The signs and symptoms of lung cancer in women can differ from those commonly seen in men. Different types of lung cancer affect different parts of the lungs, and the incidence of types of lung cancer varies between men and women.
In addition to traditional symptoms, such as a persistent cough or coughing up blood, women are more likely to first experience fatigue and the gradual onset of shortness of breath. Since these changes are subtle, a person may dismiss them as being due to inactivity or normal aging.
Lung cancer tends to be more advanced when diagnosed in women. The first symptoms may be related to this spread to bones, the brain, and other regions of the body.
This article will explore the frequent and rare symptoms of lung cancer in women, the differences in how lung cancer develops in men and women, complications, and when you should contact your doctor.
There are a number of differences between lung cancer symptoms experienced by men and by women.
The symptoms of lung cancer usually are determined by its location in the lungs. Symptoms depend on the type of lung cancer causing them, as well.
There are two major categories of lung cancer:
A third category, carcinoid tumors, makes up 1%–2% of lung tumors. These tumors are not associated with smoking and tend to occur in younger women. Many of these tumors are very slow-growing tumors.
Non-small cell lung cancers are, in turn, broken down into:
Women who develop lung cancer are more likely to be never smokers (defined as smoking less than 100 cigarettes in a lifetime) than men. It's estimated that around 20% of women are never smokers. Lung adenocarcinoma is much more common in people who have never smoked and is already more common in women than men.
Women (and those who have never smoked) also tend to be diagnosed at a more advanced stage than men. This means that the tumor is more likely to have spread to distant regions of the body such as bones or brain.
Women usually are diagnosed at a somewhat younger age than men, and lung cancer that occurs in young adults (ages 30–54) is more common in women than in men.
Due to younger age, women may have fewer other medical conditions (co-morbidities) that could affect the symptoms they experience. For example, a chronic cough related to chronic obstructive pulmonary disease (COPD, irreversible inflammatory disease of the lungs) would likely be less common.
While, across age groups, roughly 20% of women with lung cancer are lifelong nonsmokers, the number is much higher among young women diagnosed. A 2019 study looking at young adults with lung cancer found that 70% were never smokers.
The most common symptoms of lung cancer in women are often vague and begin gradually. Since lung adenocarcinomas tend to grow in the periphery of the lungs, they can grow quite large before they are diagnosed. For this reason, systemic effects (effects affecting the entire body), such as fatigue, are more common.
In contrast, small cell lung cancer and squamous cell carcinomas are uncommon. These tumors tend to grow in or near the airways and lead to obstructions that can cause a cough, coughing up blood, wheezing, and recurrent episodes of pneumonia.
Nearly 50% of people who are diagnosed with lung cancer have metastases to distant regions of the body. Metastatic lung cancer is also referred to as stage 4 lung cancer. With stage 4 lung cancer, the first symptoms may actually be related to the the effects of its spread to the bones, brain, liver, or adrenal glands.
Looking at men and women together, the most common symptoms of lung cancer are a cough, shortness of breath, coughing up blood, weight loss, and a loss of appetite. But in women, fatigue and shortness of breath usually occur first.
Fatigue is the most common symptom of lung cancer in women. Since there are many causes of fatigue (and many women experience tiredness for multiple reasons daily), this symptom may not immediately point to lung cancer.
That said, cancer fatigue, or the fatigue associated with cancer, usually differs from ordinary tiredness. It's not the type of tiredness that people can push through or that improves with a good night of rest or a cup of coffee. Some people describe the sensation as "total body tiredness."
Hearing that fatigue is a symptom might be discouraging, since it is difficult to know if this is a symptom or something harmless. If you feel like your tiredness is out of the ordinary, keeping a sleep and activity journal for a few days or weeks can sometimes make it clearer as to whether you have a logical reason to be tired, or not.
The second most common symptom of lung cancer in women is shortness of breath. During the early stages of the disease, the shortness of breath is not always obvious and can easily be dismissed as due to something else or overlooked altogether.
Early on, symptoms occur primarily with activity and may be noted only with more strenuous activity, such as walking up and down stairs or sprinting. Some people may look back at the time of diagnosis and realize that they had been modifying their activity level to adapt to the shortness of breath for some time.
Pain in the back or shoulder is a relatively common first symptom of lung cancer in women and can be caused by a combination of factors.
Back pain: Since many lung cancers in women have spread to bones at the time of diagnosis (and lung adenocarcinoma tends to spread to bones early), pain in the spine or extremities may be the first symptom of the disease. Bone metastases can be very painful, but they incorrectly may be attributed to arthritis or disc disease at first.
Sometimes metastases weaken bones so that fractures (broken bones) occur with minimal trauma (pathologic fractures). Lung cancer that spreads to the adrenal glands (adrenal metastases) can also cause back pain and has been described as similar to being kicked in the flank (the side of your body, between your ribs and hips).
Symptoms that suggest cancer rather than a bone or joint problem include:
Chest pain most commonly occurs when lung cancer invades the tender membranes (the pleura) that surround the lungs. Since lung adenocarcinomas tend to grow near the outside of the lungs, they can invade the pleura relatively early in the course of the disease.
People may experience pain with a deep breath which is often relatively sharp rather than dull. If fluid builds up between the membranes (pleural effusion), shortness of breath may occur or worsen as well.
Recurrent respiratory infections are a common symptom of lung cancer in women, and many report experiencing several episodes of bronchitis (infection and inflammation of the larger airways) or pneumonia (infection and inflammation of the air sacs) in the time leading up to diagnosis.
In early-stage cancers, tumors that obstruct the airways are common. As cancers progress, the rate of respiratory infections increases. It's recommended that people talk to their healthcare provider about a potential underlying problem if they have more than one episode of pneumonia in a year.
A persistent cough is the most common symptom of lung cancer, but it's less common in women due to the location of these tumors. That said, many people note that they've had a chronic, nagging cough at the time of diagnosis.
A lung cancer cough can appear identical to coughs for other reasons, such as viral infections, allergies, or a smoker's cough (a persistent cough seen in smokers). It may be dry or produce sputum (phlegm, mucus coughed up from the airways). It may be harsh and cause painful ribs or be barely noticeable. It may be constant or come and go.
When a tumor is near an airway, wheezing (a high-pitched whistling sound with breathing) may be present as well. Unlike the wheezing associated with conditions such as asthma, wheezing may sometimes be noticed in just one area of the chest.
Coughing up blood (hemoptysis) is the symptom most likely to suggest underlying lung cancer. For 7% of people, it is the only symptom at the time of diagnosis. That said, it occurs in about 21% of people with lung cancer overall.
Lung cancer can spread to bones and the adrenal gland, but also to the brain, liver, and lymph nodes. In some cases, symptoms of metastases are the only signs present at the time of diagnosis.
Signs and symptoms of brain metastases may include headaches, new-onset seizures, speech or visual problems, numbness and weakness, or loss of coordination.
Symptoms of liver metastases may include nausea and vomiting, abdominal pain or tenderness, a yellowish discoloration of the skin (jaundice), and intense itching.
Hoarseness may occur if a lung tumor presses on nerves near the vocal cords. A hoarse voice like this does not usually clear with coughing, and it gradually worsens.
General symptoms of advanced cancer may also occur, and since lung cancer is often diagnosed in the later stages in women, this is not uncommon. Symptoms may include:
Some lung cancers secrete (or cause the body to secrete) substances that act like hormones in the body. Referred to as paraneoplastic syndromes, the symptoms can vary widely depending on the particular protein/hormone released. Some of these include:
There are many others, which may cause a variety of neurological symptoms and other signs.
Complications of lung cancer are relatively common, especially with metastatic (stage 4) disease, and are sometimes the first signs or symptoms that lung cancer is present. Complicatons include:
Pericardial effusion: Lung cancer may spread to the membranes that line the heart, and fluid can then fill the space between these membranes. If fluid builds up slowly, it can lead to shortness of breath, palpitations, and light-headedness.
If fluid builds up rapidly or if enough fluid is present, it may limit the motion of the heart (cardiac tamponade) and cause fainting or unconsciousness.
Coughing up blood (hemoptysis): Coughing up even a small amount of blood can be an early sign of lung cancer, but coughing up a teaspoon or more of blood is a medical emergency.
Malignant pleural effusion: Fluid also commonly builds up between the membranes (pleura) that line the lungs. In some cases, cancer cells are present in the fluid.
Symptoms depend on how rapidly and how much fluid accumulates but can include shortness of breath, a cough (which is often worse when leaning forward), and chest pressure.
A needle can be used to drain the fluid (thoracentesis) and a chest tube placed. A stent (a tube to keep the airway open) often needs to be placed to keep the fluid from returning.
Spinal cord compression: When lung cancer spreads to the spine, it may result in compression of the spinal cord. Depending on the level in the spine, symptoms can include new-onset back pain, numbness, tingling, and weakness of the arms or legs, and loss of bowel and bladder control.
Spinal cord compression is a medical emergency as immediate treatment is needed to prevent permanent disability.
Blood clots: Blood clots in the legs (deep venous thrombosis) that sometimes break off and travel to the lungs (pulmonary emboli) occur often with lung cancer in women and can sometimes be the first symptom of the disease.
Symptoms can include pain, swelling, and redness of a leg, with symptoms of shortness of breath, palpitations, and sometimes unconsciousness if a pulmonary embolus occurs. Treatment includes blood-thinning medications with other emergency measures, such as the use of clot-busting drugs, needed in some cases.
Superior vena cava syndrome (SVC syndrome): When lung cancer is located near the top of one of the lungs, it can lead to compression of the large vein (superior vena cava) that returns blood from the head, neck, and upper body to the heart (SVC syndrome).
Symptoms can be dramatic and may include bulging veins in the neck, swelling of the face, neck, and upper arms, hoarseness, shortness of breath, and other symptoms. In some cases, the obstruction can be severe and partially obstruct the trachea, leading to severe shortness of breath.
Treatment involves placing a stent to maintain the trachea if severe, and reducing the size of the tumor, such as with radiation therapy.
There are a number of symptoms that should prompt you to see your healthcare provider. It's important to note that, especially with women, the symptoms of lung cancer can be vague and mild, and may not make you think of your lungs as the problem. Reasons to see your healthcare provider include:
Perhaps the most important "symptom" is your gut feeling. If something seems abnormal to you, talk to your healthcare provider, even if you think there is a logical explanation or if it is only a "nuisance" symptom.
Reasons to call 911 or seek immediate care include:
The symptoms of lung cancer in women can differ from those in men, with the earliest symptoms often being fatigue and mild shortness of breath (exercise intolerance). In some cases, however, more "typical" symptoms of lung cancer may occur, such as a chronic cough, coughing up blood, or recurrent respiratory tract infections.
The first symptoms lung cancer may not be obvious as they can be felt in the bones (bone pain), the brain (headaches), or the liver (jaundice).
It's important to remember that only vague and mild symptoms may be present early in the disease process and that seemingly unrelated problems, for example, blood clots in the legs, may be the initial symptom.
We can't stress enough that the symptoms of lung cancer in women can differ from those in men. Lung cancers usually are more advanced at the time of diagnosis in women than in men, and more advanced tumors are more difficult to treat (though there are many options now for even the most advanced cancers).
In addition to different symptoms, women who develop lung cancer are much more likely than men to be lifelong nonsmokers, and they may be very young. It's not uncommon at this time to have women in lung cancer support groups who were diagnosed while pregnant.
Despite the recent increase in lung cancer in young adults, especially women, a screening test is not available, and an awareness of symptoms is crucial in order to find these tumors as early as possible.