Stage 1 Lung Cancer: Spot the Signs, Even If You Never Smoked

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Stage 1 lung cancer signs are often subtle and may be overlooked. Lung cancer ranks second among cancers diagnosed in the United States and stands as the nation’s leading cause of death from cancer, topping even:

Even if you’ve never smoked, knowing how to spot the signs of Stage 1 lung cancer can be vital to your good health and those you care about. 

What Is Stage 1 Lung Cancer?

If you have stage 1 lung cancer, this means cancer cells haven’t metastasized (spread) to your lymph nodes and other distant parts of your body such as other organs. The size of your primary (original) tumor remains small, usually no larger than 4 centimeters.

TNM Cancer Stages

Most cancers use the tumor-node-metastasis (TNM) staging system to assess whether cancer cells have spread and how large the tumor is.

  • T (X and 0 to 4) notes the size of the primary tumor. 
  • N (X and 0 to 3) specifies whether cancer cells have spread to nearby lymph nodes.
  • M (0 and 1) indicates whether cancer cells have spread to distant parts of your body.

X notes the primary tumor can’t be assessed as it’s not showing up in imaging scans. But cancer cells may be found in spit or fluids taken from your lungs.

Stage 0 is the earliest cancer stage per the TNM system. It may also be referred to as carcinoma in situ, meaning cancer cells can only be found where they first formed in your body.

What Are the Different Types of Lung Cancer?

The 2 main groups of lung cancers include:

Non-Small Cell Lung Cancer (NSCLC)

Around 80% to 85% of all lung cancer types are diagnosed as NSCLC. The 3 main NSCLC subtypes are classified using the TNM system. 

These include:

  • Adenocarcinoma. Roughly 50% of all lung cancers are this type, making it the most common type of lung cancer. It often starts in an outer area of your lung in gland cells that make mucus and line your lung’s tiny air sacs.
  • Squamous cell carcinoma. This type often grows in the center of the lung in the thin, flat cells that cover the inside surface of your lungs.
  • Large cell carcinoma. The large and round cancer cells of this type develop anywhere in the lung and grow and spread faster than the other main NSCLC subtypes.

Small Cell Lung Cancer (SCLC)

Worldwide, small lung cancer accounts for roughly 15% to 20% of all lung cancers. This highly aggressive form of lung cancer often starts in your bronchi (airway tube) but grows and spreads quickly to other parts of your body. SCLC is often caused by heavy smoking. 

SCLCs are also regarded as neuroendocrine tumors. That’s because these tumors form when your lung’s nerve and hormone-producing cells experience uncontrolled growth.

This lung cancer type is further classified as:

  • Oat-cell carcinoma (cancer) because the cells look like small oats under a microscope
  • Combined SCLC, which is SCLC with NSCLC components

SCLC has 2 stages:

  • Limited stage. Cancer cells are in 1 lung only and may or may not have spread to your lymph nodes or the area that sits between your lungs inside your chest called your mediastinum.
  • Extensive stage. Cancer cells have spread beyond your primary lung tumor to other parts of your body such as distant organs or your other lung.

Stage 1 Lung Cancer in People Who Never Smoked

Countrywide each year, around 10% to 20% of lung cancers happen in people who never smoked or smoked fewer than 100 cigarettes in their lifetime. This equates to about 20,000 to 40,000 people.

These may be due to common risk factors such as exposure to secondhand smoke — also called passive smoking. But research also ties a gene mutation or abnormality to a higher risk of lung cancer in people considered neversmokers. 

In people who’ve never smoked, around:

  • 50% to 60% of lung cancers are adenocarcinomas
  • 10% to 20% are squamous cell carcinomas
  • 6% to 8% are small cell lung cancers and the rest are other types of lung cancer

Stage 1 Lung Cancer Risk Factors

The top risk factor and cause of lung cancer is smoking a lot of tobacco for a long time, but even light or occasional smoking can raise your risk. This includes breathing in other people’s tobacco smoke secondhand or passively. 

Other lung cancer risk factors and causes include prolonged or continued exposure to:

  • Air pollution
  • Chemical and workplace hazards such as asbestos, silica and exhaust fumes from diesel engines
  • Radon gas, a radioactive gas emitted from small amounts of uranium found in all rocks and soils (and used to build homes and other structures).

Having another lung disease such as chronic obstructive pulmonary disease (COPD) can also up your risk. And your risk may be higher if a close biological relative (e.g., parent or sibling) has a history of lung cancer.

What Are the Symptoms of Stage 1 Lung Cancer?

Stage 1 lung cancer may produce few if any symptoms. In fact, early lung cancer is often found during routine screening or when you’re being checked for another illness. 

The lungs only have a few nerve endings. Therefore, a tumor can grow in your lungs without causing much pain or discomfort. 

If present, stage 1 lung cancer symptoms may include:

  • Chest pain that lingers
  • Cough that persists or gets worse
  • Coughing up bloody mucus
  • Hoarseness
  • Lung infections that keep coming back or stick around for a long time
  • Shortness of breath or wheezing

What Are the Treatments for Stage 1 Lung Cancer?

Treatment for stage 1 lung cancer depends on the type of cancer you have, your overall health and which treatments you choose. 

Lung Cancer Surgery

Surgery aims to remove cancerous tissue. This may entail:

  • Wedge resection to remove the tumor from a small, triangle-shaped slice of lung tissue and a small amount of normal tissue
  • Segmental resection (also called segmentectomy) to remove cancerous tissue from a larger section of the affected lobe of your lung
  • Lobectomy to remove 1 lobe of your lung when cancer has spread through much of it
  • Pneumonectomy to remove the 1 lung that has cancerous tissue throughout

Chemotherapy and Radiation Therapy

Chemotherapy combines various medicines to shrink or kill cancer cells. Radiation destroys cancer cells with the help of high-powered energy beams from sources such as X-rays and protons.

Stereotactic Body Radiotherapy

Stereotactic body radiotherapy is an intense form of radiation treatment. It targets cancer cells by shooting multiple radiation beams from different angles. 

The treatment is also called radiosurgery. It may be an option for people with small lung cancer who can’t have surgery.

Targeted Drug Therapy

These target specific abnormalities within cancer cells in order to destroy them and keep them from growing and spreading. This treatment is often reserved for people with lung cancer that’s more advanced or has returned.


Cancer cells make proteins that hide them from your immune system. As a result, your immune system doesn’t attack these cells.

Immunotherapy impedes the cat-and-mouse game played by these lung cancer cells. This treatment tends to also be reserved for people with lung cancer that’s advanced or has metastasized.

Stage 1 Lung Cancer Survival Rate

The 5-year survival rate for stage 1 lung cancer is between 70% and 85%. For NSCLC, this sits around 64% while SCLC hovers around 29%.

Current survival rates provide the percentage of people who are still alive for a given amount of time after being diagnosed with the same cancer type and stage. This marker is usually 5 years. If cancer was to return, it often does so within a 5-year period following successful treatment.

How to Prevent Lung Cancer

Although you may not be able to fully prevent lung cancer, you can take action to lower your risk for it.

  • Quit smoking tobacco or never start.
  • Stay away from people while they smoke.
  • Test your home for radon, especially if it’s in an area where this is a known health risk.
  • Stay away from substances or chemicals that cause cancer, and be sure to wear protective gear and follow safety precautions at all times while at work or other places that have these.
  • Limit chest exposure to high-energy radiation such as those that come from chest X-rays, CT scans and positron emission tomography (PET) scans.
  • Drink plenty of healthy fluids such as water to help eliminate toxins from your body.
  • Follow a healthy eating plan full of nutrient-rich foods — such as the MIND diet and Mayo Clinic diet — like fruits, vegetables and other whole foods.
  • Get at least 30 minutes of brisk physical activity most days of the week, which may improve lung and immune function. Walking or running, dancing, water aerobics and other types of moderate-to-vigorous activity are great ways to bolster your lung health.

And be sure to ask your doctor if routine lung cancer screening is right for you based on your smoking, family and personal health history. Stage 1 lung cancer and other cancers caught early are much easier to treat successfully.