chemicals including asbestos, arsenic, diesel exhaust, and certain forms of silica and chromium

To minimize your lung cancer risk, get your home tested for radon and get informed about potential carcinogens at your workplace^13,14.

Second-Hand Smoke Exposure

Second-hand smoke refers to smoke that comes from burning tobacco cigarettes, cigars, pipes, or even from exhaled smoke¹⁵. It contains many harmful chemicals, including carcinogens. Exposure to secondhand smoke increases the risk of developing lung cancer by about 20-30%. Avoid second-hand smoke by asking smokers to step outside to light up and staying away from smoking areas.

Is There a Way To Tell If I Have Early Lung Cancer?

While lung cancer is generally associated with many symptoms, it commonly does not cause any symptoms in its early stages when it's localized (meaning it hasn't spread to other tissues such as lymph nodes or other organs). Depending on the type of lung cancer, localized may be referred to as Stage I in cases of non-small cell carcinoma, or limited in cases of small cell carcinoma.

This is why screening is so important. There are current guidelines in place for lung cancer screening. As stated by the American Lung Association, yearly screening is recommended for people 50-80 years old who have a significant history of smoking and are either still smoking or have quit within the past 15 years¹⁶.

The current recommended screening test is a low-dose computed tomography (CT) scan, which exposes the person to a much lower dose of radiation compared to a typical CT scan. Research has shown these screening scans significantly decrease lung cancer deaths¹⁷.

The Importance of Lung Cancer Screening

Regular lung cancer screenings are essential for early detection and better outcomes, especially for high-risk individuals since common symptoms of lung cancer may not be present or obvious.

To understand your lung cancer risk from smoking, multiply the number of packs per day you smoke by the number of years you have smoked. This result will be your pack year history and will help determine your next steps. You can also use Ezra's cancer risk calculator to better understand your risk.

The United States Preventive Services Task Force (USPSTF) recommends that adults with 20 pack-year history of smoking who currently smoke or have quit within 15 years have an annual low-dose computed tomography (LDCT) screening¹⁸.

Low-Dose Computed Tomography Scan

An LDCT screening is a safe and effective way to detect lung cancer early when it's most treatable. The test uses low-dose radiation to create images of the lungs. These images can identify small tumors that may not be visible on other imaging tests or by physical examination.

Low-dose chest computed tomography uses X-rays to create detailed cross-sectional images of the chest area. The "low-dose" aspect refers to the reduced amount of radiation exposure compared to a standard CT scan.

LDCT scans are commonly used for lung cancer screening, especially in individuals at high risk for the disease, such as current or former smokers. The lower radiation dose makes it a safer option for regular screenings, allowing healthcare professionals to detect lung cancer in its early stages when it's more treatable.

These screenings are crucial for identifying small tumors or nodules in the lungs, enabling timely medical intervention and improving the chances of successful treatment outcomes.

A primary benefit of LDCT is that it can detect lung cancer early, improving survival rates and reducing the incidence of late-stage disease. One clinical trial found that LDCT reduced mortality rates by 20 percent¹⁹. However, it also has a high false positive rate, which limits its effectiveness in some cases.

Ezra's Focused Exam: LDCT of the Chest

For people without symptoms who still want to be proactive about their health, Ezra offers a five-minute low-dose chest CT scan. Once your results are ready, you'll receive a report and a medical provider will follow up with a 45-minute consultation (based on telehealth guidelines) with a Personal Care Advisor.

Ezra's LDCT scan may help detect various conditions, including cancerous masses, emphysema, lung bullae, and pulmonary cysts to give you a thorough evaluation of lung health.

Lung Cancer Diagnostic Tools and Techniques

Fortunately, several methods are available for effective lung cancer diagnosis, and some are particularly useful for diagnosing rare tumor types and helping determine clinical stage characteristics.

Advanced Imaging and Diagnostic Procedures

Though LDCT is the primary screening method for lung cancer, other methods are helpful in certain cases.

Magnetic Resonance Imaging (MRI)

This method generates detailed images of the lungs, helping to detect tumors, determine their size, and assess their spread. Different types of MRI, such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI, provide additional information about the tumor's characteristics and blood supply.

Ultrasound (UC)

This technique uses sound waves to create images of the chest, helping to detect and guide biopsies of tumors near the chest wall. UC can complement LDCT as a means of monitoring specific types of lung cancer, such as bronchogenic carcinoma.

Biopsies

If your doctor needs to determine whether or not you have lung cancer, they will typically perform a biopsy via an open or closed method. Open biopsies are done under general anesthesia, while closed biopsies are performed through the windpipe or skin.

Types of the former include:

• Open biopsy: during this procedure, a doctor will give you a general anesthetic then make an incision in your chest, surgically removing a piece of your lung tissue. You may also undergo more extensive surgery–like the removal of a lung lobe–depending on the result of your biopsy. This procedure involves a hospital stay.
• Thoracoscopic biopsy (sometimes called VATS biopsy): after you receive a general anesthetic, your doctor will insert an endoscope through your chest wall and into your chest cavity. Different types of biopsy tools can be placed through the endoscope to retrieve lung tissue for a closer look; this procedure may also involve therapeutic steps, such as the removal of tissue lesions or a nodule.

Types of the latter include:

• Transbronchial biopsy: This procedure involves the use of a fiberoptic bronchoscope, which is a thin, long tube with a telescope on its end, allowing your doctor to take a closer look at your lungs' main airways.
• Needle biopsy (sometimes called closed, percutaneous, or transthoracic biopsy): first, your doctor will give you a local anesthetic. Then, they will use a CT scan or fluoroscopy to guide a needle through your chest wall into the area of suspicion to retrieve a tissue sample.

These additional screening methods are especially useful if initial screening results are inconclusive and have particular uses in diagnosing specific types of lung cancer. For instance, MRIs can help diagnose rare tumors like malignant pleural mesotheliomas and assess local invasion. In addition to helping diagnose bronchogenic carcinoma, UC techniques can help with tumor staging by assessing lymph node involvement.

Treating Lung Cancer: What Are Your Options?

The options for treatment depend on the type of cancer you have, such as non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), whether the cancer has spread, what stage it is, and other factors like your overall health, lung function, and cancer characteristics. Your oncologist will often recommend a combination of treatments that could include:

• Surgery
• Radiofrequency ablation
• Radiation therapy
• Chemotherapy
• Targeted drug therapy
• Immunotherapy
• Palliative care

In general:

• Individuals with small cell lung cancer are treated with chemotherapy and radiation therapy, while
• Individuals with non-small cell lung cancer are treated with targeted therapy, radiation therapy, surgery, chemotherapy, or a combination of the four.

These treatment approaches work in the following ways:

• Targeted therapy involves using drugs to stop the spread and growth of cancer cells; these drugs come in intravenous or pill format.
• Radiation therapy harnesses high-energy rays akin to x-rays in order to kill cancer cells.
• Surgery involves directly operating to remove cancerous tissue.
• Chemotherapy uses medication to kill or shrink cancer; like targeted therapy, chemotherapy drugs can be in intravenous or pill form.

Each individual's cancer is different, making the best treatment options vary on a case-by-case basis. It's important to work with a healthcare team to develop the most appropriate treatment plan for your specific situation.

What is a Lung Lobectomy?

If you do have lung cancer, there are various treatment routes your doctor may recommend, such as surgery, radiation therapy, chemotherapy, and targeted therapy. Your doctor may also opt for a lobectomy, a procedure in which one of the lung's lobes is surgically removed²⁰.

Lobectomies might be carried out if an issue is found concentrated in one portion of a lung, so that the leftover healthy lung tissue can continue to function normally while decreasing the likelihood of the disease spreading to the other lobes. They're often performed via a surgery known as a thoracotomy, which involves opening your chest. Sometimes, however, a surgeon will perform a lobectomy via a less-invasive procedure known as video-assisted thoracoscopic surgery (VATS).

Lung cancer, however, isn't the only time a lobectomy may be performed. Your doctor may recommend a lobectomy if you have the following:

• A benign tumor, which is a noncancerous growth that may press on major blood vessels and impact the function of other organs.
• A lung abscess, which is a pus-filled area that could form in the lung. The area could require removal if the abscess doesn't resolve with antibiotics.
• A fungal infection, which can grow within the body and lead to complications.
• Tuberculosis (TB), which is a chronic bacterial infection that frequently impacts the lungs.
• Emphysema, which is a chronic illness caused by elastic fibers found in the lungs breaking down.

Your physician will determine if a lobectomy is the appropriate recommended procedure for you, depending on your specific situation.

Catching It Early: Timely Diagnosis Is Key

In any case of cancer, it's crucial to catch it early to have the best outcome. This is no different when it comes to detecting symptoms of lung cancer. When a person presents with symptoms and signs concerning for lung cancer, testing and imaging can be done in order to detect lung cancer.

Tests can include blood tests, procedures such as bronchoscopy to get tissue samples, and pathology tests to look at the lung tissue cells under a microscope. Imaging tests can include X-rays or CT scans, as well as magnetic resonance imaging (MRI) to check other parts of the body for any evidence of cancer that has spread. An MRI scan is especially useful in detecting brain metastases compared to other imaging tests and poses no risk of radiation.

If you receive a lung cancer diagnosis, you'll likely have many medical providers on your team to help make a plan for treatment. These may include an oncologist, pulmonologist, surgeon, genetic counselor, and more. Lung cancer treatment options depend on cancer type and stage, and may include surgery, chemotherapy, immunotherapy, and radiation therapy.

What Can You Do to Decrease Your Risk?

Apart from quitting smoking and living a healthy lifestyle, research has shown that when it comes to lung cancer, early detection is key. The earlier cancer is detected, the better the survival rate. Women are generally diagnosed with lung cancer earlier, and therefore have better outcomes.

While the current lung cancer screening guidelines primarily focus on high-risk people who have smoked, there are still many people who develop lung cancer and have never smoked — many of them women.

Stay Vigilant Through Regular Screenings

The good news is that while lung cancer isn't completely avoidable, proactive measures like regular checkups, screening tests, and avoiding exposure to tobacco smoke and other chemicals are effective.

Understanding the early warning signs of lung cancer, from its subtle hints to the advanced stages, can empower you to take charge of your health. Since many people don't experience obvious lung cancer warning signs early on, it's vital to educate yourself about risk factors and make healthy lifestyle changes.

For those at risk, regular lung cancer screening through a yearly low-dose Chest CT is a pivotal step in the battle against this disease. The survival statistics highlight why early detection matters¹⁹:

• Localized (early-stage) NSCLC has a 5-year survival rate of 65%
• Localized SCLC has a 5-year survival rate of 30%
• Late-stage metastasized NSCLC has a 5-year survival rate of just 9%
• Late-stage metastasized SCLC has a 5-year survival rate of only 3%

The best way to improve your chances of survival is to catch cancer early. Your chances of surviving non-small cell lung cancer increases by 54% if you catch it before it has spread beyond the lungs.

With Ezra, you can undergo a low-dose CT to screen for lung cancer and also check the rest of your body with a full-body MRI. This allows you to take charge of your health on your own terms.

Start now by assessing your own risk of cancer and become more proactive about your health.

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