DEAR MAYO CLINIC: As a nonsmoker lung cancer hasn't been a concern of mine, but I recently heard it can affect people who have never smoked. If someone is concerned about lung cancer, what symptoms should they watch for, how is it diagnosed, and what treatment options are available today?

ANSWER: It can be surprising to learn that lung cancer can develop in people who have never smoked. In fact, up to 20% of lung cancers occur in people without a history of smoking. While smoking remains the leading risk factor, other contributors include secondhand smoke, air pollution, exposure to radon and a family history of lung cancer.

Possible lung cancer warning signs

One of the challenges with lung cancer is that it often doesn't cause symptoms in its early stages. When symptoms do appear, the disease is often more advanced, which is why early detection is so important. Currently, people between the ages of 50 and 80 with a significant smoking history may qualify for lung cancer screening, but you should pay attention to symptoms regardless of smoking status.

Symptoms that occur in or around the lungs include:

A new cough that doesn’t go away

Chest pain

Coughing up blood, even a small amount

Hoarseness

Shortness of breath

Wheezing

If lung cancer spreads to other parts of the body, symptoms can include:

Bone pain

Headache

Unplanned weight loss or loss of appetite

Swelling in the face or neck

If you experience new, persistent or worsening symptoms, make an appointment with a healthcare professional and ask about appropriate screening or diagnostic options.

Advanced diagnostics and staging

Diagnosis often starts with imaging. If someone has symptoms, a clinician may begin with a chest X-ray and then move to more detailed imaging, such as a CT scan. Sometimes lung cancer is discovered incidentally, when a CT scan performed for another reason reveals a lung nodule.

The next step is determining whether a nodule is cancerous or benign. Doctors often can use information from the CT scan to guide next steps. PET scans also may be used to diagnose lung cancer and determine whether it has spread.

In some cases, a biopsy is needed to confirm the presence of cancer cells. Biopsies can be performed in several ways. A biopsy guided by CT scan uses a needle inserted through the chest wall to collect tissue, while a bronchoscopy involves guiding a scope through the mouth and airways to reach the suspicious spot in the lung.

Screen on a robotic-assisted bronchoscopy machine shows diagram of a patient's lungs.

Advanced tools have improved accuracy. For example, robotic bronchoscopy allows physicians to reach nodules throughout the lungs through the airways and obtain tissue samples more precisely. This approach also can enable lymph node evaluation during the same procedure, which is critical fordetermining the stage of cancer and developing the best treatment plan.

Treatment approaches and tissue-sparing options

Treatment for lung cancer depends on several factors, including the cancer type, stage and the person's overall health. Options often include surgery, radiation therapy (like stereotactic radiation therapy ), chemotherapy, targeted therapy, immunotherapy or a combination.

Surgery is the mainstay for treating early-stage lung cancer. Increased screening has led to more cancer being detected earlier, allowing more patients to benefit from minimally invasive surgical techniques. These procedures often use video-assisted thoracic surgery (VATS) or robotic surgery approaches,and they may involve lung-sparing techniques, such as wedge resections and segmentectomies. Preserving as much healthy lung tissue as possible is important for long-term breathing function and lung health.

Depending on the extent of the disease, surgeons may remove part of a lung, an entire lobe or, in some cases, the whole lung. During surgery, teams also can use rapid, real-time pathology to confirm complete tumor removal and better understand the extent of the disease.

In certain situations, treatments such as chemotherapy, radiation therapy or immunotherapy may be given before surgery to shrink the tumor. This approach, known as neoadjuvant therapy, can make surgery possible sometimes for patients who were not previously candidates.

Lung cancer care often involves multiple specialties. Seeking care at an experienced center, where multidisciplinary teams collaborate closely, helps ensure treatments are tailored to each patient's specific cancer and overall needs.

Stay in tune with your body

Even if you've never smoked, awareness of lung cancer is important. Pay attention to symptoms that don't resolve, new or worsening breathing problems, or changes that feel unusual. Talk with a healthcare professional if something doesn't seem right.

If a lung nodule or other concern is found, today's advanced diagnostic tools can help determine whether it is cancer and guide next steps. Treatment options continue to advance, with many people benefiting from minimally invasive surgery and newer drug therapies that are improving outcomes and quality of life.

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Luis Tapias Vargas, M.D., Thoracic Surgery, Mayo Clinic, Rochester, Minnesota

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