Signs and Symptoms of Lung Cancer

Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms.

Let your doctor know if you have symptoms

If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective.

Most of these symptoms are more likely to be caused by something other than lung cancer. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

The most common symptoms of lung cancer are:

• A cough that does not go away or gets worse
• Coughing up blood or rust-colored sputum (spit or phlegm)
• Chest pain that is often worse with deep breathing, coughing, or laughing
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Shortness of breath
• Feeling tired or weak
• Infections such as bronchitis and pneumonia that don’t go away or keep coming back
• New onset of wheezing

If lung cancer spreads to other parts of the body, it may cause:

• Bone pain (like pain in the back or hips)
• Nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain
• Yellowing of the skin and eyes (jaundice), from cancer spread to the liver
• Swelling of lymph nodes (collection of immune system cells) such as those in the neck or above the collarbone

Some lung cancers can cause syndromes, which are groups of specific symptoms.

Horner syndrome

Cancers of the upper part of the lungs are sometimes called Pancoast tumors. These tumors are more likely to be non-small cell lung cancer (NSCLC) than small cell lung cancer (SCLC).

Pancoast tumors can affect certain nerves to the eye and part of the face, causing a group of symptoms called Horner syndrome:

• Drooping or weakness of one upper eyelid
• A smaller pupil (dark part in the center of the eye) on the same side of the face
• Little or no sweating on the same side of the face

Pancoast tumors can also sometimes cause severe shoulder pain.

Superior vena cava syndrome

The superior vena cava (SVC) is a large vein that carries blood from the head and arms down to the heart. It passes next to the upper part of the right lung and the lymph nodes inside the chest. Tumors in this area can press on the SVC, which can cause the blood to back up in the veins. This can lead to swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color), as well as trouble breathing. It can also cause headaches, dizziness, and a change in consciousness if it affects the brain. While SVC syndrome can develop gradually over time, in some cases it can become life-threatening, and needs to be treated right away.

Paraneoplastic syndromes

Some lung cancers may cause problems in distant tissues and organs, even though the cancer has not spread to those places. These problems are called paraneoplastic syndromes. Paraneoplastic syndromes can affect your nervous system (paraneoplastic neurologic syndrome) or your endocrine system (paraneoplastic endocrine syndrome).Sometimes these syndromes may be the first symptoms of lung cancer. Because the symptoms affect other organs, a disease other than lung cancer may first be suspected as causing them.

Paraneoplastic syndromes can happen with any lung cancer but are more often associated with small cell lung cancer (SCLC).

In paraneoplastic endocrine syndrome, the lung tumor makes hormone-like substances that enter the bloodstream and affect distant organs. Examples include:

• SIADH (syndrome of inappropriate anti-diuretic hormone): There are many diseases that can cause SIADH. Cancer is one of them. In this condition, the cancer cells make ADH (anti-diuretic hormone), a hormone that causes the kidneys to keep too much water in the body. This lowers salt levels in the blood. Symptoms of SIADH can include fatigue, loss of appetite, muscle weakness or cramps, nausea, vomiting, restlessness, and confusion. Without treatment, severe cases may lead to seizures and coma.
• Cushing syndrome: There are many reasons why a person may develop Cushing syndrome. Cancer is one of them and is called ectopic Cushing syndrome. In this condition, the cancer cells make ACTH (adrenocorticotropic hormone), a hormone that causes the adrenal glands to make cortisol. This can lead to symptoms that include weight gain, easy bruising, weakness, drowsiness, and fluid retention. Cushing syndrome can also cause high blood pressure, high blood sugar levels, or even diabetes.
• Hypercalcemia: The tumor can make a hormone called parathyroid hormone-related peptide (PTHrP) that acts on the bones and kidney to increase the level of calcium in the blood. High levels of calcium in the blood (hypercalcemia can cause frequent urination, thirst, constipation, nausea, vomiting, belly pain, weakness, fatigue, dizziness, and confusion.

In paraneoplastic neurologic syndrome, the tumor can cause the body’s immune system to mistakenly attack parts of the nervous system (brain, spinal cord, nerves), rather than the cancer cells. Examples include:

• Lambert-Eaton syndrome: In this syndrome, the tumor may cause the immune system to attack the neuromuscular junction, which is the place where nerves communicate with muscle. This can lead to muscle weakness and issues with walking, speaking, and swallowing.  One of the first signs may be trouble getting up from a sitting position. Later, muscles around the shoulder may become weak.
• Paraneoplastic cerebellar degeneration: This disease can be caused by many different cancers, including small cell lung cancer. The immune system makes antibodies meant to attack the tumor, but instead mistakenly attacks an area of the brain called the cerebellum. This can lead to loss of balance and unsteadiness in arm and leg movement, trouble speaking, trouble swallowing, and changes in vision.
• Paraneoplastic limbic encephalitis: The limbic system is a part of the brain that is in charge of storing memory, and controlling emotions and behavior, as well as blood pressure and heart rate. The tumor may cause the immune system to damage the limbic system. This can lead to memory loss, personality changes, mood changes, sleep issues, and seizures.

Again, many of these symptoms are more likely to be caused by something other than lung cancer. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.