December 4, 2021

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The clinical manifestations and common metastatic sites of lung cancer

The clinical manifestations and common metastatic sites of lung cancer

The clinical manifestations and common metastatic sites of lung cancer.  What are the clinical manifestations of lung cancer?

Although everyone’s awareness of health is increasing, statistics show that most lung cancer patients are still in the advanced stage when they see a doctor.

The treatment effect of these patients is not good, which has also prompted modern medical treatment to increase the intensity of research on advanced lung cancer. In recent years, most of the approved targeted drugs and immunotherapy drugs are related to lung cancer.

Some patients have obtained practical benefits (overall survival Period and progression-free survival period).

One of the reasons for the many patients with advanced lung cancer is that most of the potential patient groups are not high-risk groups, and screening is neglected.

Therefore, it is even more necessary to popularize some clinical manifestations (symptoms) of lung cancer, so that lung cancer can be diagnosed at an earlier time. Early diagnosis will have better treatment effects and save high treatment costs.

The clinical manifestations and common metastatic sites of lung cancer

What are the clinical manifestations of lung cancer?

The effect of lung cancer in the chest cavity: The effect of lung cancer in the chest cavity can cause a variety of symptoms, the most common being cough, hemoptysis, chest pain and dyspnea.

Cough:

50%-75% of lung cancer patients have a cough at the time of treatment. Cough is most common in patients with squamous cell carcinoma and SCLC type of small cell lung cancer because they tend to occur in the central airway.

However, patients of these two types often have a long-term history of smoking, so some coughs are considered to be caused by smoking. It is recommended that patients with long-term cough should be checked more frequently, and regular screening can be done if conditions permit.

Hemoptysis:

Hemoptysis is seen in 20%-50% of patients diagnosed with lung cancer, but the most common cause of this symptom is bronchitis.

Chest pain:

20%-40% of lung cancer patients have chest pain. Younger patients appear more often than older patients. Chest pain usually appears on the same side of the primary tumor. Persistent dull pain may be due to tumor invasion of the mediastinum, pleura, or chest wall. In addition to tumor invasion, pulmonary embolism caused by obstructive pneumonia or hypercoagulable state can also cause chest pain, so more attention should be paid.

Difficulty breathing:

Shortness of breath is a common symptom in the diagnosis of lung cancer, seen in 25%-40% of patients.

Hoarseness:

The differential diagnosis of persistent hoarseness in smokers includes laryngeal cancer and lung cancer.

Pleural involvement:

manifested as thickening of the pleura without pleural effusion on imaging examination, or malignant pleural effusion. About 10%-15% of lung cancer patients will have malignant pleural effusion during the course of the disease. This condition is considered incurable, but palliative treatment can be adopted.

Superior vena cava syndrome: Symptoms usually include a feeling of fullness of the head and difficulty breathing. Coughing, pain, and difficulty swallowing are rare. Physical examination revealed dilated jugular veins, obvious chest wall veins, facial edema, and hyperhematuria. A chest radiograph usually shows a widening of the mediastinum or a mass in the right hilar. CT can often determine the cause, location of obstruction, and the extent of collateral vein drainage.

Pancoast syndrome:

lung cancer that occurs in the upper sulcus of the lung, manifested by pain (often shoulder pain, forearm, shoulder blade and finger pain is rare), Horner syndrome, bone destruction, and hand muscle atrophy. Pancoast syndrome is most commonly caused by NSCLC (usually squamous cell carcinoma), and only a few are caused by SCLC, small cell lung cancer.

Extrathoracic metastasis: As cancer cells spread to any tissue throughout the body. Metastatic dissemination may cause the first symptoms, or it may appear later in the course of the disease.

The most common site of distant metastasis of lung cancer

Liver metastases:

Symptomatic liver metastases are rare in the early stages of the disease. Asymptomatic liver metastases may be detected by liver enzyme abnormalities, CT or PET during treatment. About 3% of patients with non-small cell lung cancer NSCLC who could have been resected in the thoracic cavity have found evidence of liver metastasis through CT examination. PET or PET-CT can detect unsuspected liver or adrenal metastasis in about 4% of patients.

Bone metastasis:

The usual symptoms include back pain, chest pain or limb pain, and serum alkaline phosphatase is often elevated. Extensive bone disease can cause elevated serum calcium levels. About 20% of NSCLC patients have bone metastases when they visit a doctor.

Adrenal metastasis:

one of the common metastatic sites of lung cancer, only a few metastases have symptoms. In patients with known or suspected lung cancer, if a unilateral adrenal mass is found due to staged CT examination, adrenal metastasis is usually considered.

Brain metastasis:

The neurological manifestations of lung cancer include metastasis and paraneoplastic syndromes.

The symptoms of central nervous system metastasis from lung cancer are similar to other tumors, including headache, vomiting, visual field defects, hemiparesis, cranial nerve dysfunction, and seizures.

In non-small cell lung cancer NSCLC, adenocarcinoma most often has brain metastasis, and squamous cell carcinoma has the least brain metastasis.

20%-30% of SCLC patients with small cell lung cancer have brain metastases at the time of treatment.

Paraneoplastic phenomena (paraneoplastic effects are remote effects that have nothing to do with direct invasion, obstruction and metastasis)

Hypercalcemia:

due to bone metastases, a few are caused by parathyroid hormone-related protein (PTHrP), calcitriol or other cytokines, including osteoclast activating factor, secreted by tumors.

Symptoms of hypercalcemia include anorexia, nausea, vomiting, constipation, drowsiness, polyuria, polydipsia, and dehydration. Confusion and coma are late manifestations, as are renal failure and nephrocalcinosis. Symptomatic patients with serum calcium ≥ 12mg/dL (3mmol/L) need treatment.

SIADH:

usually caused by SCLC of small cell lung cancer, which can lead to hyponatremia. Approximately 10% of SCLC patients will experience SIADH-related symptoms. Including anorexia, nausea, and vomiting. Rapid hyponatremia can cause brain edema.

Nervous system:

Lung cancer is the most common cancer that causes neuroparaneoplastic syndromes, most of which are caused by small cell lung cancer (SCLC). Neuroparaneoplastic syndromes are thought to be immune-mediated, and autoantibodies have been found in many cases. Various neuroparaneoplastic syndromes and their pathophysiology will be discussed elsewhere. These various neurological manifestations include but are not limited to: Lambert-Eaton myasthenia syndrome (LEMS)-the most common condition, cerebellar ataxia, sensory neuropathy, limbic encephalitis, encephalomyelitis, autonomy Neuropathy, retinopathy, and ocular clonus-myoclonus.

Blood system manifestations:

abnormalities in the blood system, including: anemia, leukocytosis, thrombocytosis, eosinophilia, a variety of hypercoagulable state diseases, etc.

Hypertrophic osteoarthropathy:

Pulmonary hypertrophic osteoarthropathy (HPO) refers to clubbing and tubular periosteum hyperplasia associated with lung cancer or other lung diseases.

Dermatomyositis and polymyositis:

Dermatomyositis and polymyositis are two different forms of inflammatory myopathy, both of which are clinically manifested as muscle weakness.

Cushing’s syndrome:

ectopic secretion of adrenocorticotropic hormone (ACTH) can cause Cushing’s syndrome. Patients usually present with muscle weakness, weight loss, high blood pressure, hirsutism, and osteoporosis. Hypokalemic alkalosis and hyperglycemia are also common.

(source:internet, reference only)


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