“Why did the doctor diagnose me with lung cancer when I have no cough, hemoptysis or sputum?” Some patients may have such a question. In fact, cancer is very “variable”. We think we know some common symptoms of lung cancer and are alert to them, but we often overlook other symptoms. These symptoms are often not caused by lung cancer itself, nor are they unique to lung cancer, and sometimes even non-oncologists may overlook them.
This article summarizes the following “unexpected” lung cancer symptoms to give you a heads up.
Symptoms caused by local expansion of lung cancer
Chest tightness and chest pain are not uncommon.
The pain varies depending on where the tumor is located. When it is close to the pleura, it can be manifested as vague or dull pain, and will be aggravated with breathing and coughing. When it is close to the heart, it can manifest as shoulder or chest and back pain.
Difficulty in breathing and swallowing
A clear airway allows for smoother breathing. A lung cancer mass can block airflow through the trachea or disrupt the trachea and alveoli to complete gas exchange, causing the patient to be unable to breathe in oxygen and expel carbon dioxide and experience difficulty breathing.
The neighbor behind the trachea is the esophagus. When the lung cancer mass runs into the neighbor’s house and takes over the others’ territory, our eating is affected and we have difficulty swallowing.
Beware of hoarseness and swelling of the face
The neighbors of the trachea and lungs are not only the esophagus, but also some lymph nodes, nerves, blood vessels, etc.
When the tumor directly presses, or metastasizes to the lymph nodes, pressing the laryngeal nerve (the main motor nerve of the larynx, which can govern the movement of the vocal cords), the vocal cords will be paralyzed, and the voice will be hoarse.
When the tumor directly invades or the metastatic lymph node presses the superior vena cava, it will obstruct the blood flow of all the veins above the chest to the heart, which will break the balance of blood circulation inside the body and lead to the accumulation of blood in the blood vessels, resulting in varicose veins in the chest wall and edema in the upper limbs and neck and face, and the patient will have breathing difficulty, dizziness and headache. The medical term for this is “superior vena cava obstruction syndrome”.
Distinguish between true and false “facial palsy”.
When lung cancer is located in the apical part of the lung, the tumor invades or compresses the cervical sympathetic nerve, causing drooping eyelids, narrow pupils, and sunken eyes on the affected side, and no or little sweating on the ipsilateral forehead and chest wall, which is known as “Horner’s syndrome” in medicine. However, patients often first notice their eyelid drooping on one side, and seek medical attention for what they think is “facial palsy”.
Symptoms of distant metastases from lung cancer
Lung cancer cells do not stay quietly in the body, but will metastasize through the body’s lymphatic vessels and blood vessels as soon as they have the chance.
When the metastasis reaches a place suitable for its growth and escapes the local immune system, the cancer cells expand rapidly like a fire, causing discomfort at the metastasis site.
When metastases appear in the brain, dizziness, headache, nausea, vomiting, weakness or even paralysis of one side of the arm or leg, epilepsy, and personality changes may occur.
When metastases appear in the liver, pain in the liver area, jaundice (yellowing of the eyes and skin), and ascites may occur.
When bone metastases occur, bone pain, fractures, and paralysis may occur.
Sometimes symptoms at the metastatic site appear earlier than at the primary site.
Extrapulmonary manifestations caused by lung cancer acting on other systems
There are also specific symptoms that may occur before and after the discovery of lung cancer that are not caused by direct tumor action or metastasis, but are related to hormones secreted by the cancer cells, known medically as “paraneoplastic syndrome. Tumor cells will secrete some biologically active peptides or amine hormones, such as adrenocorticotropic hormone, parathyroid hormone, antidiuretic hormone, etc. Patients will show special endocrine disorders, such as abnormal secretion of antidiuretic hormone syndrome (e.g. fatigue, loss of appetite, muscle weakness or spasm), ectopic ACTH syndrome (e.g. hypertension, edema), neuromuscular syndrome (e.g. muscle weakness), hypercalcemia, carcinoid syndrome, and other symptoms. ), hypercalcemia, carcinoid syndrome (e.g., skin flushing), etc. These symptoms are rare, but they should be a cause for alarm. For patients with endocrine abnormalities, doctors will pay attention to lung conditions; for lung cancer patients, doctors will pay attention to endocrine hormone levels.
Co-authors: Dr. Zhiyong Chen, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Research Institute, Dr. Jiatao Zhang, Department of Oncology, Renji Hospital, Shanghai Jiaotong University, Dr. Yue Ma