Clinical Presentation

Cough is probably the most common presenting symptom in lung cancer and is related to endobronchial erosion and irritation. Centrally located lesions may result in a change in a chronic cough, hemoptysis, pneumonia. More peripheral tumors may present with chest pain and or cough related to chest wall and pleural involvement.

Local extension of lung cancers results is varying presentations and syndromes. Invasion of the recurrent laryngeal nerve may result in hoarseness in up to 8% of cases. Dysphagia may be an indication of esophageal extension and is seen in 1-5% of presentations. Paraveterbral extention with involvement of the sympathetic nerve plexus results in Horner's syndrome (meiosis, ptosis, ipsilateral anhydrosis). Superior vena cava syndrome results from extrinsic compression of the superior vena cava. Patients present with jugular venous distention, edema of the face neck and arms.

Malignant pleural effusions are present in 30-60% of patients. If the effusion reoccurs after therapy, this represents a poor prognostic indicator.

Paraneoplastic syndromes occur in 10% of patients with lung cancer. Paraneoplastic syndromes associated with weight loss, neuromyopathies (Eaton Lambert syndrome) and elaboration of a variety of active peptides. Elevations in PTH-like peptide and calcitonin are associated with hypercalcemia, and pulmonary hypertrophy osteoarthropathy. Cushing's syndrome may present in as many as 38% of patients with bronchial carcinoid. Antidiuretic hormone (ADH) has been found elevated in as many as 50% of patients with only 5% showing symptoms of SIADH.

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