Grayson Teets was in his freshman year of college at Penn State University, and thought he was coming down with the flu. “I had a persistent dry cough, along with a fever and night sweats,” he said. His symptoms didn’t improve: “I eventually started coughing up blood, and my cough kept getting worse, which made me realize that something more serious might be going on.”

Teets was treated for pneumonia for more than 2 months before he received a biopsy. The result was shocking: he had ALK-positive lung cancer. “We don’t have a history of lung cancer in my family, so my diagnosis was definitely a surprise to all of us,” he recalled. “I was also a nonsmoker, so there was nothing about my background to make me expect that I would be diagnosed with lung cancer at 18.”

Lung cancer in teenagers is an exceeding rare occurrence, totaling 0.1 cases per 100,000 female patients and 0.3 cases per 100,000 male patients. “Common symptoms such as cough, shortness of breath, chest pain, or recurrent respiratory infections are much more likely to have another explanation,” said Jaclyn LoPiccolo, MD, PhD, attending physician at Dana-Farber Cancer Institute’s Lowe Center for Thoracic Oncology and an instructor in medicine at Harvard Medical School, both in Boston.

“The broader message is not that teenagers with respiratory symptoms should routinely be evaluated for lung cancer, but that age alone should not exclude the diagnosis when the clinical or radiographic picture is concerning. Because lung cancer is so unexpected in this age group, there can be a substantial delay between the onset of symptoms and diagnosis.”

Missing Red Flags

Teets’s nagging symptoms are a marker of how easy it can be to dismiss, rule out, or overlook a lung cancer investigation.

“The most easily missed clue is a respiratory problem that persists or repeatedly returns despite appropriate treatment,” said Eric K. Singhi, MD, lung cancer oncologist and lead for the Young-Onset Lung Cancer Program at The University of Texas MD Anderson Cancer Center in Houston. “Recurrent pneumonia in the same location, focal or unilateral wheezing, unexplained hemoptysis, or persistent lobar collapse should prompt reconsideration of an infection or asthma diagnosis. In fact, an obstructing endobronchial tumor, such as a bronchial carcinoid or mucoepidermoid carcinoma, can produce these findings. The practical message is to reassess when symptoms or imaging do not follow the expected course.”

In terms of diagnostic research-driven pearls, a 2024 study found that persistent ground glass opacity nodules may indicate early-stage lung adenocarcinoma in adolescents. A separate study analysis also found that for teenagers with lung cancer, in terms of primary site, the main site was the lower lobe (33.2%) followed by the upper lobe (26.9%).

How Treatment Can Specifically Affect Teenagers

The same analysis also found that most teenage patients (80.4%) underwent surgery, with lobectomy (39.9%) as the primary method. Among all, 9.3% of patients received radiotherapy, and 37.2% of patients received chemotherapy. No matter what form treatment takes, young people may find it takes a surprising toll on their overall well-being.

Teets had chemotherapy and a pneumonectomy, which he found very difficult. “I had been an athlete throughout my life, so it was scary to think that I was going to lose half of my lung capacity,” he said. “After surgery, it was difficult to see how much my physical abilities had changed. Initially, I couldn’t even walk up a flight of stairs without becoming extremely short of breath. That was a big adjustment for me because being active had always been such an important part of my life.”

A physician taking the time to explain to a young patient what physical challenges treatment may present can go a long way toward helping them manage their expectations.

Teets stressed that treatment can cause a special kind of emotional turmoil for young patients as well. “At 18, I was just beginning to figure out what I wanted my life to look like,” he said. “Suddenly, I was thinking about chemotherapy, surgery, scans, and whether I would be able to return to school and continue the life I had planned for myself.” Open communication between physician and patient is a key component in easing this kind of burden.

Emerging Treatments That Can Provide Better Outcomes

Some good news: There are treatment innovations that may specifically help teenage patients.

“One of the most important advances has been our ability to identify the specific molecular alteration driving an individual lung cancer,” said LoPiccolo. “Lung cancers occurring in very young patients are often biologically different from the smoking-associated lung cancers we traditionally think of and can be enriched for targetable oncogenic drivers. These can include alterations in genes such as ALK, ROS1, RET, NTRK, and EGFR, among others.

For that reason, comprehensive molecular testing is particularly important in a teenager or very young adult with lung cancer. If a targetable alteration is identified, highly effective targeted therapies may be available, and additional therapies continue to be developed. Some of these drugs can produce durable responses even in advanced disease and have activity against cancer that has spread to the brain.”

In addition, genetic evaluation can provide important information. “Because lung cancer at this age is so unusual, I would also strongly consider germline genetic evaluation to determine whether an inherited cancer predisposition could have contributed,” LoPiccolo continued. “Although we still need better treatments, the increasing ability to define and target the molecular cause of a patient’s cancer gives us substantially more therapeutic options than we had even a decade ago.”

Drug therapy is also evolving. “Targeted therapies with activity in the brain, including lorlatinib for ALK-positive disease and even newer ROS1 inhibitors, have expanded treatment options in adults,” Singhi noted. “Investigational approaches such as neladalkib and ALK-directed molecular glue degraders aim to overcome treatment resistance. For teenagers, applicability depends on the specific drug, pediatric eligibility, available evidence, and clinical trial access — adult outcomes cannot automatically be extrapolated.”

Additionally, “histology remains essential: localized bronchial carcinoid and low-grade mucoepidermoid carcinoma often have excellent outcomes with surgery,” Singhi said. “These rare cases benefit from collaboration between thoracic and pediatric or adolescent and young-adult oncology specialists.”

What a Teenager Who’s Had Lung Cancer Wants Doctors to Know

Teets is now 21, in remission, and has returned to Penn State University after missing just one semester. His illness has further fueled the ambition he had to become a doctor, and he’s already involved in cancer research. “My experience has allowed me to take something that was such a difficult part of my life and use it to help shape the person and future physician I want to become,” he said.

Teets is very grateful to his healthcare providers. “I was extremely lucky to have incredible doctors, nurses, and other members of my healthcare team who supported me throughout the process,” he said. “One of the most important things they did was treat me not just as a cancer patient but as a young person who had a life outside of the hospital. I would encourage doctors to remember that even when a young patient is dealing with a life-threatening diagnosis, they are still thinking about school, their friends, their family, their future, and all of the things they thought they would be doing at that age.”

Ultimately, Teets urges any physician who treats a teenager with lung cancer to give their patient hope: “Medical treatment is obviously incredibly important, but so is helping young patients understand that they can still have a future beyond their diagnosis.”

Singhi reported having relationships with AstraZeneca, Novocure, Amgen, Janssen, Regeneron, BMS, Bayer, Lilly, BI, CARIS, AbbVie, Nuvation Bio, and Rexanna’s Foundation for Fighting Lung Cancer. LoPiccolo reported being a paid consultant for the Lung Cancer Genetics Study funded by Troper Wojcicki Philanthropies. Teets reported being affiliated with Lung Cancer Initiative, a nonprofit organization.

Lisa Mulcahy is a freelance writer for WebMD and Medscape. She is an internationally established health journalist whose credits include The Washington Post, Good Housekeeping, Prevention, Oprah Daily, Woman’s Day, Harper’s Bazaar, Elle, Marie Claire, Men’s Health, The Los Angeles Times, Cosmopolitan, Glamour, Parade, Health, Self, Family Circle, and Seventeen. She also writes for many health organizations, including the American Heart Association and the National Multiple Sclerosis Society.