Primary lung Cancer - clinical features
Major presenting complaints are:
Cough (75%)
Cachexia (40%)
Chest pain (40%)
Dyspnea (20%)
Other symptoms include hemoptysis, wheeze, bronchiectasis, emphysema and atelectasis
(esp. with carcinoid tumours)
Local effects of Lung tumour spread

Horner’s syndrome - apical lung cancers impinging on the cervical sympathetic
plexus (Pancoast)

Metastases causing bone pain, headaches etc

Increased infections – obstruction of airways

Dysphonia – recurrent laryngeal nerve invasion

Dysphagia – Oesophageal invasion

Diaphragm paralysis – Phrenic nerve invasion

SVC syndrome – SVC compression by tumour

Cardiac tamponade – Pericardial involvement

Pleural effusion – spread into pleura
Adenocarcinoma and Squamous cell carcinoma  remain localized longer and have better
prognosis (48% survival rate)
Small cell and Large cell carcinoma (undifferentiated tumours)  most are advanced by the
time of diagnosis (usually palliative treatment)
Bronchioloalveolar carcinomas are non-invasive and do not metastasize, but kill by airway
obstruction (need resection)
Carcinoid tumours are intraluminal, will metastasize eventually and some secrete 5-HT and
bradykinin. Most are relatively run a fairly benign course allowing resection
Paraneoplastic syndromes:

SIADH (increased ADH secretion)

Hyperglycaemia

Cushing’s (Increased ACTH)

Hypercalcemia (parathyroid hormone-related peptide etc)

Hypocalcemia (Calcitonin)

Increased 5-HT and bradykinin (carcinoid syndrome)

Lambert-Eaton myasthenic syndrome (auto-Ig directed at neuronal calcium channels)

Hypertrophic pulmonary osteoarthropathy (connective tissue disease with finger
clubbing)
Small cell carcinomas  Cushing’s and SIADH
Squamous cell carcinomas  Hypercalcemia
Carcinoid tumours  Carcinoid syndrome (diarrhoea, flushing and cyanosis)
Common metastasis from lung CA go to adrenal glands (50+%), brain (20%), bone (20%),
contralateral lung, liver (30 – 50%), pericardium, and kidneys.
About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are
incidentally found on routine chest radiograph.