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Pneumonia With Lung Cancer: Causes, Risks, and More

Medically reviewed by Leonora Valdez, M.D.
Updated on April 19, 2024

Pneumonia can be life-threatening even in healthy people. But for people who have weakened immune systems, such as those with lung cancer, pneumonia can be especially serious. Pneumonia is a pulmonary infection that causes inflammation in the alveoli (small air sacs inside the lungs).

Between 50 percent and 70 percent of people with lung cancer also develop pneumonia. If you believe you may have pneumonia, get medical care immediately.

Common Signs and Symptoms of Pneumonia

The signs and symptoms of pneumonia are often similar to symptoms of lung cancer. This can make it difficult to detect and diagnose pneumonia with lung cancer symptoms. Symptoms that may occur in both conditions include:

  • Dyspnea (shortness of breath)
  • Coughing, sometimes with blood
  • Phlegm or sputum (phlegm mixed with saliva) when coughing
  • Hoarseness or raspiness
  • Chest pain when breathing, coughing, or laughing
  • Fatigue

Common symptoms of pneumonia may also include lower-than-normal body temperature, fever, sweating, shaking chills, loss of appetite, and nausea, vomiting, and diarrhea.

Causes and Risks of Pneumonia

According to the American Lung Association, pneumonia can be caused by viruses, bacteria, or fungi. Your doctor will identify the source of your pneumonia and recommend an appropriate treatment option.

Several factors can increase the risk of developing pneumonia, including:

  • Age
  • Underlying health conditions
  • Smoking
  • Exposure to air pollution, chemicals, or toxic substances such as asbestos or radon

People with other chronic lung diseases such as cystic fibrosis, ​chronic obstructive pulmonary disease (COPD), and bronchiectasis are also more vulnerable.

Health Care-Associated Pneumonia

When pneumonia develops in a health care setting, such as a hospital, it’s called health care-associated pneumonia versus community-acquired pneumonia (infection from outside a health care facility). Health care-associated pneumonia can also include ventilator-associated pneumonia, which can occur from being put on a device to support breathing.

Health care-associated and community-acquired pneumonia are usually caused by different viruses and bacteria. A common cause of community-acquired pneumonia, for instance, is ​Streptococcus pneumoniae — a major cause of bacterial pneumonia. Health care-acquired pneumonia, on the other hand, is often caused by Staphylococcus aureus (staph infection).

Lung Cancer and Pneumonia Risk

Lung cancer and lung cancer treatments weaken the body and immune system, which increases the risk of infections. People with lung cancer have a higher risk of developing infections because of poor nutrition, cancer treatments, and the cancer itself. Having other unrelated health problems — or taking certain medications for other conditions — can also increase the risk of infection.

A healthy immune system works to fight infection. However, lung cancer and some cancer treatments can cause changes in immune system cells. For instance, people who undergo chemotherapy can have low counts of white blood cells, which fight infections such as pneumonia.

Lung Cancer Treatments and Pneumonia

Pneumonia — as well as other respiratory infections, like bronchitis — can result from certain tests, treatments, medications, and surgeries. These infections (treatment-related infectious syndromes) commonly develop after cancer treatments like radiation and chemotherapy (also known as chemo).

Chemo, in particular, is the most common cause of immunodeficiency (weakened immunity) in people undergoing cancer treatments. Chemotherapy can decrease the number of white blood cells known as neutrophils. This condition, known as neutropenia, can make the immune system less able to fight off infections like pneumonia.

Radiation therapy (radiotherapy) is another common cause of lowered white blood cell counts and a weakened immune system. A low white blood cell count is one of the most serious side effects of chemoradiation (chemo plus radiation therapy).

Pneumonitis, or inflammation of the lung tissue from radiation therapy or immunotherapy, can also raise the risk of pneumonia.

The Dangers of Pneumonia With Lung Cancer

Pneumonia can be serious for anyone. But getting pneumonia with lung cancer — especially in advanced stages — can be life-threatening.

Possible Complications of Pneumonia in Lung Cancer

Many complications may occur with pneumonia, especially if the infection is untreated. The most common complications include respiratory failure, sepsis, and lung abscesses.

Respiratory Failure

Respiratory failure requires breathing support with a ventilator. It’s also possible to develop a more severe form of respiratory failure called acute respiratory distress syndrome.

Sepsis

Sepsis occurs when the immune system has an extreme overreaction and attacks the body’s tissues while fighting off an infection. Sepsis can lead to organ failure.

Lung Abscesses

Although uncommon, lung abscesses are a very serious complication of pneumonia. The abscesses result when pus pockets form around or inside a lung. They may need to be drained through surgery.

Tests To Diagnose Pneumonia

Several common tests help determine whether a person has pneumonia or another lung infection, such as bronchitis. These include blood tests, measurements of lung function, certain procedures, and imaging scans.

Blood Tests and Blood Cultures

Blood testing can be used to see if antibodies that fight viruses are present in the bloodstream. Blood cultures can identify harmful bacteria or fungi, in particular.

Pulse Oximetry

This test measures the amount of oxygen in the blood. This can help determine whether a person’s lung function has been impaired by an infection like pneumonia.

Arterial Blood Gases

In this test, a sample of blood is drawn from an artery to measure levels of oxygen and carbon dioxide. Like pulse oximetry, arterial blood gas tests can help assess how well a person’s lungs are functioning.

Bronchoscopy

A bronchoscopy is an endoscopic procedure that allows a doctor to use a tubelike instrument to view the lungs and bronchial tubes, or air passages, from inside. During this procedure, a doctor can clear any blockages and take mucus, fluid, or tissue samples to be looked at in a lab.

A bronchoscopy allows a doctor to see the lungs and airways and clear any blockages. (Adobe Stock)

Lung Biopsy

In a lung biopsy, a doctor obtains a piece of lung tissue and analyzes it for signs of certain diseases or conditions.

Thoracentesis

In this test, fluid is obtained from the sac surrounding the lungs called the pleural space. This fluid can then be checked for pulmonary infections and cancer. Your skin will be numbed before a needle is inserted between your ribs.

During thoracentesis, fluid is removed from the pleural space around the lungs. A needle is inserted to remove the fluid. The procedure typically takes 10 to 15 minutes. (National Heart, Lung, and Blood Institute)

Chest X-Ray or CT Scan

Imaging tests can produce detailed images of the lungs and the surrounding organs and structures.

Can Pneumonia Be Mistaken for Lung Cancer?

With adenocarcinomas — the most common type of lung cancer — chest X-rays or CT scans can sometimes lead to confusing lung cancer for pneumonia.

Early lung cancer X-rays in particular may resemble pneumonia. Because of this potential confusion, sometimes an accurate diagnosis of lung cancer or pneumonia can be made only with a biopsy of lung tissue if pneumonia appears not to get better.

Reducing the Risk of Pneumonia With Lung Cancer

There’s no guaranteed way to prevent pneumonia. However, if you have lung cancer, you can take steps to protect your lungs.

It’s important to talk with your doctor in detail to find out how best to prevent pneumonia based on your lung cancer stage, the condition of your immune system, and your lung cancer treatment plan.

Keep Up With Appropriate Vaccinations

Certain vaccines are highly recommended for people with lung cancer. However, before you receive any vaccines, talk with your oncology care team about the potential risks and benefits. Some vaccines may be more harmful than helpful, depending on your particular lung cancer case.

A few of the most common vaccines that may help prevent pneumonia with lung cancer are listed below.

COVID-19 Vaccines

These vaccines are generally recommended for people with any type of cancer to prevent infection with COVID-19. However, COVID-19 vaccines may be less effective during chemotherapy, radiation, and other cancer treatments.

Flu Vaccines

It’s unknown whether people with lung cancer and lung cancer survivors are more likely to get the flu than other individuals. However, people with cancer have an increased risk of developing complications if they do get the flu. These complications may be serious, so doctors usually advise people with cancer to receive this vaccine.

Pneumococcal Vaccine

The pneumococcal vaccine protects against certain bacterial infections, including pneumonia, and can benefit people with weakened immune systems due to lung cancer. Generally, the Centers for Disease Control and Prevention (CDC) recommends that most adults with cancer get pneumococcal vaccines.

Wash Your Hands

Frequent handwashing is always important to protect against illness. Wash your hands thoroughly with warm, soapy water before cooking or eating and after using the bathroom or blowing your nose.

Wear a Mask

Wearing a face covering in crowded environments lowers the risk of spreading disease. Masks may help protect both you and those around you.

Don’t Smoke

Smoking is a risk factor for pneumonia. Cigarette smoking and other forms of tobacco use damage the lungs, making them more prone to infections. Secondhand smoke — smoke breathed out by others — can also raise the risk of pneumonia and should be avoided as much as possible.

Keep Up Your General Health

Getting plenty of rest, eating a healthy diet, and exercising regularly may help ward off some illnesses. Always keep up with your doctor appointments, and discuss any signs or symptoms of pneumonia (or other illnesses) with your health care provider.

Managing Pneumonia With Lung Cancer

Your doctor may recommend stopping or delaying some lung cancer treatments if you have an infection such as pneumonia. They’ll carefully consider factors such as your type of cancer — for example, whether you have non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) — and where you are in your cancer treatment.

Your doctor may recommend pneumonia treatment such as antibiotic therapy to help control your infection as quickly as possible. Be sure to report any changes in your health and any new or worsening symptoms to your health care team. Early detection of an infection such as pneumonia can help ensure a positive outcome.

Find Your Team

Talking to other people who understand what you are going through can be a great source of emotional support. MyLungCancerTeam is the social network for people and their loved ones with lung cancer. On MyLungCancerTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you had pneumonia with lung cancer? Share your experiences and thoughts in the comments below or by posting on your Activities page.

References
  1. Pneumonia — Mayo Clinic
  2. Postobstructive Pneumonia in Lung Cancer — Annals of Translational Medicine
  3. Lung Cancer Symptoms — Johns Hopkins Medicine
  4. Learn About Pneumonia — American Lung Association
  5. Causes of Pneumonia — Centers for Disease Control and Prevention
  6. Why Are People With Cancer More Likely To Get Infections? — American Cancer Society
  7. Preventing Infections in People With Cancer — American Cancer Society
  8. Infectious Complications in Patients With Lung Cancer — European Review for Medical and Pharmacological Sciences
  9. Comparison of Pneumonitis Rates and Severity in Patients With Lung Cancer Treated by Immunotherapy, Radiotherapy, and Immunoradiotherapy — Cureus
  10. Pneumonia Treatment and Recovery — American Lung Association
  11. Tests for Lung Infections — University of Michigan Health
  12. Pulse Oximetry — Johns Hopkins Medicine
  13. Arterial Blood Gases (ABG) Test — University of Michigan Health
  14. Bronchoscopy — Mayo Clinic
  15. Lung Biopsy — Johns Hopkins Medicine
  16. Lung Disease Treatments — National Heart, Lung, and Blood Institute
  17. Pulmonary Adenocarcinoma Mimicking Pneumonia in a Young Adult — Cureus
  18. Preventing Pneumonia — American Lung Association
  19. Vaccinations and Flu Shots for People With Cancer — American Cancer Society
  20. COVID-19 Vaccinations in People With Cancer — American Cancer Society
  21. What Cancer Patients, Survivors, and Caregivers Should Know About the Flu — Centers for Disease Control and Prevention
  22. Pneumococcal Vaccination: Summary of Who and When To Vaccinate — Centers for Disease Control and Prevention
  23. From the Frontlines: The Truth About Masks and COVID-19 — American Lung Association
  24. Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic — Journal of Thoracic Oncology
    Updated on April 19, 2024
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    Leonora Valdez, M.D. received her medical degree from the Autonomous University of Guadalajara before pursuing a fellowship in internal medicine and subsequently in medical oncology at the National Cancer Institute. Learn more about her here.
    J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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