Dr. Ahmed
Symptoms of Lung Cancer can range from occasional cough and fatigue to marked weight loss, shortness of breath, and coughing up blood.
Basically, it depends on the stage of lung cancer, the type of lung cancer such as small cell and non-small cell lung cancer, mesothelioma, metastatic lung cancer, etc.
However, when we talk about symptoms of lung cancer, we usually don’t talk about cancers that have spread from other parts of the body to the lungs, although the pulmonary symptoms of those cancers are also the same.
What is lung cancer:
By definition, lung cancer is a form of cancer that develops and grows inside the lungs.
One of the primary causes of death that are affiliated with cancer worldwide is lung cancer.
Even those who have never smoked can get lung cancer, however, smokers are more at risk than nonsmokers.
Your risk of lung cancer increases with the number and frequency of cigarettes you’ve smoked. Quitting smoking can significantly reduce your chance of developing lung cancer, even after years of smoking.
Lung cancer staging:
Lung cancer staging is done based on the size of the tumor and the spread to the surrounding structures.
Stage 1 lung cancer:
- Stage 1 lung cancer is less than 3 cm in the greatest dimensions that does not erode the surrounding structures.
- Stage 1 lung cancer is further subdivided into stage 1 a (less than 2 cm) and stage 1b (2 to 3 cms)
Stage 2 lung cancer:
- Stage 2 lung cancer is 3 to 7 cm. It may involve the pleura or the main bronchus.
- It is further subdivided into stage 2a (3 to 5 cm) and stage 2b (5 to 7 cm).
Stage 3 lung cancer:
- Stage 3 tumor is more than 7 cm in size.
- It may involve the chest wall, diaphragm, pleura, and pericardium.
Stage 4 lung cancer:
- Stage 4 lung cancer is the one that has spread to the nearby structures such as the esophagus, mediastinum, the heart and great vessels, and the vertebral body.
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Symptoms of Lung Cancer:
Symptoms of lung cancer are variable. Patients may be asymptomatic and diagnosed when a chest radiograph is ordered for another disease or have a severe persistent cough with hemoptysis.
A Persistent Cough:
A persistent cough that worsens over time may be an early sign of lung cancer. One of the most frequent issues for which individuals see a doctor is a cough.
While most coughs have harmless causes, a persistent, severe cough might signify a more dangerous underlying illness.
The sooner lung cancer is diagnosed, if it is connected to cough, the better the treatment. Early lung cancer frequently has no symptoms, thus it is typically discovered at an advanced stage when treatment is more challenging.
Coughing can be a sign of any kind of lung cancer. However, some types of lung cancer are more likely to induce a cough due to the malignant cells clogging the lungs’ airways.
The two types of cancer that are frequently linked with coughing are squamous cell carcinoma and small cell undifferentiated cancer.
One of the strongest relations with lung cancer is the one that coughing up blood has. Blood in the sputum has been regarded as a major symptom of lung cancer.
There may be a stronger correlation between some aspects of your cough and lung cancer than others. Such aspects are listed below:
- A dry or mucus-producing cough
- A chronic cough that is persistent for 8 weeks
- Coughing while sleeping
- Chest pain induced while coughing
- Shortness of breath or difficulty in breathing
- Conditions like bronchitis or pneumonia that persist
According to the Lung Cancer Alliance, before the cancer cells have progressed to other regions of the body, roughly 50% of persons with lung cancer experience a cough. [Ref]
According to a study done in 2017, almost 57% of people with lung cancer had experienced coughs, this condition exacerbates in the later stages. [Ref]
Weakness And Fatigue
People who suffer from cancer can experience a certain form of exhaustion that is associated with cancer.
Such exhaustion can expose a person to a severe, subjective experience of psychological, physical, and cognitive loss which may be persistent and linked to cancer or its related treatments and not due to any recent activity which can be relieved through rest.
As stated above, lung cancer is regarded as the primary cause of cancer-associated deaths worldwide. Among all symptoms reported by patients with lung cancer, fatigue is a frequent one.
Due to this reason, international guidelines have advised going for early screening in order to detect any cancer-associated fatigue.
From the group of symptoms reported by patients with lung cancer, fatigue co-exists with insomnia and depression.
Even though these symptoms frequently coincide, they are routinely managed separately, despite the possibility that their molecular origins are comparable. [Ref]
Unexplained Weight Loss:
According to the American Cancer Society, esophageal, pancreatic, stomach, and lung cancers frequently present with unexplained weight loss as their first obvious sign.
REE is the “Resting Energy Expenditure” which is defined as the amount of energy your body burns while resting. A developing tumor may use a crucial amount of energy that will enhance your resting energy expenditure
Since cancer cells use up all the energy in the body, the body has to use the stored energy in the form of fat which then leads to unintended weight loss.
Balance Issues
You might get unsteady or lose your balance if you have lung cancer.
There are chances of the presence of a tumor that exists close to the superior vena cava.
Blood can back up in this vein as the tumor becomes bigger, which might make you feel lightheaded or lose your footing. The common complication of lung cancer, anemia, can also impair balance.
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Bone Pain:
Some people get bone discomfort or feel exhausted and weak. Sometimes it’s hard to distinguish between muscle and bone discomfort.
Bone pain is likely the cause if it worsens with movement, at night, or when you’re laying on your back.
Lung cancer can spread to the bones and cause discomfort in the vertebrae, pelvis, or major bones of the arms and legs.
Headaches:
A tumor located close to the superior vena cava might result in headaches. Your head may pound from backed-up blood in this vein, and you could even faint.
Headaches are also brought on by high blood calcium levels, which are present in up to 20% of lung cancer cases. [Ref]
Blood Clots:
According to researchers, cancer causes the body to become more inflamed. In turn, the inflammation leads to blood clots.
Blood clots in the legs, arms, or lungs are more likely to form in individuals with lung cancer.
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Sudden Changes in Voice or Hoarseness:
Some lung cancer patients may experience hoarse voices. It could be brought on by the malignancy putting pressure on the laryngeal nerve, a nerve located in the chest.
One of the vocal cords in your throat may become paralyzed if this nerve is pinched, resulting in a raspy voice.
Pain in the Limbs & Eyes:
In the upper portion of the lung, a specific type of lung cancer known as a Pancoast tumor appears. These tumors may extend to the ribs, the spine’s vertebrae, nerves, or blood vessels in addition to the lungs.
Your arm, upper back, or shoulder blades may experience pain from these tumors. Your hands may experience tingling or numbness as a result.
Eye issues can result from Pancoast tumors, which can cause arm and shoulder pain. Patients may notice that one eye has a smaller pupil, drooping eyelids, and less facial sweat on that side.
Horner Syndrome is the name given to this “set” of ocular problems.
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Symptoms of Small cell Lung cancer:
Patients with small cell lung cancer usually present within 8 to 12 weeks of disease onset. Only 5% of the patients with small cell lung cancer may not have any symptoms at diagnosis.
Patients can have any of the following symptoms:
Symptoms due to local growth of the tumor:
- Cough
- Shortness of breath
- Hemoptysis
- Fever
- Chest pain
Symptoms due to local spread of the tumor:
- Hoarseness of voice (recurrent laryngeal nerve involvement)
- Upper limb swelling (Superior vena cava syndrome)
- Difficulty in breathing (Collapsed bronchus and hemidiaphragm paralysis)
- Stridor (laryngeal nerve involvement)
- Difficulty swallowing (pressure effects on the esophagus)
Symptoms when cancer spreads:
- It depends on the organ involved. Symptoms may include headache, blurred vision, nausea, vomiting, confusion, and focal weakness of the limbs.
- Jaundice and anorexia may develop if the liver is involved. Backache and lower limb weakness may develop if the spine is involved.
Symptoms due to paraneoplastic syndromes:
- Patients can develop confusion due to hyponatremia as a result of SIADH or hypercalcemia.
- Weakness and fatigue may develop as a result of LEMS (lambert Eaton myasthenic syndrome).
- Diarrhea and other hormonal manifestations may also occur.
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Symptoms of Non-Small Cell Lung Cancer:
More than 80% of lung cancers are one of the two types of non-small cell lung cancers. These include squamous cell lung cancer and adenocarcinoma of the lungs.
The disease usually presents at a very advanced stage and hence symptoms of lung cancer, in this case, could be due to distant spread at presentation.
Local symptoms are the same as that of non-small cell lung cancer and include:
- Cough
- Shortness of breath
- Hemoptysis
- Chest pain
- Fever, infection, and pneumonitis
However, pleural effusions are common compared to symptoms of small cell lung cancers.
Symptoms due to local spread:
- Local spread of cancer can cause stridor, difficulty swallowing, weakness of the upper limbs, pupillary constriction, pain radiating to the upper limbs, and pericardial effusion.
Symptoms of lung cancer due to distant spread:
- The symptoms of lung cancer due to distant spread depend on the area involved. Involvement of the central nervous system can cause seizures, headaches, weakness, and loss of balance.
- Liver involvement can result in yellowish discoloration of skin and sclera, anorexia, and vomiting.
- Involvement of the adrenal gland can result in hypotension and abdominal pain.
- Spinal metastasis can lead to weakness and numbness of the lower limbs, backache, and shooting pains in the legs.
Symptoms due to paraneoplastic syndrome:
- Hypercalcemia can cause drowsiness, increased thirst, and urination.
- Cushing syndrome is due to excessive cortisol production. Patients may develop diabetes, hypertension, muscle weakness, and abdominal striae.
- Patients may develop clubbing and pains in the wrist joint. Drowsiness can develop as a result of hyponatremia due to the syndrome of inappropriate ADH secretion.
Other non-specific symptoms of lung cancer include weight loss and cachexia.
Symptoms of mesothelioma lung cancer:
Malignant mesothelioma is not a cancer of the lung parenchyma. However, it affects the lining of the lungs called the pleura.
Malignant mesothelioma occurs in people who are chronically exposed to asbestos.
More than 60% of the patients present with shortness of breath and chest pain. The chest pain is usually not associated with respiration and is persistent, however, pleuritic chest pain can also develop.
Patients may develop fatigue, fever, sweats, weight loss, and anorexia. It is unlikely to metastasize. If there is concomitant pleural effusion, that could be secondary to the involvement of the other pleura.
Stage 1 lung cancer symptoms:
Stage 1 lung cancer is less than 3 cm in size. Patients are usually asymptomatic but may develop a dry cough that is partially relieved with medications.
Anorexia and weight loss may not be noticeable at this stage. Most cases are diagnosed incidentally.
However, if the cancer is arising in an area that is close to a blood vessel or a bronchus, symptoms of shortness of breath, wheezing, recurrent chest infections, chest pain, and hemoptysis (coughing blood ) can be present.
Stage 2 lung cancer symptoms:
Stage 2 lung cancer is 3 to 7 cm in size. It usually involves the bronchus and the pleura. This causes symptoms of shortness of breath and wheezing that may be unilateral or bilateral depending on the bronchus blocked.
Involvement of the pleura causes pleuritic chest pain (pain that may increase when a person takes a breath or a deep breath), pleural effusion, and reduced movements of one side of the chest.
Pleural effusion can be massive and can cause a rapidly worsening shortness of breath and shortness of breath on lying in a specific posture (lying on one side).
Other symptoms of weight loss, cachexia, and fever may also be present.
Stage 3 lung cancer symptoms:
Stage 3 lung cancer involves the chest wall, diaphragm, pleural and pericardial surfaces. At this stage, the disease has progressed.
The size of the tumor exceeds 7 cm and so local effects are also present. There may be a bulge on one side of the chest because of the huge mass.
Invasion of the local structures can cause symptoms related to the organ involved. Involvement of the diaphragm or recurrent laryngeal nerve can lead to one-sided paralysis of the diaphragm and hoarseness of voice.
The patient may develop central chest pain and hypotension because of pericardial involvement. Pleural involvement can lead to pleural effusion and chest pain that varies with breathing.
Other symptoms like weight loss, fever, and cough with hemoptysis may be present in increased severity.
Stage 4 lung cancer symptoms:
Stage 4 cancer is the last stage of lung cancer. In stage 4 cancer, cancer has already spread to the mediastinum, heart, chest wall, pleural cavity, great vessels, and the vertebral body.
Stage 4 lung cancer may present with severe backache or body aches, and/ or paralysis of the limbs. The patient may develop arm swelling or have shooting pains in the limbs due to nerve involvement.
Involvement of the great vessels can manifest as a facial swelling, bluish and plethoric face, and painful vascular prominence due to phlebitis and thrombosis.
Involvement of the mediastinum and heart can lead to difficulty swallowing, stridor, and hypotension.
Stage 4 lung cancer symptoms of dying:
Patients in the dying stage may become drowsy, stop eating, develop severe weakness, and have a persistent cough with blood-mixed sputum.
The pain is so severe that the patient needs opioid injections for pain relief. The blood pressure may drop to a level that the patient needs fluids and pressors support.
Patients may need continuous oxygen support to maintain oxygenation and need parenteral nutrition due to severe anorexia and cancer cachexia.
The breathing may become very heavy and paradoxical. Paradoxical breathing is the inward movement of the chest with outwards movements of the tummy and vice versa.
Impaired gas exchange can lead to carbon dioxide retention in the body resulting in CO2 Narcosis. Co2 Narcosis is a condition when the patient becomes disoriented with altered sleep patterns due to abnormally high carbon dioxide in the body.
