Lung cancer is the deadliest form of cancer, causing 23% of all cancer deaths in 2020 alone. The disease is also one of the most commonly diagnosed, second only to skin cancer and breast cancer in women and skin cancer and prostate cancer in men. Knowing the symptoms of lung cancer and the tests used to screen for and diagnose the disease is important for identifying the cancer early, when it is often easier to treat.

What are the first common signs of lung cancer?

The first common signs of lung cancer include a chronic cough, shortness of breath, fatigue, weight loss and loss of appetite. However, lung cancer normally doesn’t cause any symptoms until it reaches an advanced stage. By that time, lung cancer may also cause symptoms like changes in voice, chronic respiratory infections, chest pain, bone pain, headaches, trouble swallowing and swelling of the veins in the neck and face.

Chronic cough

In early stages, cancer cells obstructing the airways in the lungs can trigger your cough reflex. Coughing due to lung cancer usually persists over time, and it tends to get worse as the disease progresses. A chronic cough that worsens, doesn’t go away, or produces blood or bloody mucus may be a sign of lung cancer.

Shortness of breath

Lung cancer can interfere with the flow of air in your lungs, making you feel like you can’t catch your breath or causing a tightness in your chest when you try to breathe. This may come on only during exercise in the early stages of the disease, but it can also occur when you’re completely at rest, especially as the cancer progresses.

Fatigue

Fatigue is one of the most common symptoms of all types of cancer, impacting an estimated 80 to 100% of people with the disease. People often say that fatigue due to cancer feels much more intense than routine tiredness and makes it difficult to accomplish even simple daily tasks.

Weight loss

Cancer can trigger changes in your metabolism, causing you to lose weight when you’re not trying to. Generally, you should tell your doctor about weight loss of 10 pounds or more that isn’t due to modifications to your diet or increased physical activity.

Loss of appetite and difficulty swallowing

A lung cancer tumor that presses against the stomach could make you feel full even when you haven’t eaten. In more advanced stages, lung cancer may also interfere with your ability to swallow, further decreasing your appetite and accelerating weight loss due to the disease.

Changes in voice

If cancer affects the nerves that cause your vocal cords to open and close, your voice may begin to sound hoarse, raspy or higher in pitch. Unlike hoarseness due to throat irritation caused by an illness or allergies, the changes usually persist over time.

Chronic respiratory infections

Lung cancer may cause microorganisms that cause bronchitis and pneumonia to get trapped in your airways, leading to infections that don’t resolve or are difficult to treat. People with lung cancer may also experience more frequent respiratory infections.

Chest pain

If lung cancer causes your lymph nodes to become inflamed, fluid to build up in your lungs or your airways to become blocked, you may experience chest pain when you breathe in deeply, cough or laugh. The pain associated with lung cancer may get worse over time.

Bone pain

When lung cancer becomes advanced enough to spread to the bones, you may experience pain in the arms, neck, shoulders, spine or pelvis. Bone pain can be difficult to separate from routine muscle and joint pain. You’re most likely to experience it when you’re moving or lying on your back. People with metastasized lung cancer may also feel bone pain at night.

Headaches and swelling of the neck veins or face

Lung cancer can press on the superior vena cava, the main route that blood takes to travel from the head back to the heart. The pressure can reduce blood flow, leading to headaches, pounding in the head, and swelling of the face and the veins in the neck.

What is the best test for lung cancer?

The only screening test recommended by the U.S. Preventive Services Task Force (USPSTF) for lung cancer is low-dose computed tomography (LDCT). This test takes pictures of your lungs using an X-ray machine attached to a computer.

During the test, you lie flat on your back while your body travels through a tube. You may need to hold your breath for a few seconds while the x-ray machine takes the picture. The test usually takes less than a minute with the whole appointment usually finished in about 30 minutes.

The USPSTF recommends an annual LDCT screening test for adults who meet all of the following criteria:

  • Aged 50 to 80
  • Current smoker or former smoker who quit in the last 15 years
  • 20 pack-year smoking history or more

A pack-year smoking history is a method of measuring how heavy of a smoker a person is. To determine your pack-years, multiply the number of packs of cigarettes you smoked per day by the number of years you smoked. For example, someone who smoked two packs per day for 5 years has a 10 pack-year smoking history, while someone who smoked two packs a day for 25 years has a 50 pack-year smoking history.

Additional screening tests for lung cancer include:

  • Chest x-ray: Imaging test where pictures of the lungs are produced with an X-ray machine
  • Sputum testing: A laboratory tests a sample of mucus for the presence of blood
  • Genetic testing: Blood test to find out if you have genetic variations that may contribute to some forms of cancer. A positive test result doesn’t indicate that you have lung cancer. Rather, it means that you’re at an increased risk for the disease.

How is lung cancer usually diagnosed? 

Lung cancer is usually diagnosed by performing a biopsy. A biopsy involves taking a tissue or fluid sample and sending it to a laboratory, where a pathologist examines it under a microscope to determine if cancer cells are present. Doctors can perform a number of types of biopsies, including:

  • Bronchoscopy: A doctor passes an illuminated tube called a bronchoscope through the mouth or nose into the airways and lungs to look for cancer and obtain tissue samples for a biopsy.
  • Endobronchial ultrasound (EBUS): A doctor passes a bronchoscope with an ultrasound device attached into the trachea to examine lymph nodes and other areas of the chest. A needle can be inserted to gather tissue samples.
  • Mediastinoscopy: A doctor makes a cut or incision at the base of the neck to take samples of lymph nodes for a biopsy.
  • Thoracentesis: A doctor inserts a needle between the ribs and draws out fluid from the lungs for a biopsy.
  • Thoracoscopy: A doctor makes an incision in the chest and inserts a lighted tube into the area between the lungs and the wall of the chest. Once the camera is in place, the doctor can look for signs of cancer and obtain tissue samples for biopsy. In some cases, this technique is also used to treat cancer by removing a mass.
  • Fine needle aspiration biopsy (FNA): A long needle may be used to obtain cells from an area that could be cancerous.
  • Open biopsy: A large incision is made in the chest between the ribs to obtain a tissue sample or remove a cancerous tumor.

In addition to a biopsy, a doctor may order additional tests to determine the stage of cancer. These may include:

  • Additional CT scans: Imaging tests that use technology similar to that of a LDCT
  • Magnetic resonance imaging (MRI): Imaging test that produces highly detailed images of the lungs and chest using magnets and radio waves
  • Positron emission tomography (PET): Test where radioactive sugar is injected into the body and specially designed cameras then take pictures to determine where the sugar goes. Cancer cells tend to use more sugar than other cells, so a PET will normally show bright areas wherever cancer is present. This can help doctors see if lung cancer has moved beyond the lungs to lymph nodes or surrounding tissues or traveled to distant parts of the body.
  • Bone scintigraphy: Also called a bone scan, this test uses nuclear medicine technology to capture images of the bones that doctors can then use to determine if lung cancer has spread.
  • Blood work: Doctors may order comprehensive blood testing to check levels of platelets, red blood cells and white blood cells.

Forward offers comprehensive cancer screening and prevention services

Through our doctor-led Cancer Prevention program, we provide comprehensive screening tests, blood work and genetic testing to detect lung cancer and other common forms of cancer, including breast, prostate, skin and colorectal. We take on the role of your preventive care doctor, using the findings of our in-depth analyses to develop a lifestyle change plan optimized to address your risk factors for cancer. By delivering ongoing support and biometric monitoring, we help you follow the plan and track your progress, so you can achieve your goal of lowering your risk for cancer.

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