Non-small-cell lung cancer (NSCLC) is one of two main categories of lung cancer. It happens when abnormal cells in your lungs grow quickly.

The good news is your chances of surviving are high if doctors find the cancer early. But this can be difficult because many symptoms often show up after the disease has spread. Or you might think something else is causing your symptoms.

“There are a lot of people that are surprised by the diagnosis to be quite honest,” says Amy Cummings, MD, a thoracic oncologist at UCLA.

Should You Get Screened?

Most people diagnosed already have advanced NSCLC, which is harder to treat. That’s why screening is important for certain groups of people. It can lead to early detection of cancer, even if it hasn’t caused any symptoms yet.

“If you have a strong family history of lung cancer, or if you have a history of smoking, it's always worthwhile to talk to your doctor about whether or not you meet criteria for screening just because the guidelines do change from time to time,” Cummings says.

The American Cancer Society recommends screenings every year for:

  • People ages 55-74 years old in good health
  • Those who currently smoke or have quit in the last 15 years
  • People who have at least a 30-pack year smoking history (the number of years you’ve smoked multiplied by the number of packs of cigarettes you smoke a day)
  • People in counseling to help them quit smoking

“Screening programs are very successful in detecting early-stage cancers that can be cured,” Cummings says.

While smoking is the most common risk factor of NSCLC, nonsmokers can get lung cancer, too. Your risk might be higher if you’re exposed to:

  • Secondhand smoke
  • Radiation
  • Workplace carcinogens
  • Environmental pollution

A family history of lung cancer, having lymphoma, or being infected with HIV also plays a role.

Common Signs of Early NSCLC

Early NSCLC symptoms might be hard to pinpoint or not show up at all. But it’s important to know what to look for, especially if you’re high risk.

A cough that won’t go away is the main symptom. Lots of conditions can trigger this, but most of them aren’t serious. And it usually goes away in 6-8 weeks.

“People that do have these lingering coughs that have gone to their doctor multiple times for treatment absolutely do need some imaging, and usually a follow-up of that imaging if there's something abnormal found,” Cummings says.

Another symptom is unexplained weight loss -- about 5-10 pounds in a few months.

“Other things that are a little bit more advanced would be coughing up blood, shortness of breath, running out of air or breathlessness -- those are all things that we can associate with lung cancer,” Cummings says.

Additional symptoms include:

  • Chest pain or discomfort
  • Wheezing
  • Hoarseness
  • Loss of appetite
  • Fatigue
  • Issues swallowing
  • Swelling in your face or neck veins

“More advanced cases of lung cancer usually also manifest with pain. This pain could be potentially anywhere in the body. Lingering pain that's not going away, lingering coughs that aren't going away ... these always need more attention,” Cummings says.

How Doctors Diagnose Early NSCLC

Even with regular doctor’s appointments and testing, it’s difficult to diagnose NSCLC without regular screening.

“It actually is pretty rare for us to be able to find something just on routine bloodwork that lets us know lung cancer is present,” Cummings says.

If you do have certain symptoms of NSCLC, like a cough that lasts more than 6-8 weeks, your doctor will most likely order imaging tests.

“Sometimes physicians go with a chest X-ray, but a CT scan is more typical in recent practice because a CT scan gives more information about anatomy and findings,” Cummings says. “There's something called lung rads, which is a scoring system that's used to determine how likely something is to be a cancer or not cancer. (Doctors) determine, based on what they're seeing on the images, how likely something is to be a cancer.”

If your doctor is unsure about what they’re seeing on the imaging tests, which is common, they’ll suggest a follow-up.

“Because usually, what cancer is going to do is over time it's going to slowly enlarge. Follow-up imaging helps you know: Is this an infection? Does it go away? Or is this something that may need to be biopsied,” Cummings says.  

These scans often pick-up things like lung nodules, which are abnormal growths that are usually not cancer. In other situations, doctors could find lung cancer by mistake.

“Sometimes with early stage I cancer, we're finding it completely incidentally, which means people had no symptoms whatsoever,” Cummings says. “They go in, they have a car accident, and then we're doing imaging and we're finding something on the scan.”

If this is the case, the same follow-up tests are suggested. If your doctor finds something that could be lung cancer, they’ll refer you to a pulmonologist. That’s a doctor who specializes in the respiratory system. They’ll do a bronchoscopy, a procedure that lets your doctor look at your lungs and air passages. Or they’ll do a biopsy, which is when your doctor cuts out a piece of tissue or draws a sample of your cells to test.

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