Lung cancer is often called a "silent" cancer because early-stage disease frequently causes no symptoms at all — a point deeply felt by Kelley, a lung cancer patient on the Manta Cares platform who was not a smoker and wondered whether earlier computed tomography (CT) screening could have caught her cancer before her blood clots signaled something was wrong.

When symptoms do appear early, they can include:

• Persistent cough that is new or has changed in character
• Shortness of breath with activities that previously felt easy
• Chest pain — especially pain that worsens with deep breathing, coughing, or laughing
• Hoarseness — a change in voice
• Unexplained weight loss
• Fatigue that feels disproportionate
• Recurring respiratory infections like bronchitis or pneumonia that keep coming back
• Coughing up blood (hemoptysis) — even small amounts warrant immediate medical evaluation

Notably, Erica shared on the platform that her father had his lung cancer discovered incidentally — imaging done for a bladder
infection caught shadows in the bottom of his lung, leading to an early diagnosis. This highlights how lung cancer is often found accidentally via imaging done for another reason.

The current standard recommendation, per U.S. Preventive Services Task Force (USPSTF) guidelines, is a low-dose CT (LDCT) scan of the chest for individuals who meet all of the following criteria:

• Age 50–80 years
• Current smoker or quit within the past 15 years
• Smoking history of at least 20 pack-years (e.g., 1 pack/day for 20 years, or 2 packs/day for 10 years)
• In good enough health to undergo treatment if cancer is found

Annual LDCT screening has been shown to reduce lung cancer mortality by approximately 20% compared to chest X-rays in high-risk populations.

Important note for non-smokers: Current guidelines are primarily designed around smoking history. However, as Kelley's experience illustrates, non-smokers do get lung cancer (from radon exposure, air pollution, genetic mutations like EGFR, and other factors). If you are a non-smoker with a family history of lung cancer, persistent respiratory symptoms, or known exposure risks, discuss with your doctor whether any imaging is warranted, even if you don't meet the formal screening criteria.

Biomarker/mutation testing is also critical once a lung cancer diagnosis is made — as Gloria (a Manta Cares patient) strongly advocated, knowing your mutation (EGFR, ALK, ROS1, KRAS, PD-L1, etc.) is essential to getting the best targeted treatment.

Lung cancer is broadly divided into two main categories:

Non-Small Cell Lung Cancer (NSCLC) — ~85% of all lung cancers:

• Adenocarcinoma — most common type, especially in non-smokers and women; often arises in the outer parts of the lung; most likely to have targetable mutations (EGFR, ALK, ROS1, etc.)
• Squamous Cell Carcinoma — typically arises in the central airways; more strongly associated with cigarette smoking
• Large Cell Carcinoma — less common; can arise anywhere in the lung

Small Cell Lung Cancer (SCLC) — ~15% of all lung cancers:

• Almost always strongly associated with cigarette smoking
• Grows and spreads much faster than NSCLC
• More responsive initially to chemotherapy, but tends to recur

Within NSCLC, biomarker/mutation subtyping is critical:

• EGFR-mutated (most common targetable mutation) — treated with TKIs (osimertinib/Tagrisso, erlotinib, gefitinib)
• ALK-positive — treated with ALK inhibitors (alectinib, brigatinib, lorlatinib)
• ROS1-positive — treated with crizotinib or entrectinib
• KRAS G12C — treated with sotorasib or adagrasib
• PD-L1 high expression — treated with immunotherapy (pembrolizumab)

As Gloria emphasized in her Manta Cares session, many newly diagnosed patients don't know different mutations exist — they think "lung cancer is lung cancer." Understanding your mutation defines your entire treatment pathway.

Staging note: Lung cancer uses Stages I–IV, and uniquely has Stage 4A (locally advanced, only in the chest) and Stage 4B
(spread throughout the body). A patient diagnosed via pleural effusion may be Stage 4A even without distant spread, as discussed by Dr. Sydney Barned in a Manta Cares clinical review.

Treatment varies significantly by type, stage, and mutation status.

Surgery (for early-stage NSCLC):

• Lobectomy — removal of a lobe of the lung (most common surgery for NSCLC)
• Segmentectomy or wedge resection — for smaller tumors or patients with limited lung function
• Pneumonectomy — removal of entire lung (rare)

Gloria (Manta Cares patient) had her right upper lobe removed via lobectomy, followed by a tyrosine kinase inhibitor (TKI) rather than chemotherapy

Targeted therapy (TKIs):

• For EGFR, ALK, ROS1, and other mutations
• Taken as daily oral pills — a major quality-of-life advantage over IV chemotherapy

Gloria shared that she never received traditional chemotherapy — her EGFR 19 mutation meant a TKI was her treatment

Immunotherapy:

• Pembrolizumab (Keytruda), atezolizumab, nivolumab
• Used when PD-L1 expression is high or in combination with chemotherapy
• Can be used as first-line or subsequent therapy

Chemotherapy:

• Platinum-based combinations (carboplatin or cisplatin + paclitaxel or pemetrexed)
• More commonly used when no targetable mutation is identified, or in combination with immunotherapy
• For SCLC: etoposide + carboplatin/cisplatin is standard

Radiation therapy:

• Stereotactic body radiation therapy (SBRT) — high-precision, limited fractions — for early-stage patients who cannot have surgery
• Conventional radiation — combined with chemotherapy for locally advanced disease

For metastatic disease: Manta Cares has a dedicated treatment map that branches based on mutation status, prior treatments, and whether squamous or non-squamous histology.

A lobectomy is the surgical removal of one lobe of the lung and is the most common surgery for early-stage non-small cell lung cancer.

Before surgery:

• You'll need pulmonary function tests (PFTs) to confirm your lungs can tolerate losing a lobe
• Imaging, such as a CT or positron emission tomography (PET) scan, to confirm staging and plan the surgery
• Stop smoking immediately — this significantly improves healing and reduces complications
• Ask whether the approach will be video-assisted thoracoscopic surgery (VATS) — minimally invasive, smaller incisions, faster recovery — or open thoracotomy
• Discuss the plan for biomarker testing of the removed tissue — as Gloria's experience shows, this is critical, and patients should proactively ask about it
• Pre-operative breathing exercises (incentive spirometry) may be prescribed
• Arrange support at home for at least 4–6 weeks

Recovery:

• Hospital stay: Typically 1–5 days, longer for open surgery
• Chest tubes: Will be in place post-surgery to drain fluid/air; removal before discharge
• Pain management: Expect significant chest wall discomfort; ask about nerve blocks and multimodal pain control
• Activity: Walking is encouraged early; heavy lifting and strenuous activity are restricted for 4–6 weeks
• Breathing: Expect to feel more winded than before — your remaining lung tissue will gradually compensate, but this takes weeks to months
• Return to normal activity: Many patients return to light activities in 4–6 weeks; full recovery can take 3–6 months
• Kelley (Manta Cares lung cancer patient) noted her physical movement became more limited after her diagnosis and treatment, which affected her ability to exercise as she had before

A persistent cough is one of the most common and disruptive symptoms of lung cancer, and managing it requires understanding its cause:

Causes of cough in lung cancer:

• The tumor itself is irritating the airway
• Post-obstructive pneumonia or infection
• Treatment side effects (some TKIs and immunotherapies can cause or worsen cough)
• Mucus accumulation
• Pleural effusion (fluid around the lung)

What may help:

• Stay well-hydrated — helps thin mucus
• Elevate your head when sleeping to reduce nighttime coughing
• Humidifier in the bedroom
• Avoid irritants — smoke, strong perfumes, and cold, dry air
• Cough suppressants (antitussives): Ask your oncologist about codeine-based cough syrup or dextromethorphan for symptomatic relief
• Steroid inhalers or bronchodilators may be prescribed if airway inflammation is contributing
• Treat the underlying infection if the cough is from post-obstructive pneumonia
• Palliative radiation can reduce cough caused by tumor obstruction of a major airway
• If a pleural effusion is causing the cough, a thoracentesis (drainage procedure) can provide significant relief

Always report a new or worsening cough — especially one with blood — to your care team immediately.

Shoulder pain in lung cancer is important to understand because it can signal specific, serious conditions:

Pancoast tumor / Superior sulcus tumor: This type of tumor grows in the top (apex) of the lung and can directly invade the shoulder's nerve structures. The pain typically:

• Starts in the shoulder and radiates down the inner arm to the hand (along the ulnar nerve distribution — the pinky and ring finger side)
• May feel like a deep, aching or burning pain
• Can be severe and constant, often worse at night
• May be accompanied by Horner's syndrome (drooping eyelid, small pupil, reduced sweating on one side of the face)
• Often mistaken initially for a shoulder injury or rotator cuff problem, leading to delayed diagnosis

General bone metastases to the shoulder: If lung cancer has spread to the shoulder bones or spine, the pain:

• Is typically a deep, dull ache that may be constant
• Is often worse at night or with movement
• May be associated with tenderness over the bone

Referred pain from the diaphragm or chest wall:

• Can feel like shoulder or neck pain without any direct shoulder involvement

If you have lung cancer and develop new shoulder pain — especially if it radiates down the arm or is accompanied by weakness or numbness in the hand —contact your oncology team promptly for evaluation.