"Doctor, I only had an occasional cough—how could it be mid-stage lung cancer?" This is the question I hear most in 30 years of practice. WHO reports over 2.2 million new lung cancer cases globally each year; China accounts for nearly 30%, and about 80% of patients are diagnosed at an advanced stage, with a 5-year survival of only 19.7%. The main reason is that many people lack awareness of lung cancer symptoms and mistake early signs for a cold or bronchitis, delaying care.
Symptoms vary by tumor location, size, and spread: local, systemic, and metastatic. Local symptoms are often early signals and the most overlooked; high-risk people should watch closely.
These relate directly to tumor pressure or irritation of the airways. One or more lasting over 2 weeks should prompt concern.
• Persistent cough: The most common early symptom (up to 75%). Lung cancer cough is often a dry, irritating cough or scant white frothy sputum; cough medicine helps little and it lasts over 2 weeks. If the tumor presses on a bronchus, the cough can become harsh or metallic. • Blood in sputum or hemoptysis: One of the most specific early signs (about 30–40%). See a doctor immediately for any amount. • Chest tightness, shortness of breath, difficulty breathing: As the tumor grows or causes pleural effusion, breathing worsens; at first with activity, later at rest. • Chest pain: Often dull or aching (about 25–30%); worse with cough, deep breath, or movement if the tumor involves the pleura or chest wall. • Hoarseness: If the tumor spreads to mediastinal nodes and presses the recurrent laryngeal nerve, hoarseness persists and throat lozenges do not help—a possible sign of spread.
• Unexplained weight loss: About 60% lose 5 kg or more in 1–3 months without dieting. • Persistent fever: Cancer fever (37.5–38.5°C, antibiotics ineffective) or infection-related fever. • Fatigue and night sweats: Constant tiredness that rest does not relieve; drenching night sweats can signal low immunity and active disease.
• Brain: Headache, dizziness, nausea, vomiting, numbness, seizures, blurred vision. • Bone: Pain at the metastasis site, often worse at night; pathologic fracture. • Liver: Right upper pain, bloating, poor appetite, jaundice, ascites. • Lymph nodes: Swelling in neck, supraclavicular, or armpit; hard, poorly mobile, painless.
High-risk includes: long-term smoking (including secondhand/thirdhand), family history of lung cancer, exposure to dust/asbestos/radiation, age 50+, chronic lung disease (e.g. COPD, TB).
1. Self-monitor and record symptoms (time, frequency, details). 2. See the right department: respiratory or thoracic surgery first. 3. Complete recommended tests: chest CT (first choice), blood count, sputum exam; bronchoscopy, lung biopsy, tumor markers as needed; brain CT/MRI, bone scan, abdominal ultrasound for metastasis. 4. Follow-up: High-risk people should have annual chest CT even without symptoms; nodules need follow-up per doctor.
Answers to the most common concerns.
Persistent dry cough (little or no phlegm), little response to cough medicine, lasting over 2 weeks—especially in high-risk people—warrants prompt evaluation. More so if there is blood in sputum, chest pain, or weight loss.
About 20–30% of early lung cancer has no clear symptoms. High-risk people 50+ should have annual low-dose chest CT; it can find tumors under 5 mm and can raise early detection to over 80% and 5-year survival to about 70–80%.
No—bronchitis, TB, bronchiectasis can cause it—but lung cancer is a key cause to rule out. Middle-aged/older and high-risk people should see a doctor immediately for any blood in sputum and have chest CT and sputum tests.
Yes. Smoking (e.g. over 20 pack-years, over 10 cigarettes/day) is the top risk factor. Even without symptoms, annual chest CT is recommended. Incidence is 10–20 times higher in smokers; about 40% of early cases are found only by screening.
Persistence and specificity: Cold/bronchitis usually improve in 1–2 weeks and do not typically include blood in sputum, unexplained weight loss, or metallic cough. Lung cancer symptoms often last over 2 weeks and can include blood in sputum, chest pain, hoarseness, weight loss; cold medicines and antibiotics do not help.
Lung cancer is dangerous because early symptoms are easy to miss, so many are diagnosed late. Knowing key symptoms, getting regular screening if high-risk, and seeking care when something is wrong can greatly improve early detection and cure. If you are high-risk or have persistent cough, blood in sputum, chest tightness, or weight loss, see a respiratory or thoracic specialist and get a chest CT. Early detection, diagnosis, and treatment are key to reducing mortality and improving quality of life.
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