Cancer in lymph nodes: What happens and treatment
Lung Cancer Symptoms: What You Should Know
Most of the time, lung cancer has no symptoms in its early stages. Your lungs don't have many nerve endings, so a tumor can start to grow there without causing pain. You may not notice the signs until your cancer has begun to spread.
When signs of the disease start to appear, they can include:
These problems usually happen because of blocked breathing passages or because the cancer has spread farther into the lung, nearby areas, or other parts of the body.
Early-stage lung cancer often has few symptoms. When it's caught early, it's usually because the patient had a screening. (Photo Credit: E+/Getty Images)
Stage I lung cancer symptoms
This early stage of lung cancer often doesn't cause any symptoms. Stage I lung cancer is more likely to be caught because you had a screening, not because you noticed anything wrong. If you do have symptoms, they may include:
Stage IV lung cancer symptoms
When your cancer reaches this stage, it has begun to spread to more spots in your lungs, the fluid around your lungs, or other places in your body. In addition to respiratory symptoms such as coughing and wheezing, you may have:
Less common lung cancer symptoms
Some symptoms affect parts of your body that don't seem related to to your lungs. Those signs include:
Lung cancer symptoms on the skin
In addition to sweating issues caused by Horner syndrome, lung cancer can cause other issues with your skin. They include:
Lung cancer is the leading cause of cancer deaths among all genders. Lung cancer rates are falling across the board, but the decline hasn't been as big for younger women. Experts aren't sure why this is happening. Genetic mutations may play a role. Lung cancer has traditionally been associated with older men who have a history of smoking, so doctors may not suspect lung cancer at first when a nonsmoking young woman comes in with general symptoms such as cough or frequent respiratory infections.
There are two main types of lung cancer: small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). NSCLC is more common and makes up about 85% of all lung cancer cases. Within NSCLC, there are three subtypes:
There are two types of SCLC, mainly based on the type of cells involved and how they look under a microscope: small-cell carcinoma and mixed small-cell/large-cell cancer. It's sometimes called combined small-cell lung cancer. SCLC is strongly linked to cigarette smoking.
Both SCLC and NSCLC have many symptoms in common: cough, chest pain, wheezing, and hoarseness, for instance.
Non-small-cell lung cancer symptoms
NSCLC is more likely than SCLC to cause Horner syndrome, the collection of symptoms that affects your pupil, eyelid, and sweating on one side of your face.
Small-cell lung cancer symptoms
This type tends to grow and spread more quickly to other parts of your body. That means it's more likely to produce symptoms, such as:
SCLC is more likely than NSCLC to cause hypercalcemia and interfere with your adrenal glands.
If you have any of these symptoms of lung disease, especially an ongoing cough, blood-streaked mucus, wheezing, hoarseness, or a lung infection that keeps coming back, see your doctor. You'll get a thorough checkup, and you may also get X-rays or other tests.
Go immediately to the emergency room if you have any of the following:
In its early stages, lung cancer often has no symptoms. If you're coughing up mucus (especially if it's streaked with blood), have wheezing, hoarseness, chest pain, or frequent cases of bronchitis or pneumonia, these can be signs of lung cancer. Many of the symptoms of SCLS and NSCLC are the same. Those symptoms can also be signs of other illnesses. It's important to talk to your doctor if you have concerns.
How long can you have lung cancer without knowing?
Lung cancer can grow in your body for years before you start to notice symptoms.
Is cancer in the lungs curable?
Experts generally don't use the word "cured" when it comes to lung cancer. They're more likely to say you're in "remission" or that your body shows "no evidence of disease" (NED). At 5 years or more of remission or NED, your doctor might consider you cured. The earlier your cancer is found and you begin treatment, the better your outcome is likely to be. That's why experts have begun to encourage lung cancer screening for certain people at higher risk. You may want to look into the benefits of screening if you meet these requirements:
How long can you live with lung cancer?
How long you'll live depends on many factors, including:
The survival rates for lung cancer have been increasing with the development of new treatments.
What If My Lung Cancer Comes Back?
Katie Trimble is a two-time lung cancer survivor. At age 48, the never-smoker from Centerville, Utah, who hiked every day, was diagnosed with stage 3 lung cancer in March 2021.
To shrink the lime-sized tumor in her right lung, Trimble was treated with a medication targeting the EGFR gene mutation that causes her type of cancer. She also underwent surgery, chemotherapy, and radiation.
A year later, an imaging scan and blood test indicated that her lung cancer was gone. Then, just a few months later, in July 2022, she started experiencing severe headaches. They were "so painful I felt like my head was going to explode," Trimble recalls. A visit to the emergency room and a CT scan revealed her lung cancer had spread to her brain.
Throughout the recurrence and subsequent treatment, she has tried to maintain a positive outlook, even though at times it was challenging.
"It's mind over matter," says Trimble, now 51. Working 20 to 40 hours per week as a hairstylist helps her focus on something other than cancer. "If you don't wallow in self-pity, I think it's better," she explains.
Here's what experts say you should do if you're worried about or have been told your lung cancer has come back.
First, Get Regular Checkups After Finishing TreatmentAfter finishing treatment for lung cancer, recurrence is a possibility that looms on many survivors' minds. For some, unfortunately, recurrence becomes a harsh reality.
"Some survivors say it's worse than when they were first diagnosed," notes Emily Tonorezos, MD, director of the Office of Cancer Survivorship at the National Cancer Institute in Rockville, Maryland. "Going through cancer treatment is traumatic, and so, to face a recurrence might feel like revisiting that trauma."
But it's important to not let fear of recurrence prevent you from following up with your doctors and doing the tests they recommend. Even if you feel fine, staying on schedule with these regular checkups is essential.
"Many times, there are no symptoms, particularly in early stages," says Janani Reisenauer, MD, chair of thoracic surgery and an interventional pulmonologist at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota. "That is why surveillance with imaging is so important for early detection — even with recurrence."
Lung cancer recurrence is frequently detected on a CT scan of the chest that is repeated at specific intervals after initial treatment. It's usually done every six months initially and then annually, says Albert Rizzo, MD, chief medical officer at the American Lung Association and a practicing pulmonologist in Wilmington, Delaware. Sometimes, he adds, cancer is a surprise finding on chest imaging done for other reasons.
Know the Symptoms of Lung Cancer RecurrenceSome patients start to have symptoms before their next surveillance scan. Experts say these symptoms include:
If your symptoms are persistent, your doctor can order imaging tests to see if your lung cancer has come back.
Find Out the Extent and Type of Lung Cancer RecurrenceBesides visualizing the chest, scans can look at other areas of the body where lung cancer may spread, including abdominal structures and bones. If you have headaches or other neurological symptoms, a brain scan may be recommended, says Christina Annunziata, MD, PhD, senior vice president of extramural discovery science at the American Cancer Society in Atlanta.
Based on the imaging's findings, your doctor will be able to assess the extent of your lung cancer. And depending on your tumor's location, a biopsy may be done to confirm a diagnosis, says Anne Chiang, MD, PhD, an associate professor in the division of thoracic medical oncology at Yale University School of Medicine in New Haven, Connecticut.
The biopsy can also test for specific mutations and biomarkers to determine which treatment is most likely to be effective. Be sure to ask your doctor whether your cancer is positive for any targeted mutations or biomarkers (sometimes referred to as next-generation sequencing), says Clarke Low, MD, director of thoracic oncology at Intermountain Health in Salt Lake City.
Specific treatments can be prescribed to target these particular mutations in the lung cancer cells, says Dr. Annunziata. "The mutated genes (EGFR, ALK, ROS, BRAF, MET, RET, NTRK, HER2) would direct the choice of treatment," she explains.
Most targeted treatments are given as pills, but some are intravenous. If a patient doesn't have any mutations for which there are targeted treatments, then "a biomarker (PD-L1) can predict how effective immunotherapy will be and whether it can be used on its own or in combination with chemotherapy," says Dr. Low.
Ask About Treatment Options and Prognosis for Lung Cancer RecurrenceLow also recommends asking these questions:
"You should always ask about clinical trials," says Dr. Chiang, "since participation may allow access to cutting-edge treatments that won't be commercially available until many years."
Now may also be the time to ask your doctor about your prognosis. This will depend on many factors, including how long it has been since your initial lung cancer was treated, where in the body the lung cancer has recurred, and how many locations in the body the cancer has spread, says Low.
A cancer that recurs in the lung may respond to a change in chemotherapy, targeted therapy, or immunotherapy. Distant recurrences in the bone or brain may benefit from radiation therapy. In some cases, surgery may be an option, Dr. Rizzo says, noting that "this is where discussions with your treating team are so important."
Dr. Reisenauer adds that "sometimes recurrences can be managed with curative intent, but this is very variable." Your overall health also factors into your prognosis.
Build a Strong Support NetworkA strong support system can make a big difference in helping you cope with a recurrence of lung cancer. Reisenauer suggests asking your doctor to connect you with a social worker and mental health professional. "This is an integral part of a patient's treatment," she says.
Hopefully, you had a supportive network of family or friends at the time of your initial diagnosis. And hopefully, you can lean on them for support during your recurrence as well, says Rizzo.
There are also online and in-person patient support groups sponsored by advocacy organizations such as the American Lung Association. These groups "can offer advice and encouragement regarding next steps once a recurrence has occurred," Rizzo says, adding that some patients in these groups have survived multiple recurrences.
Trimble says trying to stay upbeat and having family and friends rally around her has helped.
"The type of cancer that I have, I feel like there's no cure for it, but you can still live a long life, depending on if the medication keeps working," she says.
Her advice to others in the predicament of facing a recurrence of lung cancer: "Just know that there is a light at the end of the tunnel. [If you believe this,] you can beat anything that comes your way."
Durvalumab Consolidation Therapy Shows Promise In Elderly Patients With Stage III NSCLC
Consolidation durvalumab led to comparable outcomes among older patients with unresectable stage III non–small cell lung cancer (NSCLC) vs a younger cohort with the same cancer; this patient population was underrepresented in the PACIFIC trial.
Australian investigators have determined consolidation durvalumab to be as effective among a patient population 70 years and older who has unresectable stage III non–small cell lung cancer (NSCLC) as in those who are younger than 70 years, according to new findings published in Journal of Geriatric Oncology.1
The setting for the consolidation treatment with the anti–PD-L1 antibody—treatment administered following a cancer's disappearance after initial treatment2—was post platinum-based chemoradiotherapy (CRT). These investigators explained that they researched the treatment in this setting because older patients had been underrepresented in the PACIFIC trial, and results trended toward poorer outcomes (worse survival and greater toxicity) for patients 70 years and older. They sought a more comprehensive understanding of durvalumab's safety and efficacy in these patients.
Their study population consisted of 65 patients 70 years and older and 87 patients younger than 70 years. The median overall age was 67 (range, 46-84) years, and 63.2% were male patients. An ECOG performance status (PS) of 0 (indicating the patient remains full active) was more common in the younger group (61%) vs the older group (46.6%), and an ECOG PS of 1, more common in the older vs the younger group (50.8% vs 33.3%). Rates of baseline chronic obstructive pulmonary disease (COPD) and cardiovascular disease were common in the older patients vs the younger patients, at 46.1% and 67.7% vs 23% and 48.3%, respectively, and current tobacco use was more common among the younger patients (79.3% vs 52.3%) and former and never-use statuses more common in the older patients (29.2% vs 10.3% and 18.5% vs 10.3%, respectively.
Image of lung cancerImage credit: didesign - stock.Adobe.Com
"Lung cancer incidence increases with age, with the media age at diagnosis in Australia being 71 years old," the authors wrote. "Real-world data can inform clinicians about outcomes for patients who are underrepresented in randomized controlled trials, allowing for further generalizability of the results."
Their primary outcome was 2-year overall survival (OS), which was the time from durvalumab initiation to death from any cause. Secondary outcomes were progression-free survival, treatment-related toxicity, treatment-related death, and toxicity-related treatment discontinuation.
The 152 patients included in this multicenter retrospective cohort study all had at least 1 cycle of durvalumab, but median overall administrations were 22, and this did not vay by age. The median follow-up was 26 (range, 4.1-56.7) months. Patients in the older-age group were more likely to have received carboplatin-based chemotherapy (P < .001).
Rates of treatment delay (30.8% vs 34.5%; P = .61), treatment stoppage due to toxicity (24.6% vs 16.1%; P = .23), or disease progression (30.8% vs 29.9%; P = .23) did not vary between the older and younger groups, respectively.
Median overall 2-year OS was 70.6% (95% CI, 63.2% vs 78.1%), and median OS was not reached. However, the 2-year OS was 65.2% (95% CI, 53.4%-77%) in the older patients vs 74.8% (95% CI, 65.4%-84.2%) in the younger cohort. Older age, Charlson Comorbidity Index (CCI) score of 5 or higher, and EGFR mutations were associated with OS (P < .10).
The median overall PFS and PFS among the younger population were the same, at 30.3 months, while among the older patients, this was 26.7 months (HR, 1.46; 95% CI, 0.80-2.65; P = .22); also in the latter group, a potential link was seen between EGFR mutations and previous tobacco use and worse PFS.
When toxicity was gauged, 94.7% of all patients had an adverse event (AE) during CRT, with 25.7% of these being grade 3 or 4; this toxicity grade was not linked to older age or ECOG PS, but it was linked to longer time to durvalumab initiation (P = .049). Among the 77% of patients who had an AE during durvalumab consolidation, 14.5% were grade 3 or 4; significant differences in toxicity were not seen between the older and younger patients. Grade 3 or 4 AEs were linked to a CCI score of 5 or higher (P = .01) and COPD (P = .07) on univariate analysis, and the CCI score of 5 or higher retained its significance on multivariate analysis (P = .022).
The authors note that their study is not the only one to have evaluated the treatment regimen set out in the PACIFIC trial, and that despite their small sizes or limited study sites, these analyses still add valuable findings for groups underrepresented in PACIFIC. Speaking to their study in particular, while admitting that there were more non–NSCLC-related deaths among their older patients, they emphasized that this may suggest age to not be a determinant of treatment tolerance of durvalumab; that instead, comorbidity burden may hold more influence in this regard.
"The increasing recognition of frailty as a prognostic entity in NSCLC should prompt clinicians to undertake additional assessment when determining appropriate treatment for older patients in the future," they concluded. "As treatment options for early lung cancer become increasingly complex, oncologists should bear these factors in mind when assessing the risk of harm and likelihood of benefit in older patients."
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