Symptoms of Lung Cancer

Onconurse.com
Fact Sheet
Symptoms of Lung Cancer
As a lung cancer survivor, your experiences are in some
behind a diagnostic test or exam that may seem odd on
respects unique, beginning with your symptoms. It’s
its face, and to give you an idea of the range of symp-
important to note that the process of the discovery of
toms that lung cancers may cause. As you can see,
cancer is, by most people’s accounts, associated with
symptoms vary tremendously. Discuss any symptoms
great emotional upheaval. There may be a few of us
with your doctor.
who are so highly evolved spiritually or who have lived
so full a life that we accept a cancer diagnosis with
Pulmonary symptoms
equanimity, but this is not the case for most of us.
The symptoms of lung cancer that are clearly and direct-
ly related to lung function are:
Your unique illness
• Coughing, the most common symptom, experi-
Lung cancer, formally called bronchogenic carcinoma, is
enced by 74 percent of patients
not one disease, but a collection of diseases that affect
• Bloody sputum (phlegm; 57 percent)
the same organ and often cause similar symptoms.
• Shortness of breath (37 percent)
It might be tempting to compare your experiences with
others who have had lung cancer, but it would be best
• Chest pain (25 percent)
to avoid making uneven comparisons that might upset
• Hoarseness (18 percent)
you, as is likely to happen if you don't know the pre-
cise types and stages of lung cancers being compared.
• Paralysis of the diaphragm, either symptomless or
If someone else experienced a treatment failure, for
perceived as shortness of breath
example, you might assume that your treatment will fail
• Wheezing or vibrating breathing noises (stridor)
as well. Please keep in mind that the variation in lung
cancer types means that your experience with symp-
• Recurrent pneumonia or bronchitis
toms, diagnosis, and treatment might well be very dif-
• Difficulty swallowing (dysphagia)
ferent from someone else’s.
Symptoms in other organs
Symptoms and syndromes
Non-respiratory symptoms associated with lung cancer
Some very noticeable symptoms of lung cancer, such as
might be associated with pressure of a tumor on anoth-
persistent cough, are directly associated with pulmonary
er organ or with spread of disease (metastasis) outside
(lung) function and are reasonably well understood.
the lungs or bronchial tubes.
Other symptoms are more obscure, involving organs
outside the respiratory system. Still other symptoms
The symptoms listed below have been associated with
involve metabolic systems that seem not to be related at
spread of disease in many patients. Unlike the list for
all to lung cancer.
pulmonary symptoms, the order of this list is not indica-
tive of frequency of occurrence. In some cases, several
In the course of getting a diagnosis, you may hear ref-
of these symptoms might occur together.
erence to a particular syndrome. A syndrome is a col-
lection of simultaneous symptoms with a common
• Swelling of the face, arms, and neck, possibly
cause, observed often enough in patients with a given
with visible veins on the skin of the chest caused
disease to characterize that disease.
by superior vena cava syndrome (SVCS), pressure
of a tumor on the large chest vein known as the
The lists of symptoms in the sections that follow may
superior vena cava.
seem complex or ominous. Symptoms and syndromes
are listed here to indicate to you the range of things
• Pancoast syndrome, caused by a tumor that
your doctors may look for, to help give some reason
presses on a nerve in the superior sulcus, a
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Onconurse.com
Fact Sheet
Symptoms of Lung Cancer
groove in the upper lung and its sac through
• A lump in a salivary gland
which runs a major artery. Symptoms of Pancoast
• A lump in one tonsil
syndrome include:
• A breast lump
° Horner’s syndrome, including weak or
drooping eyelid, lessened or no perspiration
• Bleeding in the gastrointestinal tract detectable
on one side of the face, and a smaller pupil
with fecal occult testing
in one eye
Symptoms linked to tumor metabolism
° Pain in the shoulder
Ten to twenty percent of lung cancer patients experi-
ence symptoms or groups of symptoms (syndromes) in
° Weakening of hand muscles
organs that are neither invaded by nor obstructed by the
° Destruction of bone, which might be per-
tumor. These findings are called paraneoplastic syn-
ceived as bone pain
dromes. In some instances they appear early in the
development of lung cancer and might trigger early
° Headache
diagnosis.
° Weakness, numbness, or paralysis
Investigators believe paraneoplastic syndromes are
° Dizziness
caused by various substances released by tumors, such
as hormones, hormone-like proteins, bioactivators
° Partial loss of vision
called cytokines, proteins called antibodies released by
° Bone or joint pain
white blood cells, or by differences in the availability of
critical metabolic substances such as iron.
° Abdominal pain upon probing
Some paraneoplastic syndromes are rare. Some can be
° Unexplained weight loss
caused by other cancers or other illnesses in addition to
° Loss of appetite
lung cancer. Not all subtypes of lung cancer are capable
of causing all of the paraneoplastic syndromes.
° Unexplained fever
The most common paraneoplastic syndromes in non-
° Yellowing of the skin (jaundice)
small cell lung cancer patients are:
° Fluid in the chest or abdomen (effusion,
ascites)
• Hypercalcemia (high blood calcium levels).
Overstimulated parathyroid glands or cytokines
° Cardiac symptoms, including thready or
released by the tumor such as tumor necrosis
irregular pulse and difficulty breathing
factor, interleukin-1, transforming growth factor
Rare symptoms of metastasis include:
alpha, and some prostaglandins might recruit too
much calcium from bone into the blood. Another
• Lumps in or beneath the skin
possible cause of hypercalcemia is invasion of
• Protrusion of the eyes
bone by a tumor. The many symptoms associated
with hypercalcemia are described under
• Eyelid tumors
“Endocrine syndromes” below.
• Perforation of the bowel experienced as severe
• Excess growth of certain bones, especially in
abdominal pain with fever
fingertips (hypertrophic osteoarthropathy)
• Acute pancreatitis experienced as severe abdomi-
• Blood clots
nal pain and swings in blood sugar levels
• Excess breast growth in men (gynecomastia)
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Onconurse.com
Fact Sheet
Symptoms of Lung Cancer
The most common paraneoplastic syndromes in small
Vein and artery (vascular) syndromes
cell lung cancer patients are:
Certain types of lung tumors can affect the circulatory
system as follows:
• Syndrome of inappropriate antidiuretic hormone
(SIADH), causing low blood levels of sodium.
• Thrombophlebitis, an inflammation in an artery or
SIADH is caused by secretion of antidiuretic hor-
vein caused by a blood clot
mone by the tumor. Antidiuretic hormone, also
• Arterial thrombosis, a blood clot in an artery
called vasopressin, acts on the kidney to lower
levels of sodium in the blood (hyponatremia).
• Nonbacterial thrombotic endocarditis (NBTE), a
The many symptoms associated with SIADH are
deposition of material onto the valves of the heart
described under “Endocrine syndromes” below.
Skin (cutaneous) syndromes
• Blood clots
Various skin conditions are associated with some cases
• Loss of balance and unsteady arm and leg motion
of lung cancer. These conditions are thought to be
(cerebellar degeneration)
caused by aberrant behavior of white blood cells and
their antibodies reacting either to the tumor or to sub-
The sections that follow, organized by body system,
stances produced by the tumor:
describe these and other paraneoplastic syndromes in
detail.
• Chronic inflammation of the skin (dermatomyosi-
tis) often occurs in conjunction with muscle and
Blood (hematologic) syndromes
subcutaneous tissue inflammation.
Certain lung cancer tumors produce hormones, anti-
• Gray-black warty patches on the elbows, knees,
bodies, or cytokines that can disrupt the normal growth
armpits, or groin (acanthosis nigricans)
and activity of red blood cells, white blood cells, or
platelets. In other instances, blood imbalances might be
• Itching (pruritis)
caused by iron deficiency or chemotherapy. These
• Chronic red patches (erythema multiforme)
might manifest as:
• Dark patches (hyperpigmentation)
• Excessive numbers of platelets (thrombocytosis),
causing blood clots
• Hives (urticaria)
• Too few or poorly functioning platelets, causing
• Scaly patches (scleroderma)
bruises and tiny “blood blisters” (thrombocy-
• New tissue growth in fingertips (digital clubbing),
topenic purpura)
a widening and rounding of the fingertips and
• Irregular growth, appearance, or untimely
nails and, when fingers are viewed from the side,
destruction of red blood cells (polycythemia,
a loss of normal indentation where the fingernail
hemolytic anemia, red-cell aplasia) causing
emerges from the skin.
fatigue
Musculoskeletal syndromes
• Abnormal levels or functions of blood proteins
Certain lung tumors can cause the following symptoms
(dysproteinemia) causing fatigue, headache, or
by producing hormones or causing unusual tissue
dizziness
growth:
• Abnormal white blood cell production or function
• Inflamed muscles, skin, and subcutaneous tissue
(leukemoid reaction, eosinophilia) causing fevers,
(polymyositis-dermatomyositis) is thought by
fatigue, or perhaps no symptoms at all
some researchers to be a paraneoplastic syn-
drome. Some researchers believe this finding
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Onconurse.com
Fact Sheet
Symptoms of Lung Cancer
justifies intensive testing for presence of malig-
Hormonal (endocrine) syndromes
nancy; other studies have found no link between
Certain types of lung cancers are capable of producing
malignancy and this syndrome.
hormones that act on organs within the brain (the pitu-
itary and hypothalamus) or upon other organs such as
• Abnormal bone growth in certain bones, especial-
the kidneys, adrenal glands, thyroid, ovaries, or testes.
ly fingertips (hypertrophic osteoarthropathy). This
abnormal bone growth is visible on x-ray and
• Syndrome of inappropriate antidiuretic hormone
bone scans and might be associated with bone
(SIADH), resulting in low levels of sodium in the
or joint pain.
blood, often is associated with small cell lung
cancer and sometimes bronchial carcinoid tumors.
• Softening of the bones (osteomalacia)
Symptoms include:
• Various painful or dysfunctional muscular symp-
° Fatigue
toms (myopathy)
° Loss of appetite
Nervous system (neurologic) syndromes
° Muscle cramps or weakness
Some or most of the paraneoplastic syndromes that
affect the nervous system appear to be caused by an
° Nausea
attack of antibodies against healthy tissue. Antibodies are
° Vomiting
white blood cell proteins that normally sequester and
immobilize foreign tissue such as viruses or bacteria.
° Restlessness and confusion
• Cerebellar degeneration, causing problems with
° Seizures
balance or unsteady arm and leg movements.
° Coma
• Lambert-Eaton myasthenic syndrome (LEMS),
° Respiratory arrest
characterized by muscle weakness and dysfunc-
tion, especially in the pelvis and thighs and, at
° High blood calcium levels (hypercalcemia).
times, joint soreness, difficulty swallowing, and
Symptoms are: loss of appetite (anorexia),
other symptoms resembling myasthenia gravis.
nausea and vomiting, lethargy and weak-
ness, irritability, frequent urination
• Peripheral neuropathy, evidenced by pain, tin-
(polyuria), excessive thirst (polydipsia),
gling, or numbness in hands or feet.
dehydration, constipation, cardiac symptoms
• Encephalopathy, an infection or inflammation in
such as irregular pulse, and confusion and
the brain.
coma in acute stages.
• Myelopathy, presenting as bone pain or tender-
• Cushing’s syndrome, an overproduction of
ness or bone marrow dysfunction.
adrenal hormones by cancerous tissue. The most
common symptoms in lung cancer patients are:
• Psychosis, mimicking mental illnesses such as
schizophrenia or bipolar disorder.
° Weight loss
• Dementia
° Fluid retention (edema)
• Pseudo-obstruction of the bowel, including
° Muscle weakness (myopathy)
nausea, vomiting, abdominal pain, and changed
° High blood pressure (hypertension)
bowel habits.
° Less common Cushing’s symptoms in lung
• Rarely, visual changes (retinopathy)
cancer patients are stretch marks (striae),
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Onconurse.com
Fact Sheet
Symptoms of Lung Cancer
obesity in the trunk with thinning of arms
Miscellaneous syndromes
and legs, moon-shaped face, fatty hump on
Several syndromes sometimes associated with lung can-
the back of the neck (“buffalo hump”),
cer are not classified within other groups:
bone loss, diabetes, and moodiness.
• High levels of uric acid in blood (hyperuricemia),
• Carcinoid syndrome, characterized by skin flush-
causing joint pain
ing, diarrhea, and wheezing or asthma symptoms
• Nephrotic syndrome, heralded by fluid retention
• High or low blood sugar (hyper- or hypoglycemia)
in various body parts, weight gain, high blood
pressure, and poor appetite.
• Breast growth in males (gynecomastia)
• Cachexia, or weight loss in spite of adequate
• Discharge of milk from the nipple (galactorrhea)
nutrition.
• Excess levels of growth hormone, possibly linked
This fact sheet was adapted from Lung Cancer (forth-
to excessive bone growth or clubbing of fingers
coming) by Lorraine Johnston, © 2000 by Patient-
• Excess calcitonin secretion, usually symptomless
Centered Guides. For more information, call (800) 998-
9938. This material has been reviewed by an MD and
• Excess levels of thyroid-stimulating hormone,
will receive further technical review prior to publica-
possibly causing symptoms of hyperthyroidism
tion.
such as high blood pressure, heat intolerance,
hair loss, moodiness, weight loss.
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