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{{Lung cancer}}
{{Lung cancer}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, {{CZ}}
{{CMG}}; {{AE}} {{KSH}} {{CZ}} {{SC}}


==Overview==
==Overview==
[[Symptom]]s that suggest lung cancer include:<ref name="Hamilton">{{cite journal | last =Hamilton | first =W | coauthors =  Peters TJ, Round A, Sharp D | title =What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study | journal =Thorax | volume =60 | issue=12 | pages =1059–1065 | publisher = BMJ Publishing Group Ltd. | date =Dec 2005 | pmid =16227326 }}</ref>
Common symptoms of lung cancer include [[dyspnea|difficulty breathing]], [[hemoptysis]], [[Chronic cough|chronic coughing]], [[chest pain]], [[cachexia|weakness and wasting]], [[dysphonia|difficulty speaking]], and [[Symptom|symptoms]] related to [[paraneoplastic syndromes]].
* [[dyspnea]] ([[shortness of breath]])
* [[hemoptysis]] (coughing up blood)
* chronic [[coughing]] or change in regular coughing pattern
* [[wheezing]]
* [[chest pain]] or pain in the abdomen
* [[cachexia]] (weight loss), [[Fatigue (physical)|fatigue]] and loss of [[appetite]]
* [[dysphonia]] (hoarse voice)
* [[clubbing]] of the fingernails (uncommon)
* [[dysphagia]] (difficulty swallowing).


If the cancer grows in the [[airway]], it may obstruct airflow, causing [[dyspnea|breathing difficulties]]. This can lead to accumulation of secretions behind the blockage, predisposing the patient to [[pneumonia]].
==History and Symptoms==


Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.
=== History ===


Depending on the type of tumor, so-called [[Paraneoplastic phenomenon|paraneoplastic phenomena]] may initially attract attention to the disease.<ref name="Honnorat">{{cite journal | last =Honnorat | first = J | coauthors = Antoine JC | title = Paraneoplastic neurological syndromes | journal = Orphanet Journal of Rare Diseases | volume =2 | pages =22 | publisher = BioMed Central Ltd. | date = May 2007 | url=http://www.ojrd.com/content/2/1/22 | pmid =17480225 | doi=10.1186/1750-1172-2-22 | accessdate =2007-09-05 }}</ref> In lung cancer, these phenomena may include [[Lambert-Eaton myasthenic syndrome]] (muscle weakness due to [[autoimmune disorder|auto-antibodies]]), [[hypercalcemia]] or [[syndrome of inappropriate antidiuretic hormone]] (SIADH). Tumors in the top (apex) of the lung, known as [[Pancoast tumor]]s,<ref name="Jones">{{cite journal | last =Jones | first =DR | coauthors =Detterbeck FC | title =Pancoast tumors of the lung | journal =Current Opinion in Pulmonary Medicine | volume =4 | issue =4 | pages =191–197 | date =Jul 1998 | pmid =10813231 }}</ref> 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]]), as well as [[muscle weakness]] in the hands due to invasion of the [[brachial plexus]].
*Specific areas of focus when obtaining the history are outlined below:<ref name="pmid11899115">{{cite journal |vauthors=Kaerlev L, Teglbjaerg PS, Sabroe S, Kolstad HA, Ahrens W, Eriksson M, Guénel P, Gorini G, Hardell L, Cyr D, Zambon P, Stang A, Olsen J |title=The importance of smoking and medical history for development of small bowel carcinoid tumor: a European population-based case-control study |journal=Cancer Causes Control |volume=13 |issue=1 |pages=27–34 |year=2002 |pmid=11899115 |doi= |url=}}</ref>


Many of the symptoms of lung cancer ([[bone pain]], [[fever]], [[weight loss]]) are nonspecific; in the elderly, these may be attributed to [[comorbidity|comorbid illness]]. In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of [[metastasis]] include the bone, such as the [[Vertebral column|spine]] (causing back pain and occasionally [[spinal cord compression]]), the liver and the brain. About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest x-rays.
:*[[Age]]
:*[[Family history]] of [[cancer]]
:*Personal history of [[cancer]]
:*Positive history of active/[[passive smoking]]
::*Number of [[Cigarette|cigarettes]]/year
::*Number of years/months of [[Smoking|active smoking]]
::*Number of years/months of [[Passive smoking|second-hand smoking]]
::*Number of years/months since [[smoking cessation]]
:*Previous primary [[infection]] of [[tuberculosis]]
:*Onset of [[Lung|pulmonary]] [[Symptom|symptoms]]
::*[[Acute (medicine)|Acute]] (< 6 weeks)
::*[[Chronic (medical)|Chronic]] (> 6 weeks)
:*Previous or current [[lung disease]], such as:
::*[[Chronic obstructive pulmonary disease]]
::*[[Interstitial lung disease]]
 
*Several [[patient]] factors may influence the likelihood of a [[benign]] versus a [[malignant]] condition; these include previous exposure to [[smoke]] or other [[carcinogen]]s such as [[asbestos]], and previously [[Diagnosis|diagnosed]] [[cancer]] or [[respiratory infection]]s.
*A [[patient]] with [[airway]] [[Symptom|symptoms]], especially [[hemoptysis]], is more likely to have [[cancer]] compared to a [[patient]] with no [[respiratory]] [[Symptom|symptoms]].
 
=== Common Symptoms ===
 
*[[Symptom|Symptoms]] that suggest lung cancer include:<ref name="Hamilton">{{cite journal | last =Hamilton | first =W | coauthors =  Peters TJ, Round A, Sharp D | title =What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study | journal =Thorax | volume =60 | issue=12 | pages =1059–1065 | publisher = BMJ Publishing Group Ltd. | date =Dec 2005 | pmid =16227326 }}</ref><ref name="Buccheri2004">{{cite journal|last1=Buccheri|first1=G.|title=Lung cancer: clinical presentation and specialist referral time|journal=European Respiratory Journal|volume=24|issue=6|year=2004|pages=898–904|issn=0903-1936|doi=10.1183/09031936.04.00113603}}</ref>
**[[Dyspnea|Difficulty breathing]]
**[[Hemoptysis]]
**[[Chronic cough|Chronic coughing]]
**Non-resolving [[pneumonia]]
**[[Wheezing]]
**[[Chest pain]]
**[[Abdominal pain]]
**[[Cachexia|Weakness and wasting]]
**[[Fatigue]]
**[[Loss of appetite]]
**[[Dysphonia|Difficulty speaking]]
**[[Dysphagia|Difficulty swallowing]]
 
=== '''Symptoms of Paraneoplastic Syndromes''' ===
 
* Various [[Paraneoplastic phenomenon|paraneoplastic phenomena]] can arise in the setting of lung cancer:<ref name="Honnorat">{{cite journal | last =Honnorat | first = J | coauthors = Antoine JC | title = Paraneoplastic neurological syndromes | journal = Orphanet Journal of Rare Diseases | volume =2 | pages =22 | publisher = BioMed Central Ltd. | date = May 2007 | url=http://www.ojrd.com/content/2/1/22 | pmid =17480225 | doi=10.1186/1750-1172-2-22 | accessdate =2007-09-05 }}</ref><ref name="pmid10888708">{{cite journal| author=Kubo M, Ihn H, Yamane K, Kikuchi K, Yazawa N, Soma Y et al.| title=Serum KL-6 in adult patients with polymyositis and dermatomyositis. | journal=Rheumatology (Oxford) | year= 2000 | volume= 39 | issue= 6 | pages= 632-6 | pmid=10888708 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10888708  }} </ref>
 
==== Endocrine ====
 
::*[[SIADH]] causing [[hyponatraemia]]: [[Small cell lung cancer]]
::*[[ACTH]] secretion ([[Cushing syndrome]]): [[Carcinoid tumor]] and [[small cell lung cancer]]
::*[[Parathyroid hormone-related protein|Parathyroid Hormone-Related Peptide (PTHrP)]] causing [[hypercalcaemia]]: [[Squamous cell carcinoma of the lung]]
::*[[Carcinoid syndrome]]
::*[[Gynaecomastia]]
 
==== Neurological ====
 
::*[[Polyneuropathy]]
::*[[Myelopathy]]
::*[[Cerebellar Degeneration|Cerebellar degeneration]]
::*[[Lambert-Eaton myasthenic syndrome]]
 
==== Other ====
 
::*[[clubbing|Digital clubbing]]
::*[[Hypertrophic pulmonary osteoarthropathy]] (HPOA): [[Squamous cell carcinoma of the lung]]
::*[[Nephrotic syndrome]]
::*[[Polymyositis]]
::*[[Dermatomyositis]]
::*[[Eosinophilia]]
::*[[Acanthosis nigricans]]
::*[[Thrombophlebitis]]: [[Adenocarcinoma of the lung]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 16:34, 5 July 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kim-Son H. Nguyen M.D. Cafer Zorkun, M.D., Ph.D. [2] Shanshan Cen, M.D. [3]

Overview

Common symptoms of lung cancer include difficulty breathing, hemoptysis, chronic coughing, chest pain, weakness and wasting, difficulty speaking, and symptoms related to paraneoplastic syndromes.

History and Symptoms

History

  • Specific areas of focus when obtaining the history are outlined below:[1]

Common Symptoms

Symptoms of Paraneoplastic Syndromes

Endocrine

Neurological

Other

References

  1. Kaerlev L, Teglbjaerg PS, Sabroe S, Kolstad HA, Ahrens W, Eriksson M, Guénel P, Gorini G, Hardell L, Cyr D, Zambon P, Stang A, Olsen J (2002). "The importance of smoking and medical history for development of small bowel carcinoid tumor: a European population-based case-control study". Cancer Causes Control. 13 (1): 27–34. PMID 11899115.
  2. Hamilton, W (Dec 2005). "What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study". Thorax. BMJ Publishing Group Ltd. 60 (12): 1059–1065. PMID 16227326. Unknown parameter |coauthors= ignored (help)
  3. Buccheri, G. (2004). "Lung cancer: clinical presentation and specialist referral time". European Respiratory Journal. 24 (6): 898–904. doi:10.1183/09031936.04.00113603. ISSN 0903-1936.
  4. Honnorat, J (May 2007). "Paraneoplastic neurological syndromes". Orphanet Journal of Rare Diseases. BioMed Central Ltd. 2: 22. doi:10.1186/1750-1172-2-22. PMID 17480225. Retrieved 2007-09-05. Unknown parameter |coauthors= ignored (help)
  5. Kubo M, Ihn H, Yamane K, Kikuchi K, Yazawa N, Soma Y; et al. (2000). "Serum KL-6 in adult patients with polymyositis and dermatomyositis". Rheumatology (Oxford). 39 (6): 632–6. PMID 10888708.

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