Early Lung Cancer Signs Most People Miss (Doctor Explains)

Lung cancer is one of the most common—and most misunderstood—conditions out there. The symptoms can be subtle, easy to ignore, or mistaken for something as simple as a cold.

In this episode of Baptist HealthTalk, thoracic surgeon Dr. Ian Bostock breaks down what lung cancer really is, the early warning signs to watch for, and when it’s time to talk to your doctor about screening.

You’ll learn:

•  The difference between types of lung cancer 
•  Why symptoms often don’t appear early 
•  Key warning signs you shouldn’t ignore 
•  Who should consider lung cancer screening 
•  The truth about smoking, vaping, and risk 
•  How early detection can save lives 

If you’ve ever wondered whether your symptoms are “just a cold” or something more serious, this is a must-listen.

🔔 Subscribe for more expert health insights from Baptist Health South Florida.

Host:
Johanna Gomez
Award-Winning Host & Journalist

Guest:
Ian Bostock, M.D.
Thoracic Surgeon 
Baptist Health Cancer Care

If you found this episode helpful, you may also enjoy the following:

Vaping Uncovered: The Hidden Damage Nicotine, Flavors & Chemicals Do to Your Lungs

Lung Cancer Awareness

Clearing the Smoke on Lung Cancer

Transcript

SPEAKER_02 0:00

So I will say that if you quit smoking more than 15 years ago, your risk of lung cancer does decrease significantly. But it's all about how much you smoked and for how long. So depending on that amount of exposure to tobacco, you may still meet criteria to get lung cancer screening, even if you quit a long time ago.

SPEAKER_00 0:20

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_04 0:30

Hello everyone, I'm your host, Joanna Gomez. Welcome back to a new episode of Baptist Health Talk, where we answer your most search questions on trending topics. Today we're diving into a condition that impacts millions of people everywhere. But a lot of us still don't recognize the warning signs. The tricky part, the symptoms can seem so small, it's easy to brush them off or mistake them for something else. The condition, lung cancer. To help us break down what's real, what's not, and what you really need to know, we are joined by Dr. Ian Bostock, thoracic surgeon with Baptist Health Cancer Care. Thank you so much for being here, Doctor. Let's start off with the basic. What is lung cancer? A lot of people have so many questions about it. And I guess it's a two-part question I'm going to give you. What is it and how does it really develop?

SPEAKER_02 1:24

All right. So just to start with the basics, there's two major types of lung cancer. We have one in which we have small cell lung cancer. Small cell lung cancer tends to be a more kind of diffuse process. You start getting a growth in the in the lung tissue, but it's less well-defined, more infiltrative, we call it, more uh encompassing a larger portion of the lung. And then we have the other type, the most common type, called large cell or non-small cell lung cancer. Uh, this one gives you more of a nodule or a growth, more of a tumor in a specific part of the lung tissue. Um then uh so those are the two main types. Most of the time when we're talking about the conversation for today would be focused on the non-small cell or large cell lung cancer uh lung cancer, because that's the one that we have the most different the most treatments with to discuss today.

SPEAKER_04 2:19

Which is that was my follow-up question out of the small one and the large one. I'm assuming that the large one is obviously more serious and the diagnosis is a little bit more serious with that one.

SPEAKER_02 2:29

No, actually, small cell is more serious. Really? But large cell is more common, and we have made more groundbreaking advancements in the past 10 years that are have really changed the way patients with large cell do.

SPEAKER_04 2:42

Okay, so that's actually a a positive and a plus. But there are three early warning signs that people should be aware of. And sometimes people just think, oh, it's nothing, but it turns into obviously something big. Let's start off with the first one.

SPEAKER_02 2:57

Yeah. So uh just something to note about lung cancer is that the majority of the times when it's in an early stage, it won't give you any symptoms. So when you have symptoms, and the ones that we're gonna talk about, those are more common in the later stages. So it's important to note that if somebody were to present with a chronic cough, like a chronic dry cough that's just not going away, lasting more than three, four weeks, that should be something to be worried about. Okay. Um presenting with shortness of breath, um, that's another another thing to be concerned about. So the most traditional symptom, it would be to um cough up blood. That's called hemoptysis. That's to be something to alarm most folks. Okay. And then unexplained weight loss, fatigue, just not feeling well are other things that we can see in lung cancer as well.

SPEAKER_04 3:44

The first two that you mentioned, I just automatically think of a cold. I mean, it we're in cold season. It happens to all of us. The flu, you have a cough, it's lingering for some time. What should be though the warning sign to the to that? How do I know the difference between a common cold cough that lingers around for a while, like a nasal drip, or even a short of breath? When should I be worried?

SPEAKER_02 4:09

You know, it's it's a great question. Honestly, there's no there's no great distinction, right? The chronic and it's very common, right? And I'm not saying every chronic cough is gonna lead to a diagnosis of lung cancer, not at all. Right. So the common things being common cold, an upper respiratory tract infection, having uh asthma or or other kind of reactive airway disease, exposure to the environment, maybe like allergens, pollen season, all those things, of course, right? But uh but if you have a cough that's been lingering, particularly in a person that's more than 50 years old, has a history of heavy smoking, or is a current smoker, that person needs to go to the doctor, primary care physician, whoever takes care of their regular health, and engage in a conversation about lung cancer screening.

SPEAKER_04 4:57

Okay, we're definitely gonna get into the smoking, but I want to find out if there we should be worried about any physical pain, something on your shoulder, uh your back, maybe that can affect you and have some signs, some warning signs to know that you should really go to the doctor and get checked.

SPEAKER_02 5:13

Yeah. So if lung cancer is giving you pain, most of the time it's because it's already in the more advanced stages of disease. So the pain that we can feel from lung cancer would be from involvement of structures inside the chest. So uh if the lung cancer is growing potentially close to the rib cage or close to the outside to the kind of the chest wall itself, that can be pretty uh uncomfortable.

SPEAKER_04 5:38

But when you say that, I'm thinking I there's no way you can feel anything going on.

SPEAKER_02 5:42

Yeah, you won't you won't feel it from the outside at all. But you'll feel it. The fact that the thing is the tumor is irritating the inside of the chest wall, which is very, very sensitive, and that can give you um a lot of discomfort.

SPEAKER_04 5:55

So a lot of people associate lung cancer with smoking. Uh, how much truth there is there to that? And if you've never smoked, is there a possibility that you can get lung cancer?

SPEAKER_02 6:07

So, yeah, the majority of lung cancer we see occurs in people that have smoked or are current smokers. Uh so we're uh about 80% of it, but 20% of lung cancer occurs in in in people that have never smoked. So that's a very in important group of people to talk about because those traditionally would be ignored by most of the guidelines.

SPEAKER_04 6:28

Absolutely.

SPEAKER_02 6:29

Um, and uh, but there's other things that can lead to a diagnosis of cancer, of lung cancer. So we talk about smoking, uh, but vaping is really important. So vaping nowadays, we just don't know the the amount of risk associated with vaping and smoking. We suspect from the preliminary data that it's actually much higher than traditional smoking. So that's something important for folks to know about. So vaping is not good.

SPEAKER_03 6:52

Yeah.

SPEAKER_02 6:52

All right, but there's other things such as exposure to asbestos, which is sometimes used as insulation for different buildings or things like that, and other traditional, traditionally uh people that worked in shipyards or or in marinas used to get exposure to it, but less common now. Uh, but also exposure to radon, which is uh is not talked about very frequently, but also air pollution, chemicals in the air, like like like cleaning materials or cleaning products, okay? Uh, and um there's certainly a genetic predisposition, particularly if that person has a history of uh maybe uh a first degree relative, like a like a parent or a brother or sister with lung cancer, those folks should engage into a lung cancer screening conversation.

SPEAKER_04 7:39

Um, you know, it it's kind of uh wild because we had a conversation here just uh uh just a couple of days ago about vaping and smoking and cigarettes. You're saying vaping is actually worse for your lungs than the cigarettes that we uh have been exposed to for so many years?

SPEAKER_02 8:00

Yeah, the the the key here is potentially. So the thing about vaping potentially is the word. Is the word, right? Because the the thing is, uh people have been smoking traditional cigarettes for a really long time. Really long time. So we know what happens. We know the relative risk or the risk associated with smoking, the exposure to tobacco and the carcinogens, and then leading to cancer. We know that the more you smoke, the worse, the the the the worse off you you the worse the exposure and the risk of cancer.

SPEAKER_04 8:27

But with But I I'm just pause you quickly because I know someone out there is listening right now and saying, but I quit smoking 20 plus years ago. So I should be in the clear now.

SPEAKER_02 8:39

So I will say that if you quit smoking more than 15 years ago, your risk of lung cancer does decrease significantly. But it's all about how much you smoked and for how long. So depending on on that amount of exposure to tobacco, you may still meet criteria to get lung cancer screening, even if you quit a long time ago.

SPEAKER_04 8:59

Okay. So you just mentioned lung cancer screening. You also mentioned things in there for the non-smokers that we can't control. Pollution, asbestos, things that we we have been exposed to that we have no control over. How can I say I've never smoked, but obviously I've been exposed to things because I have no control of how should I know, when should I know when I need a screening?

SPEAKER_02 9:23

So that's a fascinating question, and one that we don't have a specific answer to today is an area of ongoing research. So, what happens to screening for patients that don't have a history of smoking? Right now, the guidelines for lung cancer screening are if you're more than 50, significant or heavy use of smok uh of tobacco products over your lifetime. Or vaping. Or vape. Vaping could qualify, but there's very few patients that have been vaping now for more than 20 years, right? But but yes, that will do.

SPEAKER_04 9:52

That's probably something that's going to change throughout the change.

SPEAKER_02 9:54

Or if you're a current smoker, those patients or those people should engage in a lung cancer screening CD. But what about the other group? So there's this is an area of ongoing research, but I will say that if any of those factors are present, such as asbestos, radon, the exposure to chemicals or the first degree relatives, you can still have a conversation about lung cancer screening with your provider, with your primary care. And most of the time, you can still obtain a low dose CT scan if if the if the concern is there.

SPEAKER_04 10:26

Yeah. What is the process and the journey like of having a lung cancer screening? Just whenever anyone hears cancer, automatically you go into a rabbit hole in your head of thinking of just how awful that journey can be.

SPEAKER_02 10:41

Right. So this is support the this is meant to be a seamless process, very similar to one like like maybe you're getting your yearly mammogram or your colonoscopy. Okay. So it's one of one another thing that you're doing to to protect yourself. To protect yourself and and limit the risk of something more concerning happening. Uh a low-dose CT scan is an imaging study in which it usually takes about 30 seconds. You go through a imagine like a donut or a tube, the patient goes through that that imaging study for about 20 to 30 seconds, and we're getting a picture of your lungs. Uh so the uh so what the type of picture we get, imagine that the patient or the person is like a loaf of bread, and each slice of the bread is one cut of the CT scan or a couple of millimeters of your lung tissue. So it gives you a lot of uh details. It gives you a really good idea of what's going on in your lungs uh with high resolution so that you can understand if there's a nodule or a lesion or something concerning.

SPEAKER_04 11:40

Okay, so I'm under the age of 50, I have a cough, a little bit of shortness of breath, it's flu season. Should I be worried? I go to my doctor and I get a physical, and sometimes they'll do the chest x-rays. Does that consist as uh maybe being able to see something, or should I go a step further?

SPEAKER_02 12:00

So if if if you are just uh if you're a a younger person, less than 50, without any significant risk factors, and you're just going through flu season, I wouldn't be particularly concerned. A chest x-ray is good to rule out major things.

SPEAKER_04 12:15

So is that a starting, a good starting point?

SPEAKER_02 12:18

Yes and no, because chest x-rays give you a good idea. Is there pneumonia or infection in your lungs? Is there something in your lung tissue that looks dramatically abnormal? Okay. Most of the time it kind of rule outs major it rules out major things. But in in order for us to see the degree of detail we need to detect an early stage lung cancer, you really need a CT scan. But uh, but not everybody that is going through flu season is gonna need one. So we really gotta focus on those risk factors to kind of manage the the risk of the whole situation.

SPEAKER_04 12:50

So I do have a question. Have you seen a lot of pushback with people under the age of 50 to try to get a lung cancer screening?

SPEAKER_02 12:58

We do see certain resistance, but it's important to understand that the guideline that we have now for lung cancer screening is one that applies to the general public. Uh so the current guideline is if you're more than 50, if you have a history of heavy tobacco use or heavy smoking and and or are a current smoker, you should engage in lung cancer screening.

SPEAKER_03 13:18

Right.

SPEAKER_02 13:18

But what about other groups of the population that are more at risk? So this is an area of ongoing research. Guidelines get modified all the time. Our latest guideline modification was in 2021, but another one is coming soon. But there's certain groups of the population that that that need to be addressed in a different way or more nuanced way. For instance, uh, African Americans tend to have a different pattern of smoking than let's say the Caucasian or white population. How so? So they tend to start smoking a little bit sooner or earlier in their lifetime, which can um which, if that means, for instance, if somebody starts smoking at when their age is 12 or 13 and they smoke for 15, 20 years, then that gives them enough tobacco exposure to c to qualify for lung cancer screening, but they would be 30 or 40 years old by the time they reach that exposure. And our current guidelines wouldn't have them get any kind of screening CT at that age. So these are things that we're constantly looking at. We're trying to help them the most amount of people possible.

SPEAKER_04 14:20

Yeah.

SPEAKER_02 14:21

Uh so uh so more to come on that, but that's certainly an interesting question.

SPEAKER_04 14:25

You know, when you said that, I thought to myself, this is why they ask you at what age do you start smoking if you are a smoker? And a lot of times I feel, as patients, I'll be honest, when we say sometimes, oh, you're a little timid, right? To admit that you probably started smoking at a young age. But it's it's a it's the reason that they need to know is to actually calculate how much you have, I don't want to say done damage, but how much um exposure your lungs have have had. Uh, there is a lot, there are a lot of common questions. And one of the common questions that we see online is how long can you live with lung cancer? And you as as a doctor, you can imagine someone hears cancer and they think, okay, that's it.

SPEAKER_02 15:10

Yeah, you know, traditionally, if we think about lung cancer, lung cancer, and I don't want to be alarmist, but lung cancer is the number one cancer in the world for deaths, is the most lethal cancer in the world. Okay. So just to get a get perspective on that, yeah, it's like a a plane crashed every day. That's the number of people that die from lung cancer. So about 130,000 people a year die in the US from lung cancer. So it is an important problem and one to ignore to inform the public about, okay? But really, whether you live or die or get cured or not cured from lung cancer can depend on many factors. The most important one is when do we catch it, when do we diagnose it? And this is the first purpose of this conversation is to understand how lung cancer screening saves lives because it allows us to detect the disease in a much earlier stage when the patient has a lot more options. Because as things get worse, when the disease is more advanced, those options become more limited.

SPEAKER_04 16:10

Right. Uh, science, right, is something that we really should be grateful for because I think it has helped us and you doctors especially try to kind of move us along with some advances. How much have you guys leaned into science or or even AI, if it's that's part of it, to kind of find a cure? Because I think at the end of the day, that's what we're all looking for, right? A cure to any type of cancer.

SPEAKER_02 16:35

Right. So there in the past 10 years specifically, there's been major technological and scientific advances in the field of lung cancer. Yeah. We have a lot more tools at our disposal for the treatment of it. So we're achieving cure much more frequently than before, which is amazing. But we also are looking into different things. So you mentioned AI. AI in the realm of how we diagnose it, how we detect it, has been really um uh novel and and exciting. So at the Miami Cancer Institute and at Baptist Health as a whole, we're actually starting an incidental lung nodule program. So we use using AI to make sure that those that are diagnosed with a lung lesion for whatever other reasons, they were getting a scan for whatever other reason unrelated to lung cancer screening. Okay. And then the the results throughout something concerning. We are trying to use AI to help us contact those patients, get a hold of those of those providers to make them aware of the concerning finding and get them to see one of our providers.

SPEAKER_04 17:36

Before I let you go, I am really I really want you to break down the difference between treatable versus non-curable. How can we uh distinguish the two?

SPEAKER_02 17:49

So it's it's a very nuanced question. And the tricky thing is it depends on the stage, right? But so let's say early stage lung cancer, so stage one and two, most of the time curable with with uh stage one, let's say curable with probably just surgery, sometimes surgery with chemotherapy and immunotherapy. As we get into stages threes and fours, you're you're you're starting to understand more the combination of things. So maybe surgery, chemotherapy, immunotherapy for stage three. For stage four, you're looking at radiation, chemotherapy, and immunotherapy. Sometimes we achieve cures in particular situations, and sometimes we are able to prolong life very significantly, even in stage four. So the message really here is a message of hope. Even in stages, ages one through four, there's treatments available. And there's, but it's important that folks understand that where you go seek your care really matters. So if you are diagnosed with lung cancer, you want to go to a place where you're you're you're gonna be talking to experts in the field, to a multidisciplinary group of different people that have dedicated their lives to lung cancer. There's certain ways to to to to kind of give as a tip or a trick to try to to to make sure that those providers meet that criteria. A simple one is to look for places that are that are evaluated by the Commission of Cancer from the American College of Surgeons, such as the Miami Cancer Institute, that really guarantees this that standard of quality and that makes sure that all of these patients are being exposed to the sort of highest level of technology and science behind their treatment plans.

SPEAKER_04 19:26

If anyone's listening right now, they're feeling anxious about this conversation. How do we calm them down to let them know it's going to be okay?

SPEAKER_02 19:34

You know, I think it's important that you uh that that you seek out care, that you don't kind of um isolate yourself and decide that you're not gonna do anything because there's options available and there's many people that have gone through the process. And this is what we've dedicated our lives to, to helping people in this situation. So I think it's important to know that that you have a team there waiting for you. Uh and uh and I wouldn't I would encourage people to to make sure that if they have those risk factors, more than 50 years old, uh significant tobacco exposure, and or a former smoker, they should really engage in a lung cancer screening CT. So talk to your primary, talk to your doctor about it. And if you've been recently diagnosed, go to the right place.

SPEAKER_04 20:15

Yeah, and I think we know what the right place is. We'll leave it right here. Thank you so much for all your insight and your time. This has been a wonderful conversation. And for all our viewers, be sure to hit that subscribe button on our channel right here to keep up with the latest health and wellness information and tips from our experts. Thank you so much for watching.

SPEAKER_00 20:35

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