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How Do You Know You Have Lung Cancer?

Ask a Doctor

I’ve had a chronic cough for more than two weeks now. I smoked cigarettes for almost 20 years, but now I’ve been smoke free for more than 15. Maybe it’s foolish, but I’ve been avoiding the doctor for fear of what she may find. How do you know you have lung cancer?

Doctor’s Response

Up to one-fourth of all people with lung cancer may have no symptoms when the cancer is diagnosed. These cancers usually are identified incidentally when a chest X-ray is performed for another reason. The majority of people, however, develop symptoms. The symptoms are due to direct effects of the primary tumor, to effects of metastatic tumors in other parts of the body, or to disturbances of hormones, blood, or other systems caused by the cancer.

Symptoms of primary lung cancers include cough, coughing up blood, chest pain, and shortness of breath.

  • A new cough in a smoker or a former smoker should raise concern for lung cancer.
  • A cough that does not go away or gets worse over time should be evaluated by a health care professional.
  • Coughing up blood (hemoptysis) occurs in a significant number of people who have lung cancer. Any amount of coughed-up blood is cause for concern.
  • Chest pain is a symptom in about one-fourth of people with lung cancer. The pain is dull, aching, and persistent.
  • Shortness of breath usually results from a blockage to the flow of air in part of the lung, collection of fluid around the lung (pleural effusion), or the spread of tumor throughout the lungs.
  • Wheezing or hoarseness may signal blockage or inflammation in the lungs that may go along with cancer.
  • Repeated respiratory infections, such as bronchitis or pneumonia, can be a sign of lung cancer.

Symptoms of metastatic lung tumors depend on the location and size. About 30% to 40% of people with lung cancer have some symptoms or signs of metastatic disease.

  • Lung cancer most often spreads to the liver, the adrenal glands, the bones, and the brain.
  • Metastatic lung cancer in the liver may cause a loss of appetite, feeling full early on while eating, and otherwise unexplained weight loss.
  • Metastatic lung cancer in the adrenal glands also typically causes no symptoms.
  • Metastasis to the bones is most common with small cell cancers but also occurs with other lung cancer types. Lung cancer that has metastasized to the bone causes bone pain, usually in the backbone (vertebrae), the large bones of the thigh (the femurs), the pelvic bones, and the ribs.
  • Lung cancer that spreads to the brain can cause difficulties with vision, weakness on one side of the body, and/or seizures.

Paraneoplastic syndromes are the remote, indirect effects of cancer not related to direct invasion of an organ by tumor cells. Often they are caused by chemicals released from the cancers. Symptoms include the following:

  • Clubbing of fingers -- the depositing of extra tissue under the fingernails
  • New bone formation -- along the lower legs or arms
  • Increased risk of blood clots in the arms, legs, or lungs
  • Low sodium levels
  • High calcium levels
  • Low potassium levels
  • Degenerative conditions of the nervous system otherwise unexplained.

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References
American Joint Committee on Cancer. "Lung Cancer Staging." <http://cancerstaging.org/references-tools/quickreferences/documents/lungmedium.pdf>.

Santacroce, Luigi. "Paraneoplastic Syndromes." Medscape.com. Aug. 13, 2014. <http://emedicine.medscape.com/article/280744-overview>.

United States. National Cancer Institute, U.S. National Institutes of Health. "What You Need to Know About Lung Cancer." July 2012. <http://www.cancer.gov/cancertopics/types/lung>.
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