Lung%20cancer Signs and Symptoms

• The leading cause of cancer death worldwide and the second most common cancer in both men and women 
• It was estimated that 85-90% of all lung cancer cases are due to tobacco or cigarette smoking
  
  • Approximately 50% of lung cancer cases are from active smokers and approximately 15% are from second-hand smoke exposure during childhood and adolescence

• Lung cancer develops when cells inside the lungs (lining of the bronchi) begin to grow out of control, invade nearby tissues and metastasize

Primary Tumor-Related

• Cough, dyspnea, hemoptysis, wheezing

Due to Intrathoracic Spread

• May involve the nerves (hoarseness, dyspnea, muscle wasting of upper limb, Horner’s syndrome), chest wall and pleura (chest pain, dyspnea), vascular structures (facial swelling, dilated neck veins, cardiac tamponade, superior vena cava syndrome) and viscera (dysphagia)

Due to Metastatic Spread

• Bone pain with or without pleuritic pain, neurologic symptoms, limb weakness, unsteady gait, cervical lymphadenopathy, skin nodules

Paraneoplastic Syndromes

• Hypercalcemia (nausea or vomiting, abdominal pain, constipation, polyuria, thirst, dehydration, confusion, irritability)
• Syndrome of inappropriate antidiuretic hormone (SIADH) production (malaise, weakness, confusion, seizures, volume depletion, nausea, decreased level of consciousness, coma)
• Cushing’s syndrome (weakness, muscle wasting, decreased level of consciousness, confusion, psychosis, dependent edema, hypokalemic alkalosis, hyperglycemia, weight gain, moon facies, hypertension)
• Others (digital clubbing, hypertrophic osteoarthropathy, Eaton-Lambert myasthenic syndrome, peripheral neuropathy, cortical cerebellar degeneration, Trousseau's syndrome)

Other Symptoms

• Malaise, fever, loss of appetite and weight loss

• Patients ages 65 years old and above (average is 70 years old) are at a greater risk of lung cancer development
• Smoking cigarettes increases the risk of developing lung cancer
  
  • Number of packs of cigarettes smoked per day and the years spent smoking is directly related to the development of lung cancer
  • Patients aged 55-77 years with a ≥30 pack-year smoking history and individuals with 30 pack-year smoking history who quit <15 years ago belong to the highest-risk group of lung cancer

• Passive smokers have increased risk of developing lung cancer
• Occupational and environmental exposures
  
  • Asbestos, arsenic, beryllium, chloromethyl ether, chromium, nickel, polycyclic aromatic hydrocarbons, vinyl chloride, radon, cadmium, diesel exhaust fumes, coal smoke and soot, talc, uranium

• Previous lung disease (eg chronic obstructive pulmonary disease with FEV₁ ≤70% predicted, pulmonary fibrosis, tuberculosis)
• History of any cancer, thoracic radiation or alkylating agents
  
  • Survivors of cancer, lymphomas, cancers of the head and neck or smoking-related cancers 
  • Risk of cancer due to radiation is proportional to the dose received and usually starts approximately 20 years after exposure

• Family history of lung cancer
• Beta carotene supplements in heavy smokers
• Exposure to infectious agents: Human immunodeficiency virus (HIV), fungal infections, tuberculosis, aspiration

• The 2 important factors that predict the survival of patients following treatment are weight loss and performance status
• Patients who lost <10% of their pre-treatment weight and are mobile have better chances of survival

• Should include electrolytes, liver function tests (LFTs), calcium, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), creatinine 

Radiologic Factors

• Associated with scarring or suspicion of inflammatory changes
• Fluorodeoxyglucose (FDG) avidity (PET scan)
• Size, shape and density of the pulmonary nodule