1.1 Signs and Symptoms of Lung Cancer
1.1 Signs and Symptoms of Lung Cancer
Looking out for the early signs and symptoms of lung cancer is especially important as around 40% of diagnosed lung cancers are found after the disease has advanced. It is estimated that lung cancer in around one third of all patients has reached Stage III on diagnosis. Like all cancers, the earlier the disease is detected the better the prognosis and outcome. The difficulty is that patients with lung cancer may be asymptomatic until the tumor has grown large enough to obstruct airways or invade normal tissues. Screening for individuals who fit the criteria (see Section 1d) could help detect lung cancer before it becomes symptomatic.
Symptoms of lung cancer vary according to where in the lungs the tumor is located. Common signs to look out for include the following:-
Cough: A persistent cough that doesn’t go away is one of the most common symptoms of lung cancer. Most people get a cough from time to time, but if it persists, produces a lot of mucus or has a deeper or hoarse sound then have it checked out. If you notice a friend or a family member persistently coughing advise them to see their family doctor. Do not dismiss a persistent cough as a ‘smoker’s cough‘.
Shortness of Breath: There are many medical reasons for shortness of breath (or dyspnoea) such as asthma, chronic obstructive airways disease (COPD),pulmonary infections and heart problems. It can be a sign of lung cancer when a tumor begins to obstruct an airway or invade lung tissues. Shortness of breath can also occur as a result of fluid build-up (pleural effusion) around the lungs. If you or a family member become increasingly short of breath see a medical practitioner.
Hemoptysis: (coughing blood), seen mostly with squamous cell carcinoma. Coughing up blood or sputum streaked with blood is never normal and should be immediately checked by your family physician. The most common cause of hemoptysis is inflammation and irritation of the airways caused by an infection. However in 7% of lung cancers hemoptysis is the only sign. Cancer of the bronchus, or bronchogenic carcinoma, is a common lung cancer responsible for hemoptysis in 5 to 44 percent of all cases. Bleeding from malignant tumors can be secondary to invasion of the lining of the bronchus, erosion into blood vessels, or highly vascular lesions.
Guidance from the National Institute for Clinical Excellence (NICE) has focused on the above three symptoms to try and raise public awareness of the early symptoms of lung cancer in the general population and also to alert general practitioners. Nice has advised that if a patient has a new and persistent cough, develops breathlessness and has hemoptysis (blood in sputum) they should have a Chest X-Ray as soon as possible to rule out lung cancer.
Hoarseness or Loss of Voice: There are many causes for a hoarse voice or losing your voice; it is usually due to inflammation caused by an infection or sometimes allergies. Hoarseness however, can be a sign of lung cancer as the tumor grows it can put pressure on the nerves that travel to the larynx (the voice box) or on the larynx itself. If hoarseness is persistent or there is no apparent reason, such as a recent infection or ‘straining’ the voice, medical attention is strongly advised.
Chest Pain: Chest pain can sometimes be the first sign of lung cancer and is usually caused from the tumor extending into the lung lining or the ribs and muscle of the chest wall. Chest pain associated with lung cancer is often described as persistent, aching and dull. Any incidence of chest pain should always be checked by a doctor.
Symptoms associated with metastatic lung cancer can include weight loss, abdominal pain due to involvement of the liver, adrenals and pancreas, and pain due to bone metastases. Hypercalcemia is associated with squamous cell lung cancer.
Brain metastases are found in between 5% to 10% of patients with small cell lung cancer. These patients may also have abnormal adrenocorticotropic hormone (ACTH) like activity, antidiuretic hormone (ADH) which leads to water retention with edema.
A ‘paraneoplastic syndrome’ may include sensory, motor, and autoimmune neuropathy. These symptoms may precede the detection of the primary tumor.
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Spiro SG, Gould MK, Colice GL; American College of Chest Physicians. (2007) Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007 Sep;132(3 Suppl):149S-160S. (Retrieved 30th March 2015): http://www.ncbi.nlm.nih.gov/pubmed/17873166
American Cancer Society Signs and Symptoms of Lung Cancer (Retrieved 14th March 2015): http://www.cancer.org/cancer/lungcancer-non-smallcell/moreinformation/lungcancerpreventionandearlydetection/lung-cancer-prevention-and-early-detection-signs-and-symptoms
Center for Disease Control and Prevention (CDC) What Are the Symptoms of Lung Cancer? (Retrieved 30th March 2015): http://www.cdc.gov/cancer/lung/basic_info/symptoms.htm