It’s a common misconception that lung cancer has definitive symptoms or “early signs,” when in reality, lung cancer is very sneaky.
Lung cancer diagnoses come in all shapes and sizes – not only for heavy smokers battling a harsh cough. Sometimes, lung cancer is found incidentally, during a test for another complication; other times, its progression leads to strange and unexpected symptoms, affecting parts of the body other than the lungs.
If you’re concerned about your lung cancer risk, the best thing to do is speak up, says Emma Ruth Paz-Querubin, APN. This is true even for non-smokers, as various other carcinogenic and environmental exposures, like radon, can increase your risk.
Any change in your health – big or small – should be discussed with your primary care provider, adds Anne Marie Kinsey, CRNP.
Here, we sit down with the two nurse practitioners, both with expertise in lung nodule care, to discuss some common and not-so common presentations of lung cancer; how the impacts of lung cancer can trickle throughout the body; and how you can stay on track with your individual risk.
The Silent Cancer
It’s a common misconception that lung cancer, like other cancers, has definitive symptoms or “early signs,” when in reality, lung cancer is very “sneaky,” says Paz-Querubin. Studies have shown that, typically, lung cancer will not cause many symptoms, if any, unless the size of the tumor is large, advanced, or metastasized (spread). Lung cancer cells can multiply and settle in surrounding healthy tissue, or they can break off and travel through the lymph and blood vessels.
“When symptoms do appear, they’re often related to tumor location, inflammation, a nerve that’s being compressed or violated,” explains Emma.
There are tell-tale signs we warn people to watch out for that may be indicative of a worsening lung cancer, says Kinsey. These include a new cough, unlike ones you’ve experienced before; a persistent or worsening cough; shortness of breath; chest pain; unexplained weight loss; decreased appetite; and coughing or spitting up blood.
“Keep in mind, symptoms do vary, as each cancer is unique. You may experience only a few of these, or maybe none at all,” continues Kinsey.
When the Effects Go Beyond the Lungs
Lung cancer can spread virtually anywhere in the body, but most frequently the liver, adrenal glands, nervous system, brain, and bones.
Typically, when lung cancer starts to invade other systems and causes inflammation and pressure, that’s when we see more unexpected symptoms, such as bone pain, fatigue, confusion, headaches, or generalized weakness, says Paz-Querubin. However, in some cases, the particular region of a nodule or tumor location may cause specific symptoms.
Pancoast tumors are rare tumors that develop in the uppermost part of the lung; they can lead to eye complications, such as a droopy eyelid and smaller pupil, explains Kinsey. “The nerves they press on can also cause a change in perspiration, dizziness, and altered consciousness.” When a tumor is in the upper right lobe, specifically, we often see referred back and shoulder pain, adds Paz-Querubin.
“With a brain metastasis, depending on the size and location, you’ll naturally see more neurological effects, such as impacted memory and attention span, difficulty speaking, headaches, and a disruption in balance,” continued Paz-Querubin. “It catches our attention when someone complains of their gait suddenly being ‘off,’ or that they’re starting to fall/trip over things for unexplained reasons.”
There are also some reports of lung cancer leading to paraneoplastic syndromes, which are abnormal immune and nervous system responses, explains Kinsey. These can further exacerbate problems within the kidneys, adrenal glands, and central nervous system.
Many of these symptoms can also be signs of other health complications, but regardless of what may cause them, you should speak with a healthcare provider – whether it’s your primary care provider or a specialist – as soon as possible, urges Paz-Querubin. “Our first priority is to make sure that symptoms are not caused by abnormalities in the lungs related to cancer.”
“It’s important to recognize your individual risks and discuss them in full with your provider. Evaluate all your current habits, not only involving smoking but also how regularly you exercise and what your dietary intake is like. Be in tune with your body – and overall wellness – and listen to it when something feels wrong,” continues Kinsey.
Making a Change
If you are a smoker, it’s never too late to stop. The minute you quit, your lung cancer risk drops, and your lungs start to heal, says Paz-Querubin. Studies show, that by the five-year mark, the risk for developing lung cancer is down by around 40 percent. Smoking cessation counseling or support groups are a great place to start, whether you’re already in the process of quitting or considering it. Jefferson offers the following programs:
If you meet screening criteria, take advantage of it, notes Kinsey. Anyone over the age of 50 with a 20 pack-year smoking history – including anyone who has quit within the last 15 years – is eligible for a low-dose CT scan.
“We have to stay proactive with our health to potentially avoid advanced disease,” reminds Paz-Querubin.