Lung cancer is an insidious disease and initial diagnosis is often based on incidental radiographic findings with few obvious symptoms. However, symptoms that tend to raise suspicion in patients and cause them to initially suspect pathology start to occur in more advanced stages of growth. These include hemoptysis, cough, infection, hoarseness, weight loss and chest pain.
Radiographic Changes
When an incidental pulmonary nodule is detected, comparison with older images is done. If comparison shows that the nodule is new or that it is increased in size, then further workup is undertaken. Lesions that tend to have higher risk of malignancy have spiculated margins, wall thicknesses of over 15 mm, lack of calcification and rate of growth based on old imaging.
Hemoptysis
This is basically coughing up of blood and can occur for a variety of reasons. The tumor could be growing into the pulmonary vasculature, or destroying normal parenchyma (the essential tissue of the lung), causing bleeding. In addition, many fast growing tumors do not possess sufficient vascular supply to keep pace with their growth and some of the tissue may die, possibly also contributing to hemoptysis. It is commonly described as bloody sputum occurring several days in a row.
Cough
This is understandably a common symptom with lung cancer, as the mass effect of the tumor can cause considerable irritation to sensitive pulmonary parenchyma.
Hoarseness
This can occur when the passageways of the lungs are obstructed as well as if the tumor is on the left side of the lung. The recurrent laryngeal nerve routes around the aortic arch on that side and local tumor growth can impinge on it.
Infection
Pneumonias are very common in lung cancer and can be due to chronic obstruction by the tumor and collapse of the airways/alveoli, which is a risk factor for infection. Patients with cancer also tend to have depressed immune systems, which always carries with it increased risk of infection.
Weight Loss
Many patients with cancer report unplanned weight loss that can be due to a variety of reasons. One is called the Cachexia Syndrome, which is associated with an inflammatory cytokine (basically a small protein molecule with biological effects) called TNF-a. Cancers cause increased release of this cytokine and others that are involved in the inflammatory cascade, and it triggers chronic anorexia and wasting of nutrients and is sometimes even the reason behind the death of the patient. The lack of protein nutrition is often a large reason behind nutritional morbidity in cancer patients.
Chest Pain
This is usually a local mass effect of tumor growth into the chest wall or the pleura. It is usually dull, hard to localize and constant with no modification by breathing/coughing.
When a patient first presents with suspected lung cancer, some of the above symptoms are commonly the reason for presentation. However they are nonspecific, which means they occur in a multitude of other syndromes and disease processes. Care must be taken not to read into them and make a presumptive diagnosis at home. If any questions still exist or there is concern, please consult a health care professional immediately. Only they are trained to put together the clinical picture and can utilize many other resources to aid in diagnosis such as imaging for example.
References
- Abeloff's Clinical Oncology, 4th ed. Abeloff 2008.
- Chest. "Initial Evaluation of the Patient With Lung Cancer: Symptoms, Signs, Laboratory Tests, and Paraneoplastic Syndromes ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition)." Spiro S, Gould M, Colice G. Volume 132, Issue 3 (September 2007).
- Cecil Medicine, 23rd ed. Goldman, 2007.
