Introduction

Lung cancer is a serious disease in which unnatural/abnormal cells in the lung start to grow out of control, occurring as a tumor, interfering with the lung's normal function, and, in some cases, spreading to other parts of the person’s body. It's of course most commonly associated with smoking but can of course occur in people who have never smoked.

It's important to be aware of the signs and symptoms of lung cancer as the disease may not present itself in any way at all in its early stages. Some of the symptoms are quite similar to those of a common respiratory infection and can therefore be easily dismissed. It's important to know the possible warning signs and when it's appropriate to see your doctor, for proper diagnosis and treatment if required.

What are the early signs of lung cancer?

Early lung cancer often produces no symptoms at all. It may be detected on a chest X-ray performed for another reason. When symptoms do arise, they tend to develop slowly and become more apparent over time.

Early warning signs include a persistent cough, a cough that has changed in any way, unexplained tiredness, mild breathlessness, and recurrent chest infections. None of these in themselves point to cancer (there are several very common conditions which can give rise to the same sorts of problems). If, however, the symptoms are persistent, worsening, or occurring together, it is clearly worth seeing a doctor.

What are the common symptoms of lung cancer?

1. Persistent or Worsening Cough

   A cough that persists for several weeks or which worsens can be a warning sign of lung cancer. Someone who already has a chronic cough may find that the cough is becoming more frequent, more severe, or of a different character. A persistent cough is, of course, most often due to respiratory infections, asthma, or COPD. An unexplained or changing cough, however, should never be dismissed, especially if other symptoms are present.

2. Coughing Up Blood

   Coughing up blood (hemoptysis) is a symptom that requires prompt medical assessment. The blood may appear as small streaks in the sputum or in larger amounts. Lung cancer is one possible cause, but respiratory infections, bronchiectasis and a range of other lung conditions can also be the culprit. Anyone coughing up blood should get in touch with their doctor immediately. If there is a large amount of blood or the bleeding is associated with severe breathing difficulty, then it's an emergency, and you need to get to A&E.

3. Shortness of Breath

   Breathlessness can occur when a tumor blocks an airway, impairs function, or causes mucus to collect in the lungs. People may first notice that they are breathless when going up stairs, walking long distances, or doing the activities they used to be able to do without any problem at all. Heart disease, asthma, anemia, infection, and several other conditions can all cause shortness of breath. To determine the cause, a physician should assess any new, ongoing, or worsening dyspnea.

4. Chest Pain or Discomfort

   Pain or discomfort in the patient’s chest is considered to be a symptom of lung cancer if there is a tumor affecting the pleura (lung tissue). The pain worsens with laughing, coughing, or deep breathing. Chest pain has a multitude of possible causes (muscle strain, inflammation, cardiac, etc.). Any sudden or severe chest pain, particularly if it's associated with breathlessness, sweating, or faintness, will need to be assessed in an emergency.

5. Hoarseness and Voice Changes

   A person with lung cancer may have a persistently hoarse voice or a change in their voice quality. This can occur occasionally if the tumor has affected the nerve that controls the vocal cords. Hoarseness, however, can be brought on by infections, acid reflux, or vocal strain. Voice problems lasting a few weeks should be treated medically, especially if accompanied by respiratory complaints.

6. Unexplained Weight Loss

   Unexplained weight loss that occurs without any change in the person’s eating and exercise routine may be a sign of lung cancer. The impact of the cancer on the person’s appetite, metabolism, and energy needs will cause weight loss. Although weight changes can be due to several factors, unexplained and ongoing weight loss should be investigated. It's especially important to look into it if it occurs alongside a chronic cough, fatigue, or chest pain.

7. Persistent Fatigue and Weakness

   Unusual tiredness is another possible symptom of lung cancer. You may feel exhausted even after a good night's sleep, or find that you're just generally more tired than you should be, and that simple daily activities are taking far more out of you than they used to. Fatigue can be due to the body's reaction to the cancer itself, reduced appetite, anemia, or other health issues. It can also be a feature of many non-cancerous conditions. If your fatigue is not amenable to lifestyle modification, it is important to have it assessed by your doctor.

8. Repeated Chest Infections

   Repeated episodes of pneumonia or bronchitis can on occasion be associated with an underlying lung tumor. If a tumor blocks an airway, mucus can accumulate, creating the perfect environment for infection. Recurrent infections don't necessarily indicate the presence of lung cancer. Infections that keep coming back in the same part of the lung, return very quickly after treatment, or occur in conjunction with a persistent cough may all be reasons to look further.

9. Wheezing & Noisy Breathing

   Wheezing is a whistling sound that can occur when air passes through a narrowed airway. In some instances, a tumor can cause partial obstruction of an airway, and this can lead to wheezing/noisy breathing. Asthma, respiratory infections, and COPD are the more common causes. Any new wheeze (especially if it's only on one side of the chest or isn't improving as you would expect) should be looked at by a doctor.

What are the symptoms of advanced lung cancer?

When lung cancer is found to have spread beyond the lungs, it may give rise to symptoms related to the organ(s) it has spread to. The symptoms will vary from person to person.

Possible symptoms include:

• Bone pain: ongoing pain in the back, ribs, hips or other bones.
• Headaches: ongoing headaches or neurological symptoms which may occur if the brain is involved.
• Swelling of the face or neck (if the tumor is impeding blood flow through the major veins).
• Numbness or weakness: Changes in the arms, legs or other parts of the body may occur in certain circumstances.
• Loss of appetite: reduced appetite can lead to weight loss and weakness.

These symptoms have a multitude of possible aetiologies. Their presence does not in itself confirm that the cancer has metastasized, but unexplained or worsening symptoms do require investigation.

Do lung cancer symptoms differ for smokers and non-smokers?

Lung cancer can occur in both smokers and non-smokers, and the symptoms are pretty much the same in both groups. A non-smoker is just as likely as a smoker to have a persistent cough, breathlessness, chest pain and/or unexplained weight loss.

Smoking is still a major risk factor, but there are other factors which can also contribute to the disease (radon exposure, secondhand smoke, air pollution, occupational carcinogens and certain genetic changes). So don't just dismiss any concerning symptoms simply because you don't smoke.

When should you consult a doctor for lung symptoms?

If you have a cough that's been going on for several weeks, a change in your normal cough, a history of recurrent chest infections, unexplained weight loss, ongoing hoarseness or breathlessness that isn't resolving, then you should arrange a medical appointment.

Coughing up blood needs to be assessed by a doctor promptly. Go to A&E if you have a significant or heavy cough of blood, severe breathlessness, or sudden severe chest pain.

Depending on your symptoms and your medical history, a doctor may recommend a physical examination, chest imaging, a CT scan, or other investigations. If cancer is suspected, a biopsy will be required to confirm the diagnosis. Those who meet the established high-risk criteria may also benefit from low-dose CT screening, even in the absence of symptoms.

Conclusion

Lung cancer symptoms and signs will vary depending on the location, type, and stage of the disease. The most common signs and symptoms are a persistent cough, coughing up blood (hemoptysis), shortness of breath, chest pain, hoarseness, unexplained weight loss, fatigue, and recurrent respiratory infections.

Although the above may not necessarily be due to cancer, any changes should be addressed immediately. It is necessary to consult a physician to determine what may be causing these changes. It is also vital to be aware of these early signs of cancer, refrain from smoking, and avoid exposure to dangerous things.

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