Clinical Manifestations of Lung Cancer

doi:10.1378/chest.65.3.299

Chest

Volume 65, Issue 3, March 1974, Pages 299-306

https://doi.org/10.1378/chest.65.3.299 Get rights and content

The incidence and mortality of lung cancer continue to increase steadily. Clinical manifestations are varied, and have been presented as related (1) to the primary tumor, (2) to tumor extension or metastases, (3) to systemic effects, and (4) to several syndromes associated with lung cancer.

Section snippets

ASYMPTOMATIC PHASE

Study of serial x-ray films has revealed that some localized lung cancers grow slowly and lesions can be identified on previous chest films for several years. Rigler et al,12, 13 traced tumors back for more than five years and in a group of operable patients for an average of three years. Extensive personal experience agrees with these reports. Nevertheless, other patients with rapidly growing nonresectable lung cancer have been found to have normal chest roentgenograms taken only three months

CLINICAL PICTURE: GENERAL

Most patients with lung cancer have respiratory symptoms when seen by the physician. Cough is common, with or without sputum. Blood streaking may be noted from ulceration of the tumor, and some patients report dyspnea and chest pain. Symptoms are usually minimal in the early stages, and the disease develops insidiously. Occasionally, however, hemoptysis occurs, which brings the patient to the physician more quickly. At other times, the first medical visit results because of secondary

Cough and Sputum

More than 99 percent of our 2,000 men with lung cancer have smoked cigarettes for some time, and cough was reported by 73 percent of patients. The frequency of this complaint on initial presentation of the patients with lung cancer varies widely in different series betweeen 21 and 87 percent (Table 1). Cough may be produced by a small tumor acting as a foreign body interfering with bronchial peristalsis, or by ulceration of bronchial mucosa. Prolonged cigarette smoking produces paralysis of

Chest Pain

When chest pain is constant and penetrating, it is usually related to invasion of the parietal pleura by tumor. Severe chest pain requiring narcotics is almost always caused by pleural metastases. Superior sulcus tumor often produces constant pain involving the shoulder and arm because of invasion of the brachial plexus. Other signs found are weakness of the hand and Homer's syndrome. Persistent chest pain with destruction of a portion of the bony thorax is most often caused by squamous cell

INFECTION AND SYSTEMIC INVOLVEMENT

Secondary infection causes increased cough, sputum, and fever related to bronchitis, bronchopneumonia, or lung abscess. Recovery from infection may be prompt or delayed, depending on bronchial patency, bronchial peristalsis, and type of organism. Fever may occur in the absence of evident infection.

Delayed resolution of pneumonia requires bronchoscopy, sputum examinations for tumor cells, consideration of possible lung neoplasm, and evaluation for possible thoracotomy.

Systemic symptoms of

Nonmetastatic Neurologic Syndromes

The cause of nonmetastatic neuromyopathy is unknown, and symptoms often appear before the cancer is recognized. The two may pursue independent courses. Corticocerebellar degeneration manifested by vertigo and ataxia usually is accompanied by marked mental changes. Onset is acute and in a few weeks the patient is unable to walk or stand. Peripheral neuropathies also occur with severe and persistent paresthesias, pains in the limbs with loss of most sensation, but little muscle weakness or

ACKNOWLEDGMENTS

This report is based on a cooperative study at the various Veterans Administration hospitals listed below, supported as collaborative research under an interagency agreement between the Veterans Administration and the National Cancer Institute.

Coordinator: Lyndon E. Lee, Jr., M.D., Assistant Chief Medical Director for Professional Services, Department of Medicine and Surgery, Veterans Administration Central Office, Washington, D.C.

Principal Investigators: Ann Arbor, Mich., Robert A. Green, M.D.

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Cited by (110)

Palliative thoracic radiation
2023, Palliative Radiation Oncology
Radiation therapy has a clear role in the palliation of thoracic cancers. It is an important component of symptom management in patients with tumors that are causing a variety of clinical conditions in the chest. No dose-fractionation scheme is clearly superior and decisions on treatment duration should take into account the patient’s performance status, social situation (including financial burden), and future plans for systemic therapy. The use of consolidative radiation in oligometastaic and oligoprogressive disease has produced some promising results in early studies and may have a role in prolonging survival and tumor control in patients with metastatic disease.
Lung cancer
2022, Cardio-Oncology Practice Manual: A Companion to Braunwald's Heart Disease
Approach to the Patient with Cough
2021, Medical Clinics of North America
Cancer screening and prevention: Sex and gender evidence in lung, breast, and colorectal cancer
2020, How Sex and Gender Impact Clinical Practice: an Evidence-Based Guide to Patient Care
The presentation, incidence, response to treatment and prognosis of most cancers are associated with gender-specific disparities. In general, men have a slightly higher risk and worse prognosis for all cancer sites when compared to women. While lung and colon cancer are more common in men, breast cancer is more common in women. Although sex and gender discrepancies in cancer susceptibility and prognosis have long been highlighted in the literature, the reasons for these differences are poorly understood. Gender differences in awareness and willingness to participate in cancer screening and prevention have been noted. Most cancer screening guidelines are not sex or gender specific. Clinicians should consider sex and gender differences in presentation, screening attitudes, response to treatment, and prognosis to help to tailor treatment and potentially improve outcomes.
Protocol for management of chronic cough
2017, Medicine (Spain)
La tos es un síntoma que constituye uno de los principales motivos de consulta en la práctica clínica. Se considera crónica cuando persiste durante más de ocho semanas, y de instauración aguda aquella de menos de tres semanas de duración.
Su prevalencia es variable dentro de la población general, encontrándose entre el 12 y el 3,3%; se encuentra muy vinculada al hábito de tabaquismo, siendo tres veces mayor en individuos fumadores, así como a la contaminación ambiental.
En este protocolo se desarrollarán las claves para el manejo del síntoma de la tos, desde su fisiopatología y etiología, hasta el abordaje de la misma en las distintas escalas de la asistencia médica.
Cough is a symptom constituting one of the main reasons for consultation in clinical practice. It is considered chronic when it persists during more than eight weeks, and acute when it lasts less than three weeks.
Its prevalence varies among the general population, ranging between 12 and 3.3%: it is greatly linked to smoking habits, it being three times higher in smokers, as well as to environmental pollution.
These guidelines will develop the keys for management of cough, from its pathophysiology and aetiology, to the approach depending on the different stages of medical assistance.
Non-microcytic lung cancer
2017, Medicine (Spain)
El cáncer de pulmón se ha convertido en un importante problema de salud pública debido a su elevada incidencia y mortalidad. Es la principal causa de mortalidad relacionada con el cáncer en todo el mundo.
Existe un amplio número de factores ambientales asociados al desarrollo de cáncer de pulmón, de todos ellos el hábito tabáquico es el más importante.
El 85% de los cánceres de pulmón diagnosticados corresponden a carcinomas de células no pequeñas y, dentro de estos, el tipo histológico más frecuente es el adenocarcinoma, con un aumento de su incidencia en los últimos años.
En el momento del diagnóstico, más del 50% se presentan con enfermedad localmente avanzada o metastásica, con una supervivencia del 15% a 5 años. El cáncer de pulmón no microcítico (CPNM) constituye un grupo de entidades que difieren en cuanto al curso clínico y pronóstico y, por tanto, con diferentes posibilidades terapéuticas, basadas en la combinación de la cirugía, quimioterapia y radioterapia. En los últimos años, la identificación de dianas moleculares oncogénicas ha permitido el desarrollo de tratamientos personalizados.
Lung cancer has become a major public health problem due to its high incidence and mortality rate. This is the leading cause of cancer-related mortality, in general, worldwide.
There are a large number of environmental factors associated with the development of lung cancer, of which smoking is the most important.
A total of 85% of the lung cancers diagnosed correspond to non-small cell carcinomas and, within these, the most frequent histological type is adenocarcinoma, with an increase in its incidence in recent years.
At diagnosis, more than 50% present with locally advanced or metastatic disease, with a survival rate of 15% at 5 years. Non-small cell lung cancer (NSCLC) is a category that differs in terms of clinical course and prognosis and, therefore, offers different possible treatment options, based on a combination of surgery, chemotherapy and radiotherapy. In recent years, the identification of oncogenic molecular targets has made it possible to develop personalised treatments.

View all citing articles on Scopus

: Manuscript submitted August 31; accepted October 17.

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Chest

CRITICAL REVIEWClinical Manifestations of Lung Cancer

Section snippets

ASYMPTOMATIC PHASE

CLINICAL PICTURE: GENERAL

Cough and Sputum

Chest Pain

INFECTION AND SYSTEMIC INVOLVEMENT

Nonmetastatic Neurologic Syndromes

ACKNOWLEDGMENTS

J Chron Dis

Dis Chest

Dis Chest

Ann Thorac Surg

Cancer Registration and Survival in California

“Cell type and the natural history of lung cancer”

JAMA

“The influence of social class in the survival of cancer patients”

Am J Pub Health

“Cancer of the respiratory tract. Recent trends in mortality”

J Int Coll Surgeons

“Natural course of inoperable lung cancer”

Chest

“Survival in lung cancer”

N Engl J Med

“The early detection of bronchogenic cancer”

Proc Nat Cancer Conf

“The duration of carcinoma of the lung”

Dis Chest

“A roentgen study of the evolution of carcinoma of the lung”

J Thorac Surg

“Survival in males with bronchogenic carcinomas resected as asymptomatic solitary pulmonary nodules”

Ann Thorac Surg

“Positive sputum cytology and negative chest roentgenograms”

Ann Thorac Surg

“Roentgenologically occult lung cancer diagnosed by cytology”

Cancer

“Positive sputum cytologic tests for five years before specific detection of bronchial carcinoma”

J Thorac Cardiovasc Surg

Diagnosis and Treatment of Tumors of the Chest

Bronchial Carcinoma

“Carcinoma of the chest with bone destruction”

Am Rev Resp Dis

“The significance of pleural effusion associated with bronchial carcinoma”

Br J Dis Chest

“The superior vena cava obstruction syndrome in bronchogenic carcinoma”

Radiology

“The superior vena caval syndrome and radiation therapy”

Radiology

“Bronchogenic carcinoma: a study of 60 necropsies”

Am J Clin Pathol

“Pathology of scalene lymph nodes”

Cancer

“The case against routine scalene node biopsy in bronchial carcinoma”

Lancet

“Scalene lymph node biopsy: Reappraisal of risks and indications”

N Engl J Med

“Scalene lymph nodes in necropsies of malignant tumors. Analysis of 166 cases”

Cancer

Tumors of the Lungs and Mediastinum

“Cranial mononeuropathy as the first sign of intracranial metastases”

Ann Intern Med

“Carcinoma of the lung and dysphagia”

Dis Chest

“Cutaneous metastases from internal carcinoma”

Cancer

CRITICAL REVIEW
Clinical Manifestations of Lung Cancer