There’s a reason most people associate lung cancer with smoking: It contributes to 80 percent and 90 percent of lung cancer deaths in women and men, respectively, according to the American Lung Association.
But here’s another stat you don’t hear as often: Roughly 30,000 people who die from lung cancer in the United States every year had never smoked or used any form of tobacco, according to the American Cancer Society. Put another way, lung cancer among non-smokers is among the top 10 most fatal cancers in the country.
Staying away from tobacco is still the most important thing you can do to reduce your risk of getting lung cancer—but there are other risk factors too.
“Risk factors for non-smoker lung cancer include things like exposure to radon gas, secondhand smoke, or a family history of lung cancers in non-smokers,” says James Stevenson, M.D., a lung cancer specialist at the Cleveland Clinic Taussig Cancer Institute.
So whether you’re a smoker, a former smoker, or have never lit up in your life, it’s important to know the symptoms that might point to lung cancer—and speak up as soon as possible if you notice any.
“Don’t let them linger too long without an evaluation,” Dr. Stevenson says. “The sooner lung cancer is detected, the more likely it is that the cancer is at an early stage, when curative treatment is possible.”
Here are eight potential signs of lung cancer you should know.
Sign #1: A Cough That Doesn’t Stop
A cough that just won’t quit could be a sign of lung cancer, but it’s important to know there are many more common and less serious reasons you could be hacking.
A cough caused by the common cold lasts up to about 18 days, according to a review in the Annals of Family Medicine. And if you have a lower respiratory infection like bronchitis or pneumonia, you could cough for as long as six to eight weeks afterward, explains Michael Wert, M.D., director of the Ohio State University Lung Cancer Screening Clinic.
Other conditions that may cause a cough include acid reflux, especially if you cough at night or after meals, or post-nasal drip, particularly if you cough in the morning and feel like you need to clear your throat.
That said, a persistent cough can also be a sign of lung cancer. Productive coughs that bring up mucus can occur if a patient has cancer inside their airways along with pneumonia, Dr. Wert says. Patients may have a dry cough if a cancer is in a location that causes airways to be restricted.
“The type of cough probably isn’t as important,” Dr. Wert says. “It’s more about the duration of cough.” The exception is the presence of blood in it (more on that below).
If you have a cough that persists more than a few weeks, make an appointment with your doctor to get checked out.
Sign #2: Coughing Up Blood
“If someone is coughing up blood, it doesn’t mean they have lung cancer,” Dr. Wert says. “It just raises suspicions a little more.”
Lower respiratory infections like bronchitis or pneumonia can cause your airways to become inflamed, so they can slough off and bleed a little bit. As a result, you may notice some red streaks in your mucus when you cough it up.
But lung cancers can cause blood in your mucus too.
“If someone is coughing off blood because they have a lung cancer, often that cancer starts inside the airways, and those cancers can have a lot of blood vessels going through it,” Dr. Wert explains. “They can bleed a significant amount.”
Noticing any kind of blood in your mucus warrants an evaluation with your doctor, but if you notice a whole lot of blood or any kind of clots, that’s when you need to see your doc the same day or head to the emergency room.
Sign #3: Shortness of Breath
Shortness of breath can be caused by a host of conditions, including those of the heart and lungs.
“If lung tumors are big enough to compress your airways from the outside, or if the tumor starts from inside the airways, it can block it off so you can’t get air in or out,” Dr. Wert explains. “That’s where the shortness of breath comes from.”
Watch for any kind of shortness of breath that is new or different from what you’ve experienced before, or shortness of breath that doesn’t go away, Dr. Stevenson says.
For instance, if you don’t normally feel short of breath walking up your driveway but notice that you start to feel that way, that’s something worth telling your doctor about.
Feel sudden or severe shortness of breath? That could be a sign you need help right away, especially if you experience other symptoms like palpitations or nausea. Know these warning signs of a heart attack.
Sign #4: Change in Voice
A change in voice, or hoarseness, can be a temporary result of a viral infection. But if it persists more than a few weeks, you should check in with your doctor, who will likely refer you to an otolaryngologist—an ear, nose, and throat (ENT) specialist—for further examination.
In some cases, a lung tumor or swollen lymph node near the center of the chest can press on one of the nerves to your vocal cord, paralyzing it, Dr. Stevenson explains. And that’s what results in the hoarseness.
Sign #5: Wheezing
It’s pretty uncommon for someone over the age of 65 to develop a wheeze out of nowhere, Dr. Wert says.
A wheeze, or a high-pitched whistling noise that’s often linked to difficulty breathing, can be noticed by a spouse if it’s loud enough. But in most cases, a doctor will hear it via stethoscope or a patient will complain about rattling themselves.
Wheezing can occur with infections like bronchitis or pneumonia, emphysema, or heart failure, but it can also come with lung cancer. This can occur if a tumor is impeding the airways, Dr. Wert says.
A new wheeze doesn’t necessarily mean lung cancer, but it does mean you should consult your doc for further evaluation.
Sign #6: Persistent Infections
“If you’re getting recurrent pneumonias and needing several courses of antibiotics in a given year, whether you’re a smoker or not, that certainly warrants further evaluation,” Dr. Wert says.
The concern: If you do have a lung tumor that’s blocking your airways, you may be unable to cough out all the mucus to get rid of the infection. As a result, the infection will return.
“It just kind of smolders,” Dr. Wert says. “The antibiotics will help put it at bay for a few weeks or months, but then it comes back pretty quickly.”
That’s why many doctors order a follow-up chest x-ray eight to 12 weeks after you start your meds. They want to make sure the infection has actually cleared or that there’s nothing else there, like a tumor, that’s now visible once the infection is gone.
A lot of people may get one case of pneumonia per year, particularly in the winter months, but if it’s becoming more frequent, you should seek evaluation with a lung specialist to make sure there’s nothing else going on.
Sign #7: Pain in Your Chest or Ribs
Your lungs themselves do not have pain fibers, but the lining of your lungs and your ribs do, Dr. Wert says. While it’s not common, pain in your chest or rib area could be a sign of lung cancer.
“If someone notices a nagging dull or sharp chest pain that is persistent for a few weeks or a month—and they’ve already been ruled out for a heart attack—that could be a sign they might have something pushing up against one of their ribs or pushing against the lining of the lung,” he says.
Any new or persistent pain, especially if it occurs along with the previously mentioned respiratory symptoms, should be evaluated by your doctor.
Sign #8: Unintentional Weight Loss
Losing weight when you’ve dialed in your diet and exercise plan is a good thing, but if you weren’t trying to shed any pounds, it’s a cause for concern—and reason to see your doctor.
“If you notice within the course of six months, 10 months, or a year that your clothes are fitting more loosely, you’re losing your appetite, or just saying, ‘Hey, I’m not trying to lose weight and I’m losing weight’—that’s pretty abnormal,” Dr. Wert says.
Unintentional weight loss can be a sign of many health conditions, including cancer, especially after it’s spread. But if it’s occurring along with other symptoms on this list, it may be a lung-specific cancer.
Notice Something? Here’s What to Do Next
If you notice any of these signs, it’s time to loop in your doctor to determine whether further evaluation is needed.
If you’re coughing up a lot of blood, or experiencing sudden or severe shortness of breath, that requires an immediate trip to the emergency room.
Depending on your symptoms, your doctor may first order a chest x-ray. If it’s abnormal—or if your symptoms persist—your doctor may then order a CT scan or send you to a pulmonologist for further evaluation.
While current and former smokers may benefit from regular lung cancer screening in the form of low-dose computed tomography (also called a low-dose CT scan, or LDCT), there’s no recommended screening for non-smokers. That’s why it’s especially important to be vigilant about the symptoms above and to seek prompt care if any develop.
If you believe you’re at greater risk—because of secondhand smoke or radon exposure, or if a parent or sibling didn’t smoke but had lung cancer—talk to your doctor about the possibility of screening on a case-by-case basis, Dr. Stevenson says.