Systemic symptoms.
1.Fever
Fever as the first symptom accounts for 20% to 30%. There are two causes of fever due to lung cancer, one is inflammatory fever. When central type lung cancer tumor grows, it often blocks the segment or bronchial opening first, causing obstructive pneumonia or atelectasis in the corresponding lung lobe or segment and fever occurs, but it is mostly around 38℃ and rarely exceeds 39℃. Pneumonia may occur repeatedly in the same area within a short period of time. Peripheral type lung cancer mostly develops fever in the late stage due to inflammation caused by tumor compression of adjacent lung tissues. The second is cancer fever, which is mostly caused by the absorption of tumor necrotic tissue by the body.
2.Wasting and cachexia
Late stage of lung cancer can cause severe wasting, anemia and cachexia due to the loss of appetite caused by infection and pain, increased consumption caused by tumor growth and toxins, and increased levels of cytokines such as TNF and Leptin in the body.
Symptoms of invasion and metastasis.
1.Lymph node metastasis
The most common are mediastinal lymph nodes and supraclavicular lymph nodes, mostly on the same side of the lesion, a few may be on the opposite side, mostly firmer, single or multiple nodes, and sometimes can be the first complaint to be seen. Enlargement of the paratracheal or subserosal lymph nodes may compress the airway and cause chest tightness. It may cause shortness of breath or even suffocation. Compression of the esophagus may result in dysphagia.
2.Pleural invasion and/metastasis
Pleura is a common site of invasion and metastasis of lung cancer, including direct invasion and implantation metastasis. Clinical manifestations vary depending on the presence or absence of pleural effusion and the amount of pleural fluid. In addition to direct invasion and metastasis, the causes of pleural fluid include obstruction of lymph nodes and concomitant obstructive pneumonia and pulmonary atelectasis. The common symptoms include dyspnea, cough, chest tightness and chest pain, or no symptoms at all; on examination, intercostal fullness, intercostal widening, hypopnea, hypofibrillation, solid percussion, mediastinal shift, etc. Pleural fluid can be plasma, plasma blood or blood, mostly exudate. Spontaneous pneumothorax can occur in very rare lung cancer, the mechanism of which is direct invasion of pleura and rupture of obstructive emphysema, mostly seen in squamous carcinoma, with poor prognosis.
3.Superior Vena Cava Syndrome (SVCS)
Direct tumor invasion or mediastinal lymph node metastasis compressing the superior vena cava, or intracavitary embolism, narrowing or occluding it, resulting in a series of symptoms and signs, such as headache, facial swelling, cervicothoracic varices, increased pressure, dyspnea, cough, chest pain and difficulty in swallowing, and often syncope or vertigo when bending over. The anterior thoracic and epigastric veins may be compensated with varicose veins, reflecting the duration and anatomic location of the superior vena cava obstruction. Signs and symptoms of superior vena cava obstruction are related to its location. If one side of the innominate vein is obstructed, the blood flow from the head, face and neck can return to the heart through the opposite innominate vein and the clinical symptoms are mild. If the superior vena cava obstruction occurs below the entrance of the odd vein, in addition to the above-mentioned venous dilatation, there is also abdominal venous anger, and blood flows into the inferior vena cava by this route. If the obstruction develops rapidly, cerebral edema with headache, drowsiness, agitation and change of consciousness may occur.
4. Kidney metastasis
About 35% of patients who die from lung cancer are found to have kidney metastasis, which is also the most common site of metastasis in patients who die within 1 month after lung cancer surgery. Most of the kidney metastases have no clinical symptoms, but sometimes they may manifest as back pain and renal insufficiency.
5.Gastrointestinal metastasis
Liver metastasis can be manifested as loss of appetite, pain in liver area, sometimes accompanied by nausea, serum γ-GT is often positive, AKP is progressively increased, and liver enlargement, hardness and nodularity can be found during physical examination. Small cell lung cancer is more likely to have pancreatic metastases and may present with pancreatitis symptoms or obstructive jaundice. Lung cancer of various cell types can metastasize to liver, gastrointestinal tract, adrenal gland and retroperitoneal lymph nodes, which are mostly asymptomatic clinically and are often detected during physical examination.
6.Bone metastasis
The common sites of bone metastasis of lung cancer include ribs, vertebrae, iliac bone, femur, etc., but ipsilateral ribs and vertebrae are more common, manifesting as local pain and fixed pressure pain and percussion pain. Spinal metastases may compress the spinal canal leading to obstruction or compression symptoms. Joint involvement may lead to joint effusion, and cancer cells may be detected by puncture.
7.Central nervous system symptoms
(1) Brain, meningeal and spinal cord metastases have an incidence of about 10%, and the symptoms may vary depending on the metastatic site. The common symptoms are increased intracranial pressure, such as headache, nausea, vomiting and change of mental status. Meningeal metastases are less common than brain metastases and often occur in patients with small cell lung cancer, and their symptoms are similar to those of brain metastases.
(2) Encephalopathy and cerebellar cortical degeneration The main manifestations of encephalopathy are dementia, psychosis and organic lesions. It has been reported that the above symptoms can be relieved after tumor resection.
8. Heart invasion and metastasis
It is not uncommon for lung cancer to involve the heart, especially in central type lung cancer. The tumor can invade the heart through direct spreading, or it can spread retrogradely through lymphatic vessels, blocking the draining lymphatic vessels of the heart and causing pericardial effusion. In the case of faster development, the symptoms of pericardial tamponade may be typical, such as heart urgency, palpitations, jugular and facial venous anger, enlarged heart borders, low and distant heart sounds, hepatomegaly and ascites.
9.Symptoms of peripheral nervous system
Compression or invasion of cervical sympathetic nerve by cancer causes Horner’s syndrome, which is characterized by pupil narrowing on the side of the disease, ptosis, inversion of the eyeball and absence of sweating on the face. Compression or invasion of brachial plexus nerve may cause brachial plexus compression syndrome, which is characterized by burning-like radiating pain, local sensory abnormalities and trophic atrophy in the ipsilateral upper limb. If the tumor invades the phrenic nerve, it may favor diaphragm paralysis, chest tightness and shortness of breath, and paradoxical movement of diaphragm can be seen under X-ray fluoroscopy. When the laryngeal nerve is compressed or invaded, it may cause vocal cord paralysis and hoarseness. Tumor of the apical lung (supraglottic sulcus) invades the cervical 8 and thoracic 1 nerves, brachial plexus nerve, sympathetic ganglion and adjacent ribs, causing severe shoulder and arm pain, abnormal sensation, light paralysis or weakness of one arm and muscle atrophy, which is called Pancoast syndrome.