Lung Cancer Clinical Presentation

There are no specific signs and symptoms for lung cancer, and the clinical presentation of lung cancer may vary from patient to patient. At the time of diagnosis, the vast majority of patients with lung cancer have advanced disease. The frequent absence of symptoms until locally advanced or metastatic disease is present reveals the aggressive nature of lung cancer and also highlights the urgent need to expand efforts to routinely screen patients at high risk.

Research indicates that many cases of lung cancer are often detected incidentally via chest imaging. In about 7% to 10% of cases, lung cancer is detected and diagnosed in asymptomatic patients when a chest radiograph is performed to diagnose other conditions. At initial diagnosis, 20% of patients have localized disease, 25% of patients have regional metastasis, and 55% of patients have distant disease spread. In some cases, high-risk patients may be diagnosed while asymptomatic through screening with low-dose computed tomography.

About three-fourths of nonscreened patients with lung cancer present with one or more symptoms at the time of diagnosis. The most common symptoms include cough, dyspnea, and hemoptysis. Although the clinical presentation of lung cancer is not specific to the classification or histology of the cancer, certain obstacles may be more likely with different types. One study noted that the most common symptoms at presentation were cough (55%), dyspnea (45%), pain (38%), and weight loss (36%), as well as hemoptysis. The new onset of cough in a smoker or former smoker should raise suspicion for lung cancer.

The clinical manifestations of lung cancer may be due to intrathoracic effects of the tumor (e.g., cough, hemoptysis, pleural disease), extrathoracic metastases (most commonly liver, bone, brain), or paraneoplastic phenomena (e.g., hypercalcemia, Cushing syndrome, hypercoagulability disorders, various neurologic syndromes). Squamous cell and small cell cancers usually cause a cough early due to the involvement of the central airways. Hemoptysis is a significant symptom in anyone with a history of smoking. Although bronchitis is the most frequent cause of hemoptysis, 20% to 50% of patients with underlying lung cancer present with hemoptysis.

While rare, patients with lung cancer may present with shoulder pain, Horner syndrome, and hand-muscle atrophy, and this group of symptoms is referred to as Pancoast syndrome. Pancoast syndrome is most frequently due to lung cancers arising in the superior sulcus. Metastasis from lung cancer to bone is generally symptomatic, and pain in the back, chest, or extremity and elevated levels of serum alkaline phosphatase are frequently present in patients who have bone metastasis. Moreover, levels of serum calcium may be elevated due to extensive bone disease, and an estimated 20% of patients with non–small cell lung cancer have bone metastases at the time of diagnosis.

The American Cancer Society (ACS) indicates that in addition to the signs and symptoms mentioned above, patients with lung cancer may also experience hoarseness, new-onset wheezing, and fatigue. The ACS also encourages individuals to seek medical care early if they are experiencing any symptoms, since early detection and treatment may improve overall clinical outcomes in some patients.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.