Lung Cancer: Symptoms, Smoking Risk and How It Differs from TB

A cough that will not go away is easy to ignore, particularly if you smoke, because many smokers cough every morning. But a cough that lasts for weeks, changes in sound or brings up blood is a warning that needs a chest X-ray, not another cough syrup. Lung cancer is one of the commonest and deadliest cancers in the world, and in Pakistan it is often mistaken for tuberculosis or a stubborn chest infection, which delays diagnosis.

Lung cancer symptoms

Early lung cancer may cause no symptoms. As it grows, watch for:

• A cough that lasts more than three weeks, or a long-standing cough that changes or gets worse
• Coughing up blood or rust-coloured mucus
• Shortness of breath, wheezing, or a new breathing problem
• Chest, shoulder or back pain that is worse with deep breathing or coughing
• Hoarseness that does not clear
• Repeated chest infections or pneumonia in the same place
• Unexplained weight loss, loss of appetite and tiredness
• Swelling of the face or neck, or bone pain, in advanced disease

Is it lung cancer or TB?

Pakistan has a heavy burden of tuberculosis, and TB can cause a long cough, coughing blood, night sweats and weight loss, exactly like lung cancer. Both can also exist together. Anyone with a cough of more than two to three weeks needs a chest X-ray and sputum tests for TB. If TB tests are negative and the cough continues, further tests such as a CT scan should follow. Please do not start TB treatment on guesswork, and do not stop looking for a cause when the first treatment does not work.

What causes lung cancer?

• Smoking is responsible for the great majority of cases. This includes cigarettes, bidis, hookah and shisha. Risk rises with the number of years and cigarettes.
• Breathing other people’s smoke
• Air pollution, smog and smoke from cooking on wood, dung or coal in poorly ventilated kitchens
• Workplace dust and fumes, such as asbestos, silica, brick kiln smoke and chemicals
• Radon gas in some buildings
• Family history, and earlier chest radiation

About one in ten people with lung cancer has never smoked, so non-smokers with a long cough should be checked too.

How it is diagnosed

Doctors usually start with a chest X-ray, then a CT scan. A small tissue sample from the lung (through a bronchoscopy or a needle) confirms the diagnosis and the type, and scans and tests show the stage. Doctors also test the cancer for particular gene changes that can be treated with targeted tablets.

Treatment

• Early cancers can often be cured with surgery or focused radiotherapy.
• Radiotherapy and chemotherapy are used alone or with surgery.
• Targeted therapy tablets work against cancers with specific gene changes.
• Immunotherapy helps the body’s immune system attack cancer.
• Palliative care, including pain and breathlessness relief, helps at every stage.

Outcomes are much better when lung cancer is found early, which is why a persistent cough should be investigated promptly.

Screening for heavy smokers

In some countries, people aged roughly 50 to 80 who have smoked heavily (around 20 pack-years) are offered a yearly low-dose CT scan. Availability in Pakistan is limited, so ask your doctor whether it is suitable for you. It is not a replacement for quitting.

The best protection: quit smoking

• Quitting at any age lowers risk, and the benefit grows every year.
• Set a quit date, and tell family and friends.
• Ask your doctor about help. Counselling together with nicotine replacement or prescription medicines such as bupropion roughly doubles the chance of success.
• Avoid shisha, which is not a safe alternative. A single session can expose you to as much smoke as many cigarettes.
• Keep your home and car smoke-free, particularly around children.
• Cook in a ventilated kitchen and wear a mask on high-smog days and in dusty jobs.

When to see a doctor

• A cough for more than three weeks, or any blood in sputum
• New shortness of breath, wheeze or chest pain
• Repeated chest infections, or unexplained weight loss
• You are a long-term smoker with any change in your usual cough

Key takeaways

• A cough lasting more than three weeks, or coughing blood, needs a chest X-ray and tests.
• Lung cancer and tuberculosis look alike, and must be told apart by testing.
• Smoking, including shisha, is the main cause, but air pollution and workplace dust matter too.
• Quitting at any age helps, and medical support improves your chances.

Related medicines on Medimart

Cancer treatment is decided by your oncologist. Examples of commonly used medicines:

• Bupropion: a prescription medicine sometimes used to help quit smoking
• Ondansetron: helps control nausea and vomiting from chemotherapy

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse cancer care products and tuberculosis medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. A cough that lasts more than three weeks should always be investigated.