Many patients have no signs, but the range of possible signs, not least of all because more than half of patients at presentation have metastatic disease, is considerable:¹ The most common sites of metastasis from lung cancer are the Brain, Liver, Adrenals, and Bones (BLAB).
- haemoptysis
- persistent cough and sputum production
- clubbing – in up to 30% (not small cell)
- hypertrophic pulmonary osteoarthropathy (HPO) – 1-10% (usually adenocarcinoma)
- pulmonary collapse
- pneumonia – recurrent, persistent
- pleural effusion
- fixed inspiratory rhonchus
- tender ribs – secondary
- mediastinal compression ± nerve involvement
- supraclavicular / axillary lymphadenopathy
- brain / liver / bone metastases
- anorexia / weight loss / cachexia / fever – 20%
- endocrine changes
- hypercalcaemia (↑ PTH) – small cell carcinoma
- hyponatraemia (SIADH) – oat cell carcinoma
- Cushing’s syndrome (ectopic ACTH) – oat cell carcinoma
- neurological manifestations ~ 1%
- Eaton-Lambert syndrome (oat cell carcinoma)
- peripheral neuropathy
- cerebellar degeneration
- polymyositis
- cortical degeneration
- haematological features
- migrating thrombophlebitis
- disseminated intravascular coagulation (DIC)
- anaemia
- other
- skin
- acanthosis nigricans (rare)
- dermatomyositis (rare)
- nephrotic syndrome – membranous glomerulonephritis (rare)
- renal
- opportunistic infections
- skin
References
- Cancer Stat Facts: Lung and Bronchus Cancer. https://seer.cancer.gov/statfacts/html/lungb.html. . Accessed: August 10, 2020.
- Choromańska A, Macura KJ. Evaluation of Solitary Pulmonary Nodule Detected During Computed Tomography Examination. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403798/#. 2012; 77 (2): p.22-34. doi: 10.12659/pjr.882967.