1.1 Signs and Symptoms of Lung Cancer
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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 and symptoms of lung cancer to look out for include the following:-
A persistent cough that does not 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)
Coughing up blood or blood-stained sputum is never normal. However, infection, causing inflammation and irritation of the airway, is the most common cause of hemoptysis.
The most common type of cancer associated with hemoptysis is squamous cell carcinoma. However, it is importantly to know that in 7% of lung cancers hemoptysis is the only sign of cancer. 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 advise 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. Firstly, these symptoms are usually due to inflammation caused by an infection or sometimes an allergy. 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 there is no cause for the hoarseness of the voice such as a recent infection or ‘straining’ the voice, this is worrying. Indeed, medical attention is necessary if there is any persistent hoarseness.
Chest pain can sometimes be the first sign of lung cancer. This is because of 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. However, it is important to note that any incidence of chest pain needs to be investigated by a doctor.
Signs and symptoms of lung cancer: Metastasis
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.
Petty TL. (2001). The Early Diagnosis of Lung Cancer. Dis Mon. 47(6), 204–64. (Retrieved 22nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/11473242
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
Forward to Section 1D Lung Cancer Screening.Back to Section 1B Lung Cancer and Smoking.