Important: This page is for general information only and is not a diagnosis. Please see a doctor if you have a cough that does not go away, blood in mucus, or other symptoms that worry you.
What is lung cancer?
Lung cancer is cancer that forms in the tissues of the lung. The lungs are a pair of cone-shaped breathing organs in the chest that bring oxygen into the body and release carbon dioxide. Lung cancer may also form in the bronchi, the tubes that carry air from the windpipe to each lung.
There are two main types of lung cancer: non-small cell lung cancer and small cell lung cancer; non-small cell lung cancer is more common. Smoking causes most lung cancers, but nonsmokers can also develop the disease.
The types of non-small cell lung cancer are named for the kind of cells in which the cancer started: squamous cell carcinoma (which forms in thin, flat cells lining the inside of the lungs), large cell carcinoma, and adenocarcinoma (which begins in cells that line the air sacs and make mucus).
Common warning signs
Sometimes lung cancer does not cause any signs or symptoms in early stages, and it may be found during a chest X-ray done for another reason. When symptoms do appear, they may include:
- A cough that does not go away or that gets worse over time
- Chest discomfort or pain
- Trouble breathing or shortness of breath
- Wheezing
- Blood in sputum (mucus coughed up from the lungs)
- Hoarseness
- Loss of appetite
- Weight loss for no known reason
- Fatigue (feeling very tired)
- Trouble swallowing
- Swelling in the face and/or veins in the neck
These symptoms may be caused by lung cancer or by other conditions. Many coughs are caused by infections, asthma, tuberculosis, or other lung problems. But please see a doctor if your symptoms persist, especially if you have a history of smoking.
Risk factors
Smoking tobacco — now or in the past — is the most important risk factor for lung cancer. Smoking cigarettes, pipes, or cigars increases the risk; the earlier in life a person starts smoking, the more often they smoke, and the more years they smoke, the greater the risk. In India, smoked tobacco includes cigarettes, bidis, and hookah; all increase lung cancer risk.
Other risk factors for lung cancer include:
- Being exposed to secondhand smoke
- Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar at work
- Being exposed to radiation, including radiation therapy to the chest, radon in the home or workplace, or repeated imaging tests such as CT scans
- Living where there is air pollution — a major concern in many Indian cities
- Having a family history of lung cancer
- Being infected with HIV
- Taking beta carotene supplements while being a heavy smoker
Older age is the main risk factor for most cancers, including lung cancer; the chance of getting cancer increases as you get older. Having one or more risk factors does not mean you will get lung cancer — many people with risk factors never develop the disease, and some people with no known risk factors do. If you smoke, talk to a doctor about quitting; quitting at any age lowers your risk.
In some heavy smokers and former heavy smokers, screening with low-dose CT (LDCT) scans has been shown to lower the risk of dying from lung cancer; chest X-rays alone have not been shown to lower this risk. Talk to a doctor about whether lung cancer screening is right for you.
When to seek medical attention
Please see a doctor for evaluation if you have any of the following:
- A cough that does not go away or gets worse over more than 3 weeks
- Coughing up blood, even once
- Chest pain that lasts more than 2 weeks or gets worse with breathing or coughing
- Shortness of breath that is new or has lasted more than 2 weeks
- New hoarseness lasting more than 2 weeks
- Unexplained weight loss of more than a few kilograms
- Persistent fatigue that lasts more than 2 to 3 weeks
Cough that lasts more than 3 weeks should always be evaluated, especially in someone who smokes, has smoked, or has been exposed to heavy air pollution or workplace dust. In India, persistent cough should also be checked for tuberculosis (TB), which is common and treatable.
How is lung cancer diagnosed?
If you have signs that suggest lung cancer, your doctor will ask about your personal and family medical history, including any smoking and workplace exposures, and do a physical examination. Tests that may be used to diagnose and stage lung cancer include:
- Chest X-ray — a quick imaging test that takes pictures of the organs and bones inside the chest, often the first test ordered when symptoms suggest a lung problem.
- CT scan of the chest, abdomen, and brain — uses a computer linked to an X-ray machine to make detailed 3-D pictures of areas inside the body. A dye may be injected or swallowed to help organs show up more clearly.
- Biopsy — a sample of tissue is removed from the lung so a pathologist can study it under a microscope. A biopsy is the only sure way to diagnose lung cancer.
Common types of lung biopsy include:
- Fine-needle aspiration (FNA) biopsy — a thin needle, often guided by CT scan or ultrasound, removes tissue or fluid from the lung
- Bronchoscopy — a thin, lighted tube called a bronchoscope is passed through the nose or mouth into the airways to look for abnormal areas and take samples
- Thoracoscopy or thoracotomy — small or larger surgical incisions between the ribs to look at the chest organs and remove tissue
- Mediastinoscopy — a lighted tube placed at the top of the breastbone to look at the area between the lungs
- Lymph node biopsy — removal of all or part of a lymph node to check for cancer cells
Lab tests on the biopsy sample may include molecular tests that look for gene changes (such as in EGFR or ALK) that affect treatment, and immunohistochemistry that uses antibodies to identify cancer cell markers. Imaging tests such as MRI of the brain, PET scan, or bone scan may also be done to find out if the cancer has spread (this is called staging).
Treatment basics
Lung cancer treatment depends on the type of lung cancer, the stage of the cancer, gene-mutation test results, your overall health, and your preferences. Treatment plans are individualized — what is best for one person may not be best for another. Treatment may include more than one type:
- Surgery — for many early-stage non-small cell lung cancers, surgery is an option. Types include wedge resection (removes the tumor and a small area of healthy tissue), lobectomy (removes a whole lobe of the lung), pneumonectomy (removes one whole lung), and sleeve resection (removes part of the bronchus).
- Radiation therapy — uses high-energy X-rays or other types of radiation to kill cancer cells. Types include external beam radiation therapy and internal radiation therapy (brachytherapy). Stereotactic body radiation therapy can deliver larger doses precisely to small tumors.
- Chemotherapy — drugs that stop the growth of cancer cells, usually given by vein or by mouth. Chemotherapy is often combined with radiation or other treatments.
- Targeted therapy — drugs that attack specific features of cancer cells, used when biomarker tests show certain gene changes.
- Immunotherapy — drugs that help the immune system fight cancer; biomarker tests can help predict who is likely to benefit.
For people who smoke, the chance of recovery is generally better if they stop smoking before treatment begins. Talk to your cancer care team about quit-smoking support.
In India, much of the cost of lung cancer surgery, chemotherapy, radiation therapy, and diagnostic procedures including biopsy may be covered by Ayushman Bharat (PM-JAY) for eligible families, up to Rs. 5 lakh per family per year. Ask the hospital’s PMJAY desk before paying out of pocket.
Questions to ask your doctor
When you visit a doctor about a possible lung problem or after a lung cancer diagnosis, you may want to ask:
- What do you think is causing my symptoms — could it be cancer, an infection like tuberculosis, or something else?
- Do I need a chest X-ray, CT scan, or biopsy? When will I get the results?
- If it is cancer, what type and stage is it, and what does that mean?
- Was a biomarker (gene mutation) test done? What were the results, and how do they affect treatment?
- What are my treatment options — surgery, radiation, chemotherapy, targeted therapy, immunotherapy — and what side effects can I expect?
- How will treatment affect my breathing, day-to-day activities, and ability to work?
- Will I need to stop smoking? Is there support to help me quit?
- Should I get a second opinion? Many people choose to get a second opinion to confirm the diagnosis and treatment plan.
- Is my treatment covered under PMJAY or any other scheme?
- Are there clinical trials I should consider?
Bring a family member or trusted person to the visit. Write the answers down — it is normal to feel overwhelmed.
When urgent care is needed
Please seek urgent medical help — go to the nearest hospital or call an ambulance — if you have any of the following:
- Sudden serious difficulty breathing or severe shortness of breath
- Coughing up large amounts of blood
- Severe chest pain
- A fever ≥ 100.4°F / 38°C during chemotherapy — this is an emergency
- Sudden weakness on one side of the body, sudden severe headache, sudden vision changes, or seizures (these can occur if cancer has spread to the brain)
- A severe allergic reaction (sudden swelling of face or throat, full-body rash, difficulty breathing) within 24 hours of a treatment
- Sudden confusion or fainting
In India, you can call 108 or 112 for ambulance services. The Indian Cancer Society helpline is 1800-22-1951 for non-emergency questions and support.
If you live in Bihar and need a starting point for lung cancer evaluation, Mahavir Cancer Sansthan in Phulwarisharif, Patna is Bihar’s super-specialty cancer centre and has surgical, medical, and radiation oncology departments. AIIMS Patna also has a developing oncology department, and IGIMS (the State Cancer Institute) in Patna provides cancer care.
