Early stage lung cancer usually has no specific symptoms, so it is difficult to be detected. However, early stage lung cancer may also have some “clues” to remind you of early detection and early treatment. As the disease progresses, lung cancer will show symptoms related to local spread and distant metastasis in advanced stages. This article introduces the common early and late symptoms of lung cancer, if you have suspected symptoms, please seek medical attention immediately.
Early stage lung cancer, what are the possible symptoms?
Patients with early-stage lung cancer may not have any symptoms. This is mainly because the alveoli do not have sensory nerves and cannot feel pain. The lungs are relatively large, and early lung cancer lesions are usually small, so they rarely cause significant symptoms. Most of the associated symptoms appear due to the increased size of the tumor, which involves the bronchi and pleura. Even if symptoms appear, they are ignored because most of them are atypical such as cough and chest pain.
On the other hand, screening is the most effective means to detect early lung cancer, and the internationally recommended screening means is low-dose spiral CT, which is not widely carried out due to the limitation of examination cost, instruments and professionals.
The common symptoms of early lung cancer are summarized as follows, and knowing these can help us to be alert and seek medical treatment in time.
- Chronic cough. This is the most common symptom of lung cancer, usually an irritating dry cough, sometimes accompanied by coughing sputum; chronic cough is caused by lung cancer invading the trachea and bronchi; although nearly half of lung cancer patients have chronic cough at the time of diagnosis, not all patients with chronic cough have lung cancer.
- Coughing up blood. This is one of the common symptoms of lung cancer patients and is the only symptom in 7% of patients in clinical practice. It can manifest as blood in sputum or bloody sputum. Once more severe coughing of blood occurs, it indicates disease progression and critical condition. It is due to the invasion of bronchial mucosa by tumor cells. The tumor is surrounded by abundant blood vessels, and when the capillaries or small blood vessels rupture, it will lead to coughing up blood.
- Chest pain. Nearly half of patients will have chest pain early. It is worse with deep breathing, coughing, and laughing. The pain is often dull or vague, diffuse, and often not clearly localized, sometimes not consistent with the tumor site. The internal organs are not sensitive to pain, but sensitive to pulling. Therefore, it is often when the tumor invades the pleura and chest wall that persistent chest pain occurs. When the tumor causes pleural effusion, it will also cause chest pain.
- Shortness of breath. It often manifests as shortness of breath after exercise, inspiratory dyspnea, and chest tightness; it is caused by tumor compression of the airway, or obstruction leading to pneumonia, pulmonary atelectasis (decreased volume or air content of lung segments or lobes), malignant pleural effusion, and diffuse alveolar lesions; sometimes shortness of breath is often mistakenly thought to be due to aging or weight gain.
- Recurrent infections. Expressed as fever, cough, and sometimes yellow pus sputum; tumor compression or obstruction of the bronchi, causing obstructive pneumonia in the distal lung drainage; at the same time, patients with lung cancer have decreased immunity and are prone to infection.
- Shoulder or arm pain. This is a common manifestation of supraglottic sulcus (Pancoast tumors) [2]; in addition to shoulder pain and medial upper arm pain, this pain can radiate toward the little finger. It can sometimes be characterized by weakness and tingling in the hand, as well as Horner’s syndrome – drooping eyelids, absence of sweating on one side of the face, and flushing and sweating on the other. Suprapulmonary sulcus tumors are located at the narrow thoracic inlet and tend to invade the nerves, blood vessels and their adjacent ribs and vertebrae, causing these symptoms.
- Unexplained weight loss. This generally refers to a weight loss of more than 5% over a period of 6 to 12 months. A subset of lung cancer patients clinically present with weight loss before diagnosis. It is sometimes overlooked because there is no significant discomfort.
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Other symptoms that may occur include.
- Fatigue and lethargy. This is a general feeling that is difficult to relieve with good rest;
- Heartness of voice. Tumors or enlarged lymph nodes in the mediastinum that compress or invade the recurrent laryngeal nerve can paralyze the vocal cords and cause hoarseness, which is a symptom that is often difficult to take seriously;
- Swelling of the face, neck, and arms. It may also be accompanied by dilated veins in the neck and chest, a manifestation of superior vena cava syndrome (SVC syndrome), a complication of lung cancer;
- Gasping. When the tumor obstructs the airway, it can cause wheezing during breathing;
- Thrombotic symptoms. It manifests as pain and swelling in the legs and life-threatening pulmonary embolism if the thrombus occurs in the lungs;
- Paraneoplastic Syndromes. It manifests as pestle and mortar fingers, painful enlarged joints in the extremities, myasthenia gravis, hypercalcemia, and carcinoid syndrome.
Some studies have found that people who smoke are more likely to ignore early symptoms of lung cancer. However, lung cancer is not the only disease that smokers need to worry about. In recent years, the incidence of lung cancer in young, non-smoking women is on the rise, so if you experience one or more of these symptoms, you need to get checked out at the earliest possible time.
It is worth noting that lung cancer sometimes has no symptoms in its early stage, and many people find lung nodules by chance during health checkups and only find out it is lung cancer after further examination. Therefore, lung cancer screening is very important.
Late stage lung cancer, what are the possible symptoms?
What is commonly referred to as advanced lung cancer is stage IV lung cancer that has spread locally (pleura and lung), or has metastasized distantly (bone, brain, liver, adrenal gland). It is the final stage of lung cancer and often exhibits symptoms associated with local spread and distant metastasis.
Common symptoms include chronic cough, shortness of breath, fever, coughing up blood, chest pain, enlarged lymph nodes, and hoarseness when the tumor presses on the laryngeal recurrent nerve, and difficulty swallowing when it presses on the esophagus.
In addition, when brain metastasis occurs, headache, vomiting, visual impairment, mental abnormality, unilateral limb weakness or abnormal sensation, hemiplegia or ataxia, phantom smell, etc. may occur.
In the case of bone metastasis, chest pain, back pain, limb pain, paralysis, pathological fracture and hypercalcemia may occur
In liver metastases, abdominal distention, loss of appetite, epigastric mass, pain in the liver area, jaundice, itchy skin, and even confusion.
Patients in advanced stages usually have fatigue, loss of appetite and unexplained weight loss. Some of these patients may even have symptoms such as extreme lethargy, weakness and general failure, which is professionally known as “cachexia”. The main manifestations of cachexia are as follows.
- Involuntary weight loss. Unexplained, uncontrollable weight loss, even if the caloric intake is not high, but the consumption of lung cancer exceeds the intake, resulting in weight loss.
- Muscle atrophy. Muscle atrophy is accompanied by fat loss, which can be dangerous. In addition, in overweight patients, muscle atrophy without significant weight loss usually occurs in cachexia.
- Poor appetite (loss of appetite). This is not just “not wanting to eat”, but anorexia and loss of appetite.
- Loss of appetite.
- Decreased quality of life. These three symptoms can lead to a significant decrease in quality of life.
- Decreased quality of life.
Advanced lung cancer is usually inoperable and is treated primarily with supportive and symptomatic care, including nutritional support therapy for cachexia. Although advanced lung cancer is difficult to cure, it is treatable. Current chemotherapy, radiotherapy, targeted therapy, and even the latest immunotherapy have the potential to control, and improve the symptoms of advanced lung cancer and improve the quality of life.
Therefore, even if you have entered the advanced stage of the disease, don’t lose your confidence, and actively cooperate with your doctor’s treatment, you can live a longer and more comfortable life.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Wang Zhen, Associate Chief Physician Dr. Xue-Tao Lai Dr. Kai Yin