Lung cancer natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni Saarah T. Alkhairy M.D Dildar Hussain, MBBS [2]

Overview

The majority of lung cancers present with advanced disease because the symptoms tend to occur later in the course of the disease. The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, fatigue, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention. There are a variety of complications associated with lung cancer such as pleural effusion, leg weakness paresthesias, bladder/bladder dysfunction, seizures, hemiplegia, cranial nerve palsies, confusion, personality changes, skeletal pain, and/or pleuritic pain, atelectasis, and/or bronchopleural fistula. The prognosis of lung cancer is poor if diagnosed during the advanced stages.

Natural History

• The majority of lung cancers present with advanced disease because the symptoms tend to occur later in the course of the disease.
• The patient experiences non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, dysphonia, dysphagia, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention.
• While of duration of symptoms, the tumor cell may double 20 times.
• In more advanced disease, the tumor may spread to other organs such as the spinal cord, brain, and bone.
• These patients may develop symptoms such as leg weakness, paresthesias, bladder dysfunction, seizures, hemiplegia, cranial nerve palsies, confusion , personality changes, skeletal pain, and pleuritic pain.
• Once the cancer spreads to the other organs, it is most likely fatal.

Complications

General Complications

The complications associated with Lung cancer are:

• Breathing difficulties

• Lung cancer patients can experience trouble breathing especially when tumors grow and block the airways. Also, it is possible for fluid to build up in the lungs of the patients which makes it difficult for the lungs to fully expand when inhaling.

• Pneumonia

• If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.

• Hemoptysis (coughing up blood)

• Occasionally lung cancer can cause bleeding in the airways which results in the patient coughing up blood.

• Pain

• It is possible that lung cancer will cause pain as well, especially if it spreads to the lining of the lung, or other areas of the body, like the bones.
• There are treatments to help combat the pain.

• Pleural effusion

• Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties.
• There are treatments available to help drain the excess fluid

• Metastasis

• In many cases, lung cancer will spread out to other parts of the body. Some of the more common places lung cancer metastasizes to are the bones, liver, brain, and adrenal glands.

• Horner's syndrome

• Tumors in the top (apex) of the lung, known as Pancoast tumors, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome).

• Superior vena cava syndrome
  • SVCS is a group of symptoms caused by obstruction of the superior vena cava. More than 60% of cases of superior vena cava obstruction are caused by malignant causes, typically a tumor outside the vessel compressing the vessel wall.

Surgical Complications

• Bronchopleural fistula

• It is when air leaks from a pneumonectomy bronchial stump
• Approximately 2% of patients that undergo a pneumonectomy experience this
• It will most commonly occur approximately 7 to 10 days after surgery

• Hemothorax

• In most cases it occurs from bronchial vessels or lung parenchyma
• It may have the symptoms of hypovolemia
• Usually, it can be treated by transfusion

• Atelectasis
• Sputum retention

Prognosis

The prognosis of lung cancer is poor and it depends on the following:

• Whether or not the tumor can be removed by surgery
• The stage of the cancer: the size of the tumor, whether the cancer has spread outside the lung
• The patient’s general health
• Whether the cancer has just been diagnosed or has recurred

Non–small cell lung cancer survival rate by stage

Stage	5-year survival rate
IA	49%
IB	45%
IIA	30%
IIB	31%
IIIA	14%
IIIB	5%
IV	1%

Small cell lung cancer survival rate

• To view the prognosis among patients with small cell lung carcinoma, please click Here