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These Early Signs Of Lung Cancer Are Often Missed, Oncologists Say

Lung cancer is the second-leading cause of cancer death in the United States after skin cancer, according to the American Cancer Society. The disease is to blame for about 1 in 5 cancer deaths, and the ACS estimates more than 125,000 people will die from it this year.

These statistics are grim, but there's a reason why lung cancer often progresses past the point where it's treatable: Early signs of lung cancer are often missed (or nonexistent).

"Most patients may not have symptoms unless it has spread or unless there is evidence it is metastatic or there is involvement of major structures," says Dr. Amna Sher, a medical oncologist at Stony Brook Cancer Center.

Early diagnosis can significantly improve a person's chances of survival. For instance, the five-year survival rate for the most common type of lung cancer, non-small cell lung cancer, which includes adenocarcinoma, squamous cell carcinoma and large cell carcinoma, is 65 percent if diagnosed while it's still localized (in other words, it hasn't spread elsewhere in the body).

Those numbers drop to 37 percent if it spreads to structures near the lungs, like the lymph nodes, and just 9 percent if it spreads to more distant areas of the body, such as the brain.

It's a lot to take in. But the bottom line is this: "If lung cancer can be diagnosed at an early stage, the patient will have more treatment options and a better chance of remission," says Dr. Xiuning Le, a V Foundation clinical scholar at the University of Texas' MD Anderson Cancer Center. "It is extremely important to detect lung cancer as early as possible."

But how? Doctors shared commonly missed early signs of lung cancer and what to do if you're concerned.

Commonly missed sign

A persistent or worsening cough is a commonly missed early sign of lung cancer, Sher says.

"It warrants an evaluation if someone has a new or persistent cough … which has been ongoing for several weeks or months, especially in a high-risk patient with a strong history of smoking," she says. "For example, you got a course of antibiotics, but it's been two months, and you're still coughing — seek medical attention."

Sher says doctors often see patients come in with months of a persistent cough, but an abnormal X-ray prompts a deeper dive into the cause of the issue.

Easy to dismiss

Le and another expert agree that a chronic cough is an easy-to-miss sign of lung cancer. Part of the problem: Chronic coughs are often similar to other diseases, including those at a higher risk for lung cancer — primarily smokers — may already have.

"Most — but not all — cases of lung cancer are associated with a prior tobacco smoking history," says Dr. Brett Bade, the director of the Lung Cancer Screening Program at Northwell Lung Insitute in New York. "Tobacco smoking is a risk factor for both lung cancer and lung disease. Chronic obstructive pulmonary disease, for example, can also cause a chronic cough and shortness of breath. People may attribute their symptoms to their lung disease or prior tobacco use."

In other words, patients may be used to coughing and consider it normal.

Even people without a history of smoking or lung disease may chalk a persistent cough up to something else, and usually, something less severe.

"Patients may think it's just an upper respiratory infection or virus," Sher says. "It may be seasonal. Patients have allergies. If you're around patients with kids, you're exposed to all these viruses and may think you just didn't get better."

Other overlooked signs

A persistent cough isn't the only early sign of lung cancer that's easy to overlook.

"Since the lungs don't have many pain receptors, most symptoms of lung cancer are related to the tumor's involvement of a local structure or another organ," Bade says. "For example … shortness of breath may develop if the tumor involves the airway. Similarly, if the tumor spreads to a bone, the involved bone becomes painful."

Bade says that other common signs of lung cancer a patient may not recognize include: fatigue, hoarseness, chest pain, bone pain, reduced appetite and weight loss.

Diagnosis, treatment

Doctors will biopsy the involved site to diagnose lung cancer.

"Frequent biopsy sites include the lungs, lymph nodes in the neck or chest or drainage of fluid from around the lungs," Bade explains. "If other organs are involved, your doctor may recommend a biopsy of those sites; examples might include the liver, the adrenal gland or a bone."

Le says that several factors determine a patient's lung cancer treatment plan, mainly: the type of lung cancer, the cancer's stage, and genetic and immunological features of the specific patient.

"In general, surgery, radiation and systemic therapies are all effective treatments for lung cancer," Le says. "There are many different options within the (therapy) class."

A care team will work with a patient on the best option for their specific case.

If you're concerned about lung cancer, talk to your doctor.

"Early recognition and early treatment is the key to longer lung cancer survival," Le says. "If you have new symptoms or suspect you are eligible for lung cancer screening, you should discuss it with your doctor."

5 Signs Of Lung Cancer Even Nonsmokers Need To Know

The chest isn't the only spot that might feel heavy or tight, Dr. Chiang says. "If it goes to the bone, maybe in one of your vertebrae, you can weaken that bone and sometimes you can be more susceptible to a fracture," she notes.

As for how lung cancer pain might differ from, say, anxiety-related chest pressure, again, it can be hard to differentiate, both experts agreed. The main thing to look for? It's new—and not letting up.

3. You're strangely short of breath.

Vassallo was super active before her lung cancer symptoms settled in. So when she started having issues with her breathing, it was particularly noticeable. "I'd go to martial arts classes and lift weights, still in pain and tiring out really quickly," she explains. "I was training for a half-marathon at the time, but I eventually had to stop—I couldn't go longer than a few minutes without wanting to pass out."

In Vassallo's case, her tumor was putting pressure on her lungs, causing her respiratory system to become inflamed and agitated. But people can have a hard time inhaling because the cancer is causing fluid to build up in the lungs, Dr. Chiang says. "You might even have some shortness of breath changing positions because, if you're bending over, that fluid sort of 'goes with gravity' either to the front or the back."

Vassallo was a generally athletic person, so her lung capacity changes were stark. But what if you're not logging miles on a daily basis? "Typically what I hear from my patients is that things have changed over time and you're in a different place than you were before," Dr. Chiang notes. "It might be something like, 'Oh gee, I used to be able to fold all my laundry in one go, and now I have to take several breaks while I'm doing that because I get really tired and short of breath.'"

4. You're dropping weight without trying.

One doc thought acid reflux was to blame for Vassallo's woes, so she was put on a GERD diet (a.K.A. Things that discourage heartburn, like whole grains, vegetables, watery foods like watermelon, and foods with a higher pH, like bananas and melons). When Vassallo went on to lose weight over the course of a few months, she figured her new eating habits were the cause.

According to Dr. Chiang, weight loss is often associated with all types of cancer, not just lung. "That's because cancer cells use a lot of sugar, and sometimes people lose their appetite," she notes. (Cancer cells grow more rapidly than normal cells, Dr. Chiang explains, and suck up a lot of energy.) "So even though they're not trying to lose weight, they may just have a loss of appetite and not be interested in food."

So what's a red flag? If you've dropped 10 pounds, or roughly 5% of your body weight, over several months without trying, bring it up to a doc ASAP.

5. You've developed blood clots.

Roughly 10% of people with any kind of cancer develop blood clots because they tend to have "sticky" blood or a tumor that can compress blood vessels. If you have a clot, you might feel throbbing, cramping, swelling, or redness in the legs or arms, or sudden breathlessness or chest pain. Clots can be particularly prevalent in lung cancer, Dr. Puri says. "I recall one of my patients who was extremely active. He used to bike, had his own company, and just had a blood clot out of nowhere. Blood clots don't happen in healthy young people without risk factors."

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