Lung cancer is among the deadliest and most prevalent of all the cancers. The incidence of lung cancer has declined over the past decade because of the reduction in smoking.
Most of the patients with lung cancer are diagnosed when they have locally advanced disease or even when cancer spreads to bones and other organs of the body.
This is because of the lack of effective screening, the absence of symptoms in the early stages, and the aggressive nature of the disease.
15 important symptoms of lung cancer
The most common, although non-specific, symptoms of lung cancer are cough, hemoptysis, shortness of breath and chest pain.
- Cough is present in the majority of patients with lung cancer. Patients with small cell and squamous cell lung cancer are most likely to present with cough as these cancers involve the major airways. Smokers with a new onset of cough and weight loss should always be considered an alarming sign and investigated.
- Hemoptysis: Hemoptysis is coughing out blood. It may be present in about half of the patients with lung cancer. Occasionally, the patient may bleed into the airways, asphyxiate and die.
- Chest pain: chest pain, often characterized as dull and aching in character, may be localized to the site of cancer. It may be pleuritic i.e. varies with the breathing pattern, especially when it involves the pleura (covering of the lungs). Patients may also develop chest pain because of a clot in the pulmonary arteries (pulmonary embolism), obstructive pneumonitis and when cancer involves the bones (especially the ribs and spine)
- Shortness of breath: Shortness of breath is present in patients with lung cancer because of the local disease, obstruction of the airways, obstructive pneumonitis, lung collapse, pulmonary embolism (clot in the pulmonary arteries), pleural and pericardial effusions. Patients may also develop paralysis of the diaphragm and develop shortness of breath.
- Hoarseness of voice: Hoarseness of voice may be a feature of cancer of the larynx or lung cancer when it involves the recurrent laryngeal nerve.
- The patient may notice facial plethora and engorged neck veins or feel heaviness in the neck and head as a result of obstruction of the neck veins (superior vena cava syndrome).
- Patients may notice muscle wasting of the hands and Horner’s syndrome (ipsilateral pupillary constriction, drooping of the upper eyelid, the absence of sweating over the face and sinking of the ipsilateral eyeball). These features are common with the Pancoast tumour (lung cancer involving the apex of the lungs).
- Skeletal pains: patients may present with skeletal pains due to the bony spread of cancer. Patients may develop severe backache and occasionally develop fractures.
- Patients may develop hyperpigmentation and features of Cushings or Addison’s disease due to the spread of cancer to the adrenal glands.
- Neurological involvement can cause focal weakness (loss of sensation or power in one of the limbs), headache, vomiting, seizures, and change in mental status.
- Patients may develop hypercalcemia as a result of direct involvement of the bones or as a result of paraneoplastic syndrome. These patients develop polyuria, dehydration, mental status changes, renal stones, nausea, anorexia and abdominal pain.
- Hyponatremia (because of SIADH) especially in small cell lung cancer, can cause nausea, vomiting, headache, blurred vision and change in mental status.
- Patients may notice pallor (anaemia) and develop blood clots in various parts of the body.
- Clubbing and hypertrophic pulmonary osteoarthropathy (bony proliferation) involving the wrists, ankles and phalangeal bones may become prominent.
- Weight loss and fever are nonspecific symptoms that may mimic other pulmonary diseases like pulmonary tuberculosis. However, these symptoms can be the only initial symptoms and marked weight loss may occur in advanced lung cancer.