A cough is one of the most common symptoms that sends people to the doctor. As many as 30 million medical visits are related to coughing. Most coughs are caused by upper respiratory infections like a cold or bronchitis. But a cough that lasts for several weeks, gets worse over time, or is accompanied by symptoms like unexpected weight loss or trouble breathing could warn of lung cancer.
Many different coughs are symptoms of lung cancer. The type of cough depends on where the tumor is located and how it affects the lungs, but there isn’t one specific type of cough that would indicate lung cancer.
What Does a Lung Cancer Cough Feel Like?
A lung cancer cough can differ from person to person. In general, a cancer-related cough will feel dry and not improve with medications or other remedies.
"Unlike coughs caused by infections, which may resolve over time or respond to antibiotics, a lung cancer cough typically lingers and may gradually worsen," says Fatemeh Ardeshir-Larijani, MD, a thoracic oncologist at Winship Cancer Institute of Emory University in Atlanta.
People with lung cancer describe their coughs as:
Chronic and dry
A feeling of pressure or tightness in their chest
Shortness of breath
Coughing up blood
The type of cough depends on the tumor's location. For example, coughing up blood may be a sign that the cancer has invaded a blood vessel in the lung, says Dr. Ardeshir-Larijani. And if the tumor blocks an airway, it can cause pneumonia, resulting in a mucus-filled cough. "These variations in cough characteristics can offer important clues in diagnosing and managing lung cancer," says Ardeshir-Larijani.
The likelihood of having a cough at the time of lung cancer diagnosis depends on the type and stage of the cancer. A cough is the most common symptom in people with advanced lung cancer, affecting about 34 percent of those with stage 4 lung cancer when diagnosed. Nearly 41 percent of people with small-cell lung cancer (SCLC) have a cough. But almost 60 percent of those with stage 1 lung cancer have no cough or other symptoms at diagnosis.
The location of the cancer also influences the likelihood of coughing. "About 60 to 70 percent of patients with central tumors report a persistent cough at diagnosis," says Ardeshir-Larijani. "It's less common with tumors in the outer parts of the lungs."
Even though coughing can be a lung cancer symptom, only a very small percentage of people with chronic coughs have lung cancer. Coughing is more often a normal response meant to help keep the body healthy. "A cough is a way for us to clear things from our airway and from deep within the chest so that they can't cause injury or harm to us," says Cherie Erkmen, MD, a professor of thoracic surgery at Temple Health Systems in Philadelphia.
Causes of Lung Cancer Cough
A chronic cough is a response to irritation, inflammation, or a blockage in the airway. Lung cancer can cause all these problems. Most lung cancers that cause coughs are based in the central airways — the trachea (windpipe) and bronchi, which are the largest breathing tubes in the body. These airways are lined with cough receptors, which stimulate coughing when irritated by cancer cells.
Cancer cells sometimes spread to the membranes that surround the lungs, called the pleura. This causes a buildup of fluid called a pleural effusion. The extra fluid makes it harder for the lungs to expand. A cough can be a symptom of pleural effusion.
These multiple causes behind lung cancer coughs are why there is no specific type of cough associated with lung cancer, and why some patients experience a cough and others do not.
Lung Cancer Cough Treatments
Treatment for a lung cancer cough depends on its cause. "If the cough is caused by the tumor itself, treating the cancer through chemotherapy, radiation, immunotherapy, or targeted therapy can shrink the tumor and reduce the cough," says Ardeshir-Larijani. Other treatments target the cough specifically.
Cancer Therapies
Certain treatments destroy cancer cells in the lungs and elsewhere in the body. By shrinking tumors, these therapies also reduce coughing:
Radiation therapy uses high-energy X-rays aimed at the body from a machine to kill cancer cells. It may be used before or after surgery, and is often combined with chemotherapy.
Chemotherapy kills cancer cells with strong medicines given as a pill or through an IV.
Immunotherapy helps the immune system attack lung cancer cells.
Targeted therapy blocks certain proteins or chemicals that help the cancer grow.
Lung Drainage
If coughing is caused by fluid buildup in the lungs, draining the fluid can relieve this symptom. A doctor places a needle into the pleural space (you will likely be given a local anesthetic). The needle is attached to a drainage tube and a collection bag. Fluid drains out over a period of a few hours.
Home Remedies
You may be able to relieve a lung cancer cough at home. Ask your medical team about these remedies:
Drink 6 to 8 glasses of water a day to stay properly hydrated.
Breathe in steam from a humidifier.
Take an over-the-counter cough suppressant.
Drink tea or warm water mixed with honey.
Suck on cough lozenges.
Practice deep breathing exercises.
Sit upright to clear phlegm from the lungs.
When to See a Doctor
Most coughs aren't caused by lung cancer. They usually come with conditions like a cold, asthma, or allergies, says Ardeshir-Larijani.
The time to be more concerned is when a cough lasts longer than 8 to 12 weeks, or is accompanied by symptoms like coughing up blood, chest pressure, unexplained weight loss, and tiredness. "While these signs don't always mean cancer, they should be checked by a doctor, especially if you're at higher risk [for lung cancer]," says Ardeshir-Larijani.
By the time a cough or other symptom appears in lung cancer, the cancer may have progressed to a late stage when it's harder to treat. "That's why it's critically important that people who are at high risk of lung cancer participate in a screening program," says Dr. Erkmen.
The American Cancer Society recommends that adults ages 50 to 80 who have smoked the equivalent of one pack of cigarettes a day for at least two decades get screened for lung cancer with a yearly low-dose computed tomography (CT) scan. The U.S. Preventive Services Task Force (USPSTF) has a more limited guideline, recommending this screening only if you meet the two previously mentioned requirements and currently smoke or have quit within the past 15 years. Even if you're not a current or former smoker, see a doctor if the cough lasts for more than a few weeks.
The Takeaway
A chronic cough can be a symptom of many different conditions, including a respiratory infection, allergy, or lung cancer.
Not everyone who has lung cancer has a cough — many people are symptomless or have limited symptoms.
There are a variety of ways to relieve a cough caused by lung cancer, including treating the cancer itself or treating the cough directly.
If you have a chronic cough, see your doctor to determine the cause.
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Resources
Sharma S et al. Cough. StatPearls. August 8, 2023.
Wolf AMD et al. Screening for Lung Cancer: 2023 Guideline Update from the American Cancer Society. CA: A Cancer Journal for Clinicians. November 1, 2023.
Nimit Sudan, MD, is a hematologist and medical oncologist with UCLA. He is an assistant clinical professor at UCLA and serves as a lead physician at the Encino community practice. He has a special interest in integrative medicine and oncology.
Dr. Sudan provides comprehensive care for adult patients with all types of hematologic and oncologic conditions. His mission is to treat every patient with the utmost compassion and care, and to develop a strong doctor-patient relationship. He is passionate about patient and family education, and educating larger communities on cancer awareness and prevention. He also has a special interest in integrative medicine, and is certified in acupuncture.
Sudan is from the Midwest, and received both his medical degree and bachelor's degree from Wayne State University in Detroit, Michigan. He completed his internal medicine residency at the Cleveland Clinic Foundation, and his hematology/oncology fellowship at Western Pennsylvania Hospital in Pittsburgh.
Stephanie Watson is a freelance health writer who has contributed to WebMD, AARP.org, BabyCenter, Forbes Health, Fortune Well, Time, Self, Arthritis Today, Greatist, Healthgrades, and HealthCentral. Previously, she was the executive editor of Harvard Women’s Health Watch and Mount Sinai’s Focus on Healthy Aging. She has also written more than 30 young adult books on subjects ranging from celebrity biographies to brain injuries in football.
