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Symptoms of lung cancer

Lung cancer is often diagnosed at an advanced stage as it causes few and vague symptoms. Early diagnosis is usually due to an incidental finding on a lung X-ray taken in another context.  

The symptoms depend on the localization of the tumor, locoregional spread, and effect of distant metastasis.

Common symptoms:

  • Coughing. Most patients have smoker's cough, therefore it is important to be aware of coughing changes.
  • Dyspnea may be a symptom of lung cancer-related bronchial stenosis, or a malignant pleural effusion, or in some cases, build of pericardial fluid. 
  • Hemoptysis may occur when the tumor has invaded the bronchial mucosa. Serious bleeding is rare, but can occur. This often starts with small tinges of blood in expectorate.
  • Respiratory tract infections are often a subsequent condition of a bronchial obstruction. Sometimes lung cancer is detected after work-up for bronchial pneumonia. 
  • Pain may occur due to large atelectases with infections. Usually, this is symptomatic of advanced cancer with direct involvement of the chest wall or pleura. 
  • In advanced cancer, general symptoms are often observed such as reduced appetite, weight loss, and fatigue.

Symptoms of acute conditions 

  • Compression of airways (dyspnea/stridor, tachypnea, coughing)
  • Vena cava superior syndrome (dyspnea/stridor, tachypnea, dilated veins on the upper body, edema of the face and neck/arms, chest pain, difficulty in swallowing, vocal cord paralysis)
  • Hypercalcemia (confusion, somnolence, nausea/vomiting, muscle aches, polyuria, constipation, dehydration)
  • Threatening spinal cord lesion (loss of muscle power and/or sensitivity, pain, incontinence, reduced coordination)

Paraneoplastic syndromes

Paraneoplastic syndromes are due to remote effects of malignant tumors. Such side effects are more frequently associated with lung cancer, especially small-cell type, than other cancers.

Some symptoms and findings:

  • Endocrine (hypercalcemia, Cushing's syndrome, Syndrome of inappropriate anti-diuretic hormone secretion (SIADH))
  • Neurological (Lambert-Eaton myasthenic syndrome (gradual weakness of lower extremities) encephalopathy, peripheral neuropathy)
  • Hematological (anemia, leukemoid reactions, thrombocytosis or thrombocytopenia)
  • Cutaneous (hyperkeratosis, dermatomyositis)
  • Other (nephrotic syndrome, anorexia, clubbing)

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