First Symptoms of Lung Cancer

By Randolph Meresmaa

Lung cancer is the most lethal of malignant diseases worldwide and is still the leading cause of cancer related deaths in the USA. Although the overall deaths in Western Europe and United Stated have decreased since 1991, global lung cancer rates are expected to rise because of ongoing tobacco use.

For the majority of the time lung cancer is clinically silent because they grow from a single malignant cell to a potentially detectable lesion. The majority of people already have the symptoms of lung cancer at the time of diagnosis. In only about 10% of cases is lung cancer discovered incidentally in an asymptomatic patient.One of the first symptoms of lung cancer is cough, which occurs in 45-75% of patients. Cancer types with a predilection for central airway involvement may cause cough earlier in their course. But peripherally located tumors may only cause cough as a late symptom. A change in the character of a chronic cough, such as new hemoptysis or co-existent chills and fever, should raise suspicion of an additional process such as lung cancer.

Tumor involvement of the chest wall, parietal pleura, and mediastinum leads to chest pain as an initial symptom or complaint in 25-50% of patients. Other causes of pain include postobstructive pneumonitis, pulmonary embolism, and rib cage metastases.

5-8% of lung cancer patients experience hoarseness which is usually attributable to unilateral left vocal paralysis resulting from damage to the left recurrent laryngeal nerve anywhere along its intrathoracic course.

Physical exam is a vital component of the lung cancer evaluation as it may provide important prognostic, diagnostic, and staging clues. The outside appearance may look normal or it may reveal debilitation, cachexia, lethargy, pallor, jaundice, fever, or significant comorbidities. Blood pressure irregularities can be seen in conjunction with neurologic or adrenal paraneoplastic phenomena.

A thorough nervous system examination is crucial, especially in patients with headache, sensorimotor complaints, and back pain. Unilateral lower extremity swelling, tenderness, and erythema may accompany deep venous thromboses.

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