1.Blood in sputum, blood in sputum or hemoptysis This is special in early lung cancer cases, such as central lung cancer, coughing up blood often occurs in the early and middle stages of the disease, the amount of blood is small, bright red in quality or mixed with foam. The reason for this phenomenon is that the tumor surface is rich in blood vessels. Coughing damages the surface layer and causes the blood vessels to rupture. Occasionally, there are cases of coughing up more blood, which is often recurrent or lasts for a longer period of time. 2. Cough and sputum, especially dry cough Lung cancer has different symptoms due to its different locations and functional damage. As the tumor grows on the large bronchial tubes and is highly irritating, it is easy to produce cough. However, the degree of coughing varies. About 50% of patients have irritating choking cough with no sputum or a little white foamy sputum. The quality of the sputum changes after secondary infection. People with a pre-existing chronic cough should be alerted if they notice a different nature of cough than usual. Patients of advanced age should be seen early if the cough is ineffective after treatment or if it persists for a long time. Those with coughing up blood should be seen earlier. 3.Unexplained fever When central lung cancer grows to semi-obstructed or fully obstructed lumen in the bronchus, it can produce obstructive pneumonia. The fever is usually around 38℃, which can be easily reduced by anti-inflammatory treatment. However, if the obstructive lesion is not removed, the pneumonia will reappear soon afterwards, forming recurrent pneumonia. Or tumor necrosis leads to tumor fever, which is usually low fever. 4. Chest tightness and chest pain Generally the symptoms are light and the localization is vague. When the cancer invades the pleura and chest wall, the pain will increase, and the localization is clearer and more constant than before. 5.Shortness of breath Pneumonia, pulmonary atelectasis, malignant pleural effusion, diffuse alveolar lesions, etc. caused by tumor obstruction of large airways can cause 6.Heartness of voice Hoarseness occurs when lymph node metastasis compresses or invades the recurrent laryngeal nerve (left side is more common). When laryngoscopic mediastinoscopy is performed, the affected vocal cord is paralyzed. After treatment, the patient’s head and neck swelling improved significantly. 8. Horner syndrome Supraglottic sulcus tumor, often compressing the cervical sympathetic nerve, causes ipsilateral pupil narrowing. The upper eyelid droops, the eyeball sinks, the eye fissure is narrow, and the forehead is less sweaty (i.e. Horner’s syndrome). 9. Enlarged lymph nodes on the body surface Commonly, the supraclavicular lymph nodes are enlarged. 10.Other extra-pulmonary symptoms (not always present) (1) Bone and joint lesions: pain in the joints of the extremities or hypertrophic pestle finger. 21% of lung cancer is accompanied by crural finger in early stage, and most of them disappear after lung cancer surgery. (2) Arthritis: coexisting with crural fingers, it may appear first when the lung cancer lesion is very small and difficult to be detected, and manifests as symptoms of wandering arthritis. It is called rheumatoid arthritis-like arthritis, and the pain can disappear after twenty-four hours of lung surgery. (3) male breast enlargement hypertrophy: male breast enlargement on one side or both sides like female, Japan Apei et al. investigated 267 cases of lung cancer, among which 7.5% of male female breast appeared in early stage, often easily ignored, or even misdiagnosed as simple breast enlargement and removed. (4) Ectopic endocrine syndrome, Cushing’s syndrome, etc. (5) Multiple peripheral myositis. Most of them appear before the typical symptoms of lung cancer and manifest as progressive peripheral weakness and loss of appetite, and when aggravated, it may be difficult to walk and get up from bed. (1) Intracranial metastasis: sudden stroke and hemiparesis; (2) Bone metastasis: generalized bone pain or localized bone pain; (3) Liver metastasis: jaundice, generalized itching, which is rare, but the prognosis of liver metastasis is extremely poor; (4) Thoracic metastasis: chest tightness and shortness of breath due to pleural effusion, which progresses rapidly; (5) Pericardial metastasis: chest tightness and shortness of breath due to pericardial effusion, which aggravates extremely quickly. 12.Rare manifestation manifests as a cavernous lesion with rupture causing pneumothorax.