Senior Director, Surgical Oncology, Fortis Hospital, Vasant Kunj, New Delhi
Part 5 of 10 in When to Suspect Cancer and How to Refer
Persistent Cough and Lung Cancer: Warning Signs and Low-Dose CT Screening
January 25, 2026
Dr. Shubham Jain identifies persistent cough, especially with blood-streaked sputum, as a symptom that should prompt clinicians to think of lung cancer in specific patients.
Who should be considered for lung cancer
He flags patients over 40 years of age with a tobacco history, an abnormal chest X-ray finding, or a history of asbestos exposure as needing evaluation for the possibility of lung cancer.
Low-dose CT as a screening tool
The recommended screening strategy is an annual low-dose CT scan of the chest, indicated for heavy smokers aged 50 to 80 in otherwise good health who smoke more than 20 pack-years of cigarettes. The radiation dose is roughly one-tenth of a standard CT scan of the abdomen, which allows it to be used safely as a screening tool without causing harm.
Surgical treatment when detected early
Dr. Jain describes offering patients robotic lobectomy when lung cancer is detected in time, removing the affected part of the lung with minimal surgery so patients recover quickly and resume normal activities.
This article is based on a Jivo Masterclass session conducted by Dr. Shubham Jain, Senior Director, Surgical Oncology, Fortis Hospital, Vasant Kunj, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a lung cancer diagnosis or treatment? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass — Dr. Shubham Jain taught doctors across Africa on January 25, 2026.
FROM THE LIVE Q&A
Dr. Ivan (Uganda)
Biopsy is often the best way to detect cancer, but it usually takes a long time. Are there any faster options or alternatives?
Dr. Shubham Jain
This is a real issue even in India, where processing time for biopsies can be high in some regions. One workaround is relying more on FNAC, which is not the best strategy but can guide treatment decisions in select situations where a diagnosis is otherwise delayed. A second option is a frozen section facility, which gives some confirmation quickly but is resource-intensive and usually only available at high-volume cancer centres. Short of that, it is best to refer to an oncologist who can guide where a biopsy should be taken from for the best results.
Frequently Asked Questions
What are the myths in assessing suspected cancer patients?▼
The most important myth is patients' hesitancy to get a biopsy done, fearing it will cause the cancer to spread. A biopsy is one of the most crucial tests a cancer patient needs, and if planned and performed correctly it will not cause the cancer to spread. Another myth is that patients believe cancer is their own fault, from dietary habits or indulgences like tobacco or alcohol. More cases are now understood to happen because of environment or genetics rather than a patient's own fault, and it is important to destigmatise patients suffering from cancer, since stigma is what keeps them from seeking timely treatment.
Do you recommend breast conservation surgery for a small breast ductal carcinoma of the left breast?▼
Definitely. Breast conservation surgery is one of the advanced techniques for treating early breast cancer and is routinely discussed as a possibility with patients. It offers a definite cosmetic advantage, but it needs to be followed up with radiotherapy, and there are strict criteria on imaging and family history that must be met before it is offered. It is now combined with oncoplasty, which improves how the scars are closed for a better cosmetic outcome.
How do we approach cancer of unknown primary with only liver metastases or oligometastases?▼
This is a tricky situation where metastatic deposits are seen without knowing where they are coming from. A PET scan is needed to confirm there is no other site of disease in the body, and immunohistochemistry on the biopsy can give clues to where the cancer is arising from, guiding directed and targeted imaging afterward. Many times the primary is never found. If there are only liver metastases, treatment starts with a palliative intent, and depending on how the patient responds and their performance status, a curative approach involving surgery may later be attempted, though nothing can be assured to the patient in advance.
What is your take on mebendazole and ivermectin as adjunct tablets for cancer treatment?▼
These are being evaluated as adjuvant therapy for cancer, but there is not yet sufficient scientific data backing them, so standard chemotherapy remains the primary reliance. What is showing real results is targeted therapy and immunotherapy, where survival has improved and recurrences and side effects have reduced. Cost has been a sore point since these are expensive medicines, but with generic versions now available and patient assistance programmes extending to international patients, these costs are coming down.
How do you see complications from radiotherapy on the left side of the chest?▼
The most common complication with radiotherapy for left-sided breast cancers is cardiotoxicity. Radiation oncologists manage this with deep inspiratory breath-hold and gating techniques, training the patient to hold their breath during the active phase of radiotherapy so toxicity to the heart is reduced, chest wall motion is reduced, and radiation is delivered accurately to the target volume. More precise machines such as IGRT and 4D-CRT are also improving precision for left-sided breast and chest wall tumours.
Who should get an annual low-dose CT scan for lung cancer screening?▼
Heavy smokers aged 50 to 80 who are in otherwise good health and have smoked more than 20 pack-years of cigarettes.
Why is a low-dose CT scan considered safe for regular screening?▼
Its radiation dose is roughly one-tenth of a standard CT scan of the abdomen, which allows it to be used safely as a screening tool without causing harm to the patient.
In This Series: When to Suspect Cancer and How to Refer
- 1.When to Suspect Cancer and How to Refer
- 2.Breast Lump Assessment: Why Triple Assessment Comes Before a Diagnosis
- 3.Breast Cancer Screening: Mammography Guidelines and How to Prepare Patients
- 4.Persistent Hoarseness and Laryngeal Cancer: Warning Signs and Voice Rehabilitation
- 5.Persistent Cough and Lung Cancer: Warning Signs and Low-Dose CT Screening
- 6.Abdominal Bloating and Ovarian Cancer: Warning Signs and the Role of CA-125
- 7.Abnormal Vaginal Bleeding: Endometrial Cancer, Cervical Cancer and HPV Vaccination
- 8.Bowel Habit Changes and Colorectal Cancer: Colonoscopy Screening Guidelines
- 9.Common Myths About Cancer Diagnosis and Treatment
- 10.Cancer of Unknown Primary: How Doctors Find the Source