Early detection: What are the signs of lung cancer?

10.04.2025

Author

Leading Medicine Guide Editors

The mortality rate for lung cancer is still high, as the disease is often detected late and has already metastasized. On average, around 45,000 patients die from this type of cancer every year. Around 57,000 people are newly diagnosed each year. What are the signs?

Heavy (ex-)smokers and passive smokers have emerged as a clear risk group. Other pollutants such as asbestos and diesel soot in industry can also promote lung cancer.

Until now, there have been no early detection programs for known risk groups in Germany. Since July 1, 2024, the regulation of the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety has come into force and allows low-dose CT as an individual health service (IGeL) under certain conditions. The Federal Joint Committee (G-BA) is currently reviewing its inclusion in the catalog of guidelines and, accordingly, whether the statutory health insurance funds will cover the costs.

Was sind erste Anzeichen für Lungenkrebs? Eine Niedrig-Dosis-CT kann wichtige Anhaltspunkte liefern.

What symptoms indicate lung cancer?

One of the biggest problems with lung cancer is that symptoms only appear very late. As a result, lung cancer is often only recognized when the disease is already well advanced. The following is a list of typical signs of lung cancer, which can also be associated with other diseases. Clarification by a specialist should therefore always be carried out:

persistent cough
bloody sputum
shortness of breath
chest pain and/or pain in the bones
sudden weight loss
feverish spells
hoarseness
difficulty swallowing
drumstick fingers (soft tissue of the fingertips is thickened)
swelling of the lymph nodes above the collarbone
wheezing
fatigue and reduced physical performance

Risk groups for bronchial carcinoma

Few other types of cancer have such clear risk groups as lung cancer. Heavy smokers and former smokers as well as passive smokers make up the majority. In addition, employees who are regularly exposed to asbestos, diesel soot and other pollutants such as arsenic, chromium, nickel etc. are also at increased risk of developing lung cancer. Genetic factors may play a role, albeit only a minor one.

As tobacco consumption is the main cause, an early detection program for heavy smokers between the ages of 50 and 75 was developed. Experts and legislators were involved. The Federal Ministry for the Environment, Nature Conservation and Nuclear Safety approved the program last summer, but the Federal Joint Committee has yet to make a decision on its implementation and cost coverage.

How does lung cancer screening work?

The screening should consist of a low-dose CT scan, in which X-ray images of the lungs are taken to show changes such as tumors. Prerequisite for the screening: the patients must be heavy but symptom-free smokers in the specified age range. In order to be able to offer the service, which is currently still included as an IGeL, special conditions also apply to practices.

HANSE lung check in Hanover, Lübeck, Großhansdorf as a test balloon

From July 2021 to summer 2023, test subjects were invited to take part in the HANSE lung check. This was led by Hannover Medical School (MHH) and was designed to show how a lung cancer screening program can be effectively introduced and implemented for at-risk groups.

Breath test of the DZL

Since 2017, a breath test from the DZL (German Center for Lung Research) has also been in the development phase, which is intended to detect lung cancer with a high degree of accuracy based on exhaled air. However, the current status of this early diagnostic procedure is not known.

Risks of the lung cancer screening method

CT does not always provide a correct diagnosis. Sometimes suspicious changes are classified as lung cancer, which leads to further, often stressful examinations that would not have been necessary.

Even if it is a low-dose CT, there is still radiation exposure, which in turn can increase the risk of cancer.

Nevertheless, according to experts, the advantages of screening outweigh the disadvantages for the named risk group, as treatment can be faster and more successful in an emergency.

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