When cancer cells grow out of control in the lungs, they can keep your lungs from working well. Your provider will perform several tests to look for lung cancer.
Chest X-rays and CT scans can show a mass in the lung. MRI and PET scans offer more detail. You might also have a bronchoscopy. This involves a lighted tube inserted through the mouth under sedation.
Cancer is a disease that starts when cells grow abnormally. In lung cancer, the cells may start in the airways or in the tiny air sacs (alveoli). Or, they may begin elsewhere in the body and spread to the lungs. The two main types of lung cancer are non-small cell lung cancer and small cell lung cancer.
In most cases, the first symptom of lung cancer is a cough that won’t go away. Other symptoms include chest pain, wheezing or unexplained weight loss. These symptoms may also be caused by other health problems, so it’s important to see a doctor if you have them.
Coughing up bloody mucus or phlegm (sputum) is another sign of lung cancer. It’s important to let your doctor know if you’re coughing up blood or if your phlegm is unusual, like red or rust-colored.
Fatigue or feeling tired all the time is a common symptom of lung cancer. It’s because cancer cells can use up your body’s nutrients, causing you to become anemic.
Experiencing a persistent cough that doesn’t go away or chest pain that gets worse are other signs of lung cancer. Some people have a swelling in the skin of the neck, arms or upper chest (superior vena cava syndrome). Others have high levels of calcium in their blood, which causes digestive problems and extreme thirst and frequent urination. Still others have bone pain in the spine/back, pelvis or large bones of the arms and legs. Some people develop a condition called clubbed fingers. The ends of the fingers look fatter and curve downward, resembling a spoon.
Getting the right diagnosis is the first step toward treatment. Your doctor will take a detailed medical history and do tests to find out what’s causing your symptoms. These include x-rays, CT scans, MRI and PET scans. Other diagnostic procedures can be done to check for cancer in the lungs, such as sputum cytology and mediastinoscopy. During a sputum cytology test, your doctor takes a sample of your phlegm for examination under a microscope. During mediastinoscopy, you’re given anesthesia so your doctor can insert a lighted tube down your throat into your lungs to take tissue samples from lymph nodes.
If your doctor hears a wheezing sound when listening to your lungs with a stethoscope, it may be a sign that lung cancer is present. Cancer cells may also cause fluid to build up around the lungs, making it harder to breathe or causing chest pain. Your doctor can remove this fluid with a needle (thoracentesis). This is usually done in the hospital with a radiologist watching over you via CT scan.
To make a diagnosis of lung cancer, your provider will take into account your symptoms and medical history. A physical exam will be performed and a lung function test will be ordered. These tests help determine if your lung cancer can be treated with surgery, chemotherapy or radiation. It will also help determine if you have enough lung function to safely undergo an operation.
The type of lung cancer you have, its stage (whether it’s confined to one area or has spread to other parts of the body) and your smoking history will determine the treatment plan. If the cancer hasn’t spread, surgical removal of the tumor and treatment with chemotherapy or radiation will work best. If the cancer has spread, your provider will prescribe treatment to manage symptoms and shrink the cancer.
There are several tests that can be used to find out whether cancer cells have spread from the original site. These include blood tests, chest X-rays and CT or MRI scans. MRI scans are more detailed than CT scans and can pick up small lesions. The phlegm you cough up when you cough can also be tested for cancer cells with a procedure called sputum cytology. PET/CT scans are a combination of a CT and a PET scanner that allows doctors to see tumors and other abnormalities more clearly.
Sometimes a biopsy is needed to confirm the presence of cancer. A radiologist will use a CT scan to guide a needle into a mass to get a sample of the tissue for testing. This can diagnose 60 to 90% of lung cancers. In addition, a bronchoscopy or video-assisted thoracoscopic surgery can be used to look more closely at your lungs and take samples from nodules or other areas.
Doctors use a combination of treatments to treat lung cancer. They may remove only the tumor and some surrounding tissue, or they may remove part or all of your lung (resection). They can also use a surgery called radiofrequency ablation to kill cancer cells in some cases.
Chemotherapy uses drugs to destroy cancer cells and stop them from growing or spreading. This treatment is usually given in cycles. You will take chemotherapy medicine for several days in a row, then have a few weeks off to let your body recover. The number of chemotherapy cycles you will need depends on your cancer and the type of drug.
For some people with early stage non-small cell lung cancer that hasn’t spread, surgery can help control symptoms and improve survival. They might remove a section or the whole lung (lobectomy or pneumonectomy). They can also surgically remove lymph nodes from inside the chest. These surgeries are often combined with chemotherapy or radiation therapy.
If the cancer has already spread to other parts of the body, it is considered advanced lung cancer. Surgery is rarely used for advanced disease. But your doctors might try other types of treatments to reduce pain or other symptoms and improve your chance of a cure.
Doctors can look for evidence of cancer in other parts of your body with imaging tests like X-rays, CT, MRI or PET scans. They can also perform other diagnostic procedures such as bronchoscopy. During this procedure, you will be sedated and a long tube with a lighted microscope on the end (bronchoscope) is inserted into your throat. Doctors can then examine your lungs and other organs in your chest and abdomen.
Some patients who are not surgical candidates because of their age or comorbidities might be treated with radiation alone. They might receive external beam radiation or brachytherapy. For the latter, the doctor inserts a small number of radioactive pellets into the body that deliver radiation to the area.
Some patients who are treated with radiation might benefit from a therapy called targeted therapy. This is when drugs are designed to target specific proteins or genes that are important for cancer growth. It is important to talk with your healthcare team about the benefits and risks of targeted therapy.
The most important step to prevent lung cancer is to quit smoking. Smoking greatly increases your risk for both non-small cell and small cell lung cancer, which are the two main types of this disease. You should also limit your exposure to other cancer-causing substances, such as radon and chemicals used at work or in the home. Eating a balanced diet that includes plenty of fruits and vegetables may also reduce your risk. Some studies have shown that people who exercise regularly have a lower risk of developing lung cancer than those who are inactive.
Lung cancer can develop over many years before symptoms appear. This is why it’s important to get screened for lung cancer if you are at risk. Lung cancer screenings can find tumors that are too small to be seen on X-ray or CT scan and can help detect the disease at an early stage, when it is easier to treat.
If you’re at high risk for lung cancer, UT Southwestern can offer a computed tomography (CT) screening test and possibly a bronchoscopy. We can also provide expert genetic counseling and risk assessment to help you learn about your risk and manage it.
Our experts can recommend treatment depending on the type and stage of your cancer. If it’s in an early stage and confined to the lung, surgery to remove the cancerous part of the lung or a portion of healthy tissue around it might be an option. We also can use radiation or chemotherapy to kill cancer cells and prevent them from growing.
Research shows that a number of lifestyle factors can decrease your risk for lung cancer, including regular physical activity and eating a nutritious diet. We encourage people who want to avoid cancer-causing risks to consider cancer prevention clinical trials, where scientists are working to develop new ways to prevent and treat lung cancer. In addition, MSK’s online tools and screening services can help you understand your risk for lung cancer and decide if you should be screened.
Lung cancer can grow in your lungs for years before you notice symptoms. Symptoms depend on where the tumor is located and what stage it is in.
Common lung cancer symptoms include a cough that doesn’t go away, weight loss and feeling tired all the time. Other symptoms are a swollen lymph node and heart problems.
Breathing is usually an automatic process, but if you’re experiencing shortness of breath for no apparent reason or it gets worse with activities, it could be a sign of lung cancer. Your doctor may recommend you try breathing exercises or body positions to help with the problem.
It’s normal to experience shortness of breath at times from things like exercise, extreme temperatures, high altitudes or having an infection (like bronchitis). If you’re experiencing a new onset of shortness of breath, however, it’s important to call your doctor and explain the situation to them.
Sometimes, lung cancer can affect your breathing by blocking airway passages, creating a blood clot that blocks blood flow to an area of the lung or causing the lung to partially collapse. In some cases, tumors can also grow into the space that surrounds your heart, causing fluid to build up in the chest cavity and making it harder to breathe.
If the symptoms persist, your doctor might drain the fluid from your chest or use a treatment called pleurodesis to prevent the occurrence of this symptom in the future. You might also need to take medicine to reduce pain or discomfort, depending on what’s causing your breathing difficulties. This symptom is called dyspnea and it becomes more common as cancer progresses. Sometimes, the muscles that aid in breathing can weaken due to a condition called cachexia.
Pain in your chest or ribs is another common symptom of lung cancer. The pain may originate from a local tumor or from the spread of the tumour to the chest wall, the lining around the lungs (pleura), the diaphragm or the ribs. If the cancer spreads to the rib bones, it may cause them to fracture or break. Pain that gets worse when you breathe, or if it occurs at night, is usually a sign of serious illness and should be investigated by your doctor immediately.
Chest pain can also be caused by pleural effusion, a build-up of fluid in the space surrounding the affected lung. This can make it harder to breathe, and if it isn’t treated, it can lead to life-threatening complications like pneumonia.
Other symptoms include:
Sometimes the symptoms of lung cancer can be similar to those of other illnesses, like a cold or a respiratory infection. These red flags include a cough that won’t go away, chest pain or feeling tired all the time. The good news is that if you do have these symptoms, it doesn’t always mean you have cancer. But it’s important to talk to your doctor about them anyway, because they can be a warning sign of cancer or something else that needs treatment.
Many people with lung cancer find it difficult to eat. It may be because their appetite decreases or because the cough, chest pain or other symptoms make eating uncomfortable. It can also be because their treatment makes the food taste bad or causes vomiting, stomach pain or diarrhoea. When people with lung cancer don’t eat enough, they can become very weak and tired. This can cause a vicious cycle where they don’t want to eat because of the pain and weakness, but then their loss of appetite gets worse because they aren’t getting the calories they need.
A loss of appetite is a common side effect of chemotherapy, radiation and immunotherapies. It can also happen when the tumor itself grows or because the cancer spreads to other parts of the body. If metastatic cancer has spread to the bones, it can cause pain in the ribs or vertebrae. If it has spread to the liver, it can cause high calcium levels (hypercalcemia), which can lead to nausea and extreme fatigue.
The most common symptoms of lung cancer include a cough that doesn’t go away, chest pain and unexplained weight loss. However, it’s important to remember that these symptoms can also be caused by other health conditions, so if you have any of them, it’s important to talk to your doctor. They can help you decide the next steps.
Cancer starts when cells in your lungs get changes that cause them to grow and divide uncontrollably. Over time, these cells can form masses, or tumors, that can keep your organs from working properly.
Depending on where the tumor is, it can affect your breathing and cause coughing or chest pain. It can also spread to other parts of the body, such as your lymph nodes or liver. If the cancer has spread, it’s called metastatic lung cancer.
Sometimes, people with non-small cell lung cancer (NSCLC) don’t have symptoms at all. And even when they do, symptoms don’t usually show until the cancer has advanced to later stages.
In later stages of lung cancer, weight loss can be a sign that the cancer has spread to other parts of the body. It can also be a side effect of treatments for NSCLC, such as surgery, radiation therapy or chemotherapy.
If you’re losing weight, talk to your doctor about it. They can recommend ways to help you eat more and get back your appetite. These include eating softer, moist foods such as soups and scrambled eggs. They can also give you anti-nausea medicine to relieve the feeling of nausea and stimulate your appetite. They can also refer you to a dietician or nutritionist if needed. This can help you manage your weight and energy during treatment. And it can help you feel better after treatment is over.
Fatigue is a common side effect of cancer and its treatment. In one study, cancer survivors said that fatigue interfered with their quality of life more than pain, nausea or depression. Cancer-related fatigue may be caused by your disease or its treatment, but it also can be a sign that something is wrong.
Lung cancer can cause changes in your body that make you feel tired. It can affect the way your body uses oxygen or slow down your metabolism. It can even impact your bone marrow, which makes blood cells. When cancer invades the marrow, it can decrease the production of healthy blood cells that carry oxygen to the rest of your body. This can cause anemia, which causes fatigue.
If you are experiencing fatigue, talk to your doctor. Your doctor may prescribe an iron supplement or recommend other ways to improve your energy. Your doctor might suggest that you take it easy on bad days and try to rest when you can. Ask for help from family and friends on these days to run errands, prepare meals or clean your house.
Sometimes lung cancer can spread to other parts of the body and can cause a group of symptoms called paraneoplastic syndromes. These are caused when the substances released by the cancer cells attack other tissues and organs. These can include a blood clot in the lungs (pulmonary embolism), spitting up of blood (haemorrhage), high calcium levels in the blood (hypercalcemia) and swelling of the face, neck or arms (superior vena cava syndrome) or drooping eyelid on one side of your face (Horner’s syndrome). Other symptoms are a cough that doesn’t go away and unexplained weight loss.
Fatigue is a common and debilitating side effect of lung cancer, and it can have a greater impact on your quality of life than many other symptoms. The fatigue can be caused by the tumour itself or by treatment. It can also be a sign of other health conditions, such as low blood cell count (anaemia), problems sleeping or depression, which can be treated.
Sometimes, non-small cell lung cancer (NSCLC) doesn’t cause any signs or symptoms in its early stages. But, it can later grow and take up more space or affect parts of the body near the lungs. This can lead to other symptoms, such as a cough, chest pain or shortness of breath.
Symptoms of metastatic cancer can also happen when the tumour spreads to other parts of the body. For example, cancer that spreads to the liver may cause a swollen abdomen, high blood calcium levels and feelings of extreme tiredness. It can also cause bone pain, especially in the ribs and vertebrae, as well as constipation and itchy skin.
If you are feeling very tired all the time, speak to your GP or cancer doctor. They will carry out an examination and check for any underlying causes, such as a low blood cell count or other health conditions. They may also reduce the dose of any medicines you are taking, such as a sleeping tablet, which could be causing the fatigue.
Lung cancer treatments may reduce pain or other symptoms and help you breathe more easily. Treatments can include chemotherapy and radiation.
Your provider will listen to your lungs with a stethoscope and ask about your smoking history. You might have a blood test or a biopsy.
A PET scan injects a harmless substance called fluorodeoxyglucose that highlights areas of the lung that are using more glucose than normal. This helps your provider find cancer cells.
Your doctor will prescribe one or more chemotherapy drugs to kill cancer cells that have spread in your lungs. These drugs may be given through a vein in your arm (intravenously) or by mouth. Chemotherapy drugs are usually given in cycles, with breaks between treatments to allow your body to recover. You will also take medicine to prevent side effects, such as nausea and vomiting.
Sophisticated tests can help your doctor determine what type of lung cancer you have, which will affect the way it grows and spreads. Careful analysis of the results of these tests helps your doctor decide what to do next.
Lung cancers are divided into two main types — small cell and non-small cell. Each of these types grow and spread differently, so each calls for different treatment.
If the cancer is found early, surgery may be an option. During surgery, your doctors will make a cut in your chest or side and remove a part of the lung that has the cancer. They may also remove nearby lymph nodes. The surgeon can then use medicine to help prevent the cancer from returning or spreading in the future.
A procedure called radiofrequency ablation can be used to treat some early-stage non-small cell lung cancers. During this procedure, your doctor will put a needle in the tumor and then send high-energy waves through it. The heat generated from this procedure will destroy the cancer cells. It may also prevent a pocket of air from forming between the inner and outer layers of your lung (pneumothorax).
If the cancer has already spread when you are diagnosed, chemotherapy and radiation therapy are standard treatments. You may also benefit from other therapies, such as targeted therapy and immunotherapy. Your doctor will recommend a treatment plan that is right for you.
Radiation therapy uses high-energy ionizing radiation (X-rays, gamma rays, protons and neutron beams) to kill cancer cells or stop their growth. It can also shrink tumors and ease pain, stiffness and other symptoms. Radiation therapy may be used alone or combined with surgery, chemotherapy and/or other treatments.
Doctors use radiation therapy to treat non-small cell lung cancer when it’s in an early stage and hasn’t spread to other parts of the chest or body. It’s also used when surgeons can’t remove the entire tumor or you have a medical condition that makes surgery risky.
In many cases, a combination of chemotherapy and radiation is the best treatment for advanced NSCLC. In these patients, the goal is to control the disease with the least damage to normal tissue and organs. Cure rates are lower than with surgery but still quite good.
Your doctors will suggest surgery if the tumor is in one of the large sections of your lung (lobes). During the operation, your doctor may also sample or remove nearby lymph nodes.
NSCLC that’s spread to other parts of your body can’t be removed with surgery. Instead, you’ll receive radiation therapy along with chemotherapy to keep the disease from spreading and to help relieve symptoms.
The challenge is to deliver a high dose of radiation to the tumor while limiting exposure to surrounding tissues and structures. Because the lungs are constantly moving, this is a challenging task for radiation oncologists. New techniques are helping to make this treatment more effective.
One approach, called three-dimensional conformal radiation therapy (3D-CRT), shapes and aims a series of radiation beams at the tumor from multiple angles. A variation, intensity-modulated radiation therapy (IMRT), uses a CT scan to help direct the shape of the beams and limit the dose to nearby healthy tissue. Another technique, stereotactic body radiation therapy (SBRT), uses a computer to target very precise points in your body for high doses of radiation. Each session lasts just a few minutes. This technique is available at some larger medical centers that have experience with SBRT.
For non-small cell lung cancer (NSCLC), which is the most common type of lung cancer, surgery may be an option if it is found early. Surgery can help keep the cancer from coming back after chemotherapy or radiation treatment. Surgery can also be used to treat symptoms, such as shortness of breath.
Doctors who are experts in lung diseases can recommend the best treatment for you, depending on your specific condition. These doctors include pulmonologists, who specialize in conditions of the lung; surgeons; medical oncologists, who treat cancer with medicines; and radiation oncologists, who use X-rays or protons to destroy tumor cells.
Before surgery, your doctor will ask about your past health problems and whether you smoke. He or she will also examine you and listen to your lungs with a stethoscope. This test can reveal fluid around your lungs, which could suggest cancer. Your doctor will also take a sample of the fluid or tissue from your lung for laboratory testing. This is called a biopsy. A doctor can perform a biopsy in many ways, including with a lighted tube that goes down your throat and into your lungs (bronchoscopy).
Chemotherapy is a treatment that uses medicine to kill cancer cells. It can be given by mouth or through a vein (IV). It works by stopping cancer cells from growing or multiplying. Your doctors will make a plan for how long you will receive chemotherapy. It is usually given in cycles, with each cycle lasting a few weeks.
If you have NSCLC that has not spread to other areas of the body, a 5-year relative survival rate is about 65%. For NSCLC that has spread to other parts of the lung or to distant areas of the body, the survival rates are lower and depend on what part of the body the cancer has spread to.
Some people who have NSCLC benefit from targeted therapy or immunotherapy, which are newer treatments that can help your body fight cancer. These treatments can be given along with surgery or on their own. If you have NSCLC that has spread to other areas of the body, your doctor will give you other treatments to help control the cancer and reduce the chance of it returning.
A growing number of cancer patients are benefiting from new therapies that harness the body’s natural ability to fight disease. These treatments include vaccines, immunotherapy and targeted therapy. Penn Medicine’s world-leading researchers are developing these and other new immunotherapies to treat cancer and other diseases, including inflammatory conditions, Alzheimer’s, multiple sclerosis, Parkinson’s and infectious diseases.
The type and stage of your cancer determines your treatment options. Careful laboratory tests can reveal the nature of your cancer and help doctors decide what kind of surgery, radiation or chemotherapy to use. Your doctor may also recommend supportive care, such as palliative care or other medicines to ease your symptoms and prevent complications from your treatment.
Your body’s disease-fighting immune cells can sometimes detect and destroy lung cancer cells. But some cancers develop proteins that hide them from these cells and help them grow. Immunotherapy aims to interrupt this process by stimulating your own immune system to attack your cancer cells.
Some types of immunotherapy work by delivering vaccines that target specific proteins found on your cancer cells. Others rev up your immune system by changing the genes in your white blood cells so they recognise and attack your cancer cells.
These treatments can be used alone or combined with chemotherapy, depending on your situation. Examples of immunotherapy for lung cancer include pembrolizumab and atezolizumab. They are usually used with chemotherapy, but they are also available as a single agent for some non-small cell lung cancer (NSCLC) patients whose tumors have certain genetic mutations.
Other immunotherapy drugs, such as nivolumab and ipilumimab, are monoclonal antibodies that prevent your tumor from developing the new blood vessels it needs to feed itself. They can be used to treat advanced NSCLC that has spread to other parts of the body, or squamous NSCLC that has not spread.
Your immune system is often suppressed by the cancer drugs you receive, and your body can develop a variety of side effects. These include fever, chills, fatigue, muscle and joint aches, loss of appetite, nausea, vomiting and weight gain from extra fluid buildup.