Dear Doctor: Our sister saw her doctor because her chest felt “heavy,” and he found fluid in her lung. Further tests showed lung cancer, which had already spread. She never coughed, and she quit smoking years ago. What are some of the symptoms of lung cancer?

Dear Reader: Although a cough can be an indication of lung cancer, it is not the only sign of the disease, and it doesn’t appear in every case. Lung cancer can take years to develop; in its earlier stages, people may have no symptoms at all. When the disease does begin to make itself known, some of the symptoms can be unusual, and, thus, not immediately associated with lung cancer.

Let’s start with a cough. It’s one of the more common symptoms of lung cancer, and it appears in up to half of all patients. This can be a new and persistent cough that isn’t associated with a cold or the flu, or it can be a chronic cough that gradually becomes worse. These coughs may be painful, and they may produce red or rust-colored phlegm or sputum, which indicates the presence of blood. Any time that you cough up blood -- whether it is bright red, which indicates new blood, or a darker hue, which signals old blood -- it’s important to see a doctor.

The presence of fluid, as in the case of your sister, is known as pleural effusion. It’s not actually inside the lungs, but in an area between the lungs and the chest wall, which is known as the pleural space. When it is associated with cancer, the condition is known as malignant pleural effusion, and it is a sign that the disease has spread. The buildup of fluid in the pleural space causes the sensation of heaviness that your sister reported, sometimes also described as a feeling of tightness. Often, it is accompanied by shortness of breath, a dry cough and exhaustion. Pleural effusion can be life-threatening, and the fluid must be drained.

Additional symptoms of lung cancer include chest pain, hoarseness, frequent bouts of bronchitis or pneumonia and persistent chest pain. Symptoms of the disease that are not lung-related include persistent fatigue or malaise, loss of appetite, unexplained weight loss, swollen or enlarged lymph nodes and shoulder or upper-back pain. Some patients develop an enlargement of the fingertips, known as clubbing. It’s important to note that each of these, including cough, can be caused by other conditions.

For adults who are at a higher risk of developing lung cancer, the recent development of an early stage screening test has been an important advance. Known as low-dose computed tomography, or a low-dose CT scan, it’s recommended for adults between the ages of 55 and 80 who are heavy smokers, or who were heavy smokers and quit less than 15 years ago. The scan, which uses a small amount of radiation, makes a detailed image of the lungs. Risks of the test include false positives, which can lead to unnecessary surgical procedures, and exposure to radiation, which itself can cause cancer. Anyone interested in the test should check with their doctor to see if they meet the screening criteria.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Our dad is 78 years old, and he has started spending a lot more time indoors and on his recliner. He’s in good health, but he says he’s getting too old for exercise to matter. What can we say to persuade him to become active again?

Dear Reader: Exercise is an important part of ongoing health and fitness, and, despite your dad’s feelings to the contrary, we never age out of our need for it.

In fact, studies show that becoming or remaining active as an older adult offers a wide array of benefits. On the physical side, regular exercise can improve cardiovascular health; help to lower blood pressure; lessen the risk of chronic diseases such as Type 2 diabetes, colon cancer and heart disease; help with balance, strength and flexibility; maintain healthy weight; improve strength and stamina; maintain joint health; help with swelling and pain due to arthritis; and lower the risk of falls. Regular exercise has mental health benefits as well. Older adults who incorporate even moderate amounts of exercise into their daily lives report enhancement to mood and outlook, improved cognitive function and a reduction in symptoms of anxiety and depression. Remaining physically active also has been shown to help older adults maintain their ability to live independently.

For a well-rounded exercise program, think in terms of a mix of activities to improve endurance, increase strength and maintain flexibility. And be creative. Walking, jogging, swimming and biking all fit the bill for moderate aerobic activities for endurance, but so do dancing, raking the lawn or playing badminton. We lose muscle mass as we age, so strength and resistance exercises, such as weightlifting or Pilates, are important. Activities like stretching, tai chi and yoga help keep joints loose and muscles limber. Current guidelines recommend that people 65 and older should do 2.5 hours of moderate aerobic exercise each week, which averages out to a manageable 20-ish minutes per day.

Although sharing this information with your dad is a good start, leading by example is even better. It’s not just older adults who fall short of the recommended levels of exercise and physical activity; up to half of all adults miss the mark. If you and your siblings live nearby, it could be helpful to your dad -- and to yourselves -- to choose an activity to do together once or twice a week and get up and moving.

A final thought: If your dad has supplementary Medicare coverage, check to see if it includes SilverSneakers. It’s a health-and-fitness program designed for older adults that will give him access to a range of fitness options, including gyms, community centers and other fitness locations. And remember, your dad should check in with his doctor or other health care provider before making any significant changes to his exercise regimen or activity. They will be able to evaluate his condition and fitness level and point him in the direction of appropriate activities. Not only will it help your dad to stay safe, he’ll have another partner and cheerleader in his corner.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I keep reading about something called “resistant starch.” People are saying I should get it into my diet. Why is it so important? How much do I need?

Dear Reader: As with so many areas of diet and medicine these days, the answer leads directly to the gut microbiome. That’s the vast and complex community of bacteria, fungi, yeasts and viruses that live in our intestines. They number in the trillions, can account for 2 to 5 pounds of our weight and, as we’re learning every day, play complex and crucial roles in our physical and even mental health. In fact, because these microscopic creatures are necessary to survival, the gut microbiome is increasingly regarded as an organ in its own right.

One of the keys to a healthy and diverse gut microbiome is keeping our microscopic residents well-fed. This involves prebiotics, a type of dietary fiber that stimulates the growth and activity of the good-guy bacteria in the gut. For fellow science nerds, prebiotic foods contain high levels of a starchy substance known as inulin and certain types of sugars, including fructo-oligosaccharides and galacto-oligosaccharides. Although apples, oats, lentils, leeks, Jerusalem artichokes, garlic, asparagus and bananas are cited as good sources of prebiotics, the fact is that a wide range of fruits, vegetables, grains and legumes contain prebiotics in varying amounts.

Another potential source of prebiotics is the subject of your question -- resistant starch. As the name suggests, these are starches, or carbohydrates, that resist digestion. That means they survive the journey through the digestive tract and make it all the way to the colon, where they become available to gut microbes. Resistant starches fall into four general categories. They may be protected by fibrous cell walls, as with grains, seeds and legumes. They are available in certain raw foods, such as raw potatoes or raw plantains. And they can be manufactured via a chemical process. What’s of particular interest is the final category. This is a range of carbohydrates that, when cooked and then cooled, develop into resistant starch. These include rice, potatoes, yams, pasta and whole grains such as oats and barley.

One benefit is that, instead of being broken down into glucose and raising blood sugar levels, these types of carbohydrates pass into the colon. This improves glycemic control, an important factor in good health. Once in the colon, resistant starches feed the beneficial bacteria that live there. Through the process of fermentation, bacteria turn resistant starch into compounds known as short-chain fatty acids. These include butyrate, which is linked to lower rates of colorectal cancers, and propionate, which has been shown to lower inflammation and improve immune support.

How much resistant starch do we need? There’s no set amount. Instead, think in terms of daily goals for dietary fiber in general. Most Americans get less than half the recommended 25 grams per day for women and 38 grams per day for men. We recommend eating from a diverse range of fresh fruit, vegetables, whole grains, legumes and nuts. If they’re new to your diet, add them slowly to avoid gas and bloating. And with every bite, know you’re making your gut microbiome very happy.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)