Lung cancer is the leading cause of cancer death in the United States, largely because it is often found late, after it has already spread. When it is caught early, the outlook is far better. Knowing the warning signs and whether you qualify for screening can make a real difference.
Types of lung cancer
- Non-small cell lung cancer (NSCLC) accounts for most cases. It includes adenocarcinoma, the most common type and the one most often seen in people who have never smoked, along with squamous cell carcinoma and large cell carcinoma.
- Small cell lung cancer is less common, strongly linked to smoking, and tends to grow and spread quickly.
Early warning signs
Early lung cancer often causes no symptoms. When symptoms appear, they can include:
- A new cough that does not go away after three weeks, or a long-standing cough that changes
- Coughing up blood or rust-colored phlegm
- Shortness of breath
- Chest pain that is worse with deep breathing, coughing or laughing
- Hoarseness
- Chest infections that keep coming back or will not clear
- Unexplained tiredness, weight loss or loss of appetite
- Wheezing that is new
Later signs can include bone pain, headaches, swelling in the face or neck, and yellowing of the skin if the cancer has spread to the liver.
These symptoms have many other causes, but if they last more than a few weeks, especially if you smoke or used to smoke, see a doctor.
Who is at risk
- Smoking is by far the biggest risk factor, linked to most lung cancer deaths. Risk rises with the number of years smoked and cigarettes per day.
- Secondhand smoke.
- Radon, a natural radioactive gas that can build up in homes. It is the leading cause of lung cancer in people who have never smoked. Inexpensive home test kits are available.
- Workplace exposures such as asbestos, diesel exhaust, silica and some metals.
- Air pollution.
- Family history of lung cancer.
- Previous radiation to the chest.
Screening with low-dose CT
Annual screening with a low-dose CT scan can find lung cancer early, when surgery or targeted radiation can often cure it. Large trials showed that screening reduces deaths from lung cancer in high-risk people.
The U.S. Preventive Services Task Force recommends yearly low-dose CT screening for adults who:
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- Are 50 to 80 years old, and
- Have a 20 pack-year smoking history, and
- Currently smoke or quit within the past 15 years
A pack-year is one pack a day for a year. Twenty pack-years could be one pack a day for 20 years, or half a pack a day for 40 years.
Screening is covered with no cost-sharing by most private insurance plans for eligible people, and Medicare covers it for eligible beneficiaries aged 50 to 77. Before your first scan, you will usually have a shared decision-making conversation with a clinician about benefits and risks.
Despite the benefits, only a small share of eligible Americans are screened. If you meet the criteria, ask your doctor.
What if a scan finds a nodule?
Lung nodules are common, and the vast majority are not cancer. They may be scars from old infections or harmless growths. Radiologists use a standard system (Lung-RADS) to decide what to do next, based on the nodule’s size and appearance. Most small nodules just need a repeat scan to check they are not growing. Larger or suspicious ones may need a PET scan or biopsy.
Screening has downsides, including false alarms, extra scans and, rarely, complications from biopsies. That is why it is offered only to people at higher risk, where the benefits clearly outweigh the risks.
Diagnosis and treatment
If lung cancer is suspected, doctors use CT and PET scans and a biopsy to confirm the diagnosis and determine the stage. Testing the tumor for genetic changes (biomarkers) such as EGFR, ALK, KRAS and PD-L1 has transformed treatment, because many lung cancers now have targeted drugs designed for their specific mutation.
Depending on the type and stage, treatment may include:
- Surgery to remove the tumor, often using minimally invasive techniques
- Stereotactic body radiation therapy (SBRT) for small tumors in people who cannot have surgery
- Chemotherapy
- Targeted therapy for tumors with specific genetic changes
- Immunotherapy, which helps the immune system recognize and attack cancer cells
Survival from lung cancer has improved in recent years, driven in part by targeted therapy, immunotherapy and earlier detection.
Reducing your risk
- Stop smoking. It is never too late. Risk falls steadily after quitting. Ask your doctor about nicotine replacement, prescription medicines and counseling, which greatly improve the chance of success. You can also call 1-800-QUIT-NOW.
- Avoid secondhand smoke.
- Test your home for radon and fix high levels.
- Use protective equipment if you work with hazardous substances.
The bottom line
Lung cancer is often silent until it has spread, so screening matters. If you are 50 to 80 and have a significant smoking history, ask about a yearly low-dose CT scan. See a doctor about any cough lasting more than three weeks, coughing up blood, or unexplained weight loss.
This article is for general information and does not replace medical advice.