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CLINICAL MANIFESTATIONS OF LUNG CANCER
The clinical symptoms of lung cancer are largely determined by the location of the tumor, its size, growth form, and the nature of metastasis. Manifestations of lung cancer are very diverse: it is an enlarged focal formation in the lungs, visible with dynamic chest x-ray; symptoms of compression and obstruction of tissues and organs adjacent to the tumor;
an increase in regional lymph nodes with lymphogenous distribution of the process; the presence of distant metastases due to hematogenous dissemination; various paraneoplastic syndromes caused by the secretion of hormone-active substances by tumor cells.
In 5-15% of patients, lung cancer in the early stage of the disease is clinically asymptomatic, usually detected by "random" chest x-ray, but the majority of patients present some complaints.
Central cancer occurs in large bronchi (main, lobar, intermediate, segmental). Groups of clinical symptoms according to the pathogenetic mechanism are divided as follows.
Primary or local symptoms are caused by the appearance of a primary tumor node in the lumen of the bronchus (cough, hemoptysis, shortness of breath, chest pain). These symptoms are usually early.
Secondary symptoms develop as a result of complications of an inflammatory nature concomitant with bronchogenic cancer, or are caused by regional or distant metastasis to neighboring organs. Secondary symptoms are usually late and appear with a relatively common tumor process.
Common symptoms are a consequence of the general effect on the body of a developing tumor and associated inflammatory complications (general weakness, fatigue, decreased ability to work, etc.)
The most persistent complaints of patients with central lung cancer are cough, hemoptysis, noisy, wheezing, including stridor, breathing, shortness of breath, chest pain, general weakness, secondary pneumonia (fever, productive cough).
Coughing, which occurs reflexively at the very beginning of tumor development, is observed in 80-90% of patients. In the beginning, it is dry, sometimes horsing. With an increase in obstruction of the bronchus, the cough is accompanied by the release of mucous membrane or mucopurulent sputum.
Hemoptysis is observed in half of patients and is detected in the form of veins of red blood in sputum, less often sputum is diffusely colored. In the late stages of the disease, sputum becomes a raspberry jelly. The cessation of sputum discharge with the onset of fever and a deterioration in the general condition of the patient indicates a complete violation of the patency of the bronchus.
Shortness of breath is expressed the brighter, the larger the lumen of the affected
The most characteristic in the clinical picture of central cancer are signs of obstructive pneumonia, characterized by transience, recurrence.
Physical research methods are of secondary importance in lung cancer, especially when recognized in the early stages of the disease.
Peripheral, cancer occurs in subsegmental bronchi and their branches and lung parenchyma. For a long time, the disease proceeds without clinical symptoms and is recognized rather late.
The first symptoms are detected only when the tumor begins to exert pressure on adjacent formations and organs or sprouts them.
The most common symptoms of peripheral lung cancer are chest pain and shortness of breath.
Clinical manifestations of a tumor with its lymphogenous spread or germination of nearby structures can be represented by compression of the esophagus with dysphagia, obstruction of the trachea, paralysis of the recurrent laryngeal nerve with the appearance of a hoarse voice, paralysis of the phrenic nerve with elevation of the dome of the diaphragm and the attachment of shortness of breath, affection of shortness of breath, and the development of Horner's syndrome.
With a Pencost tumor located in the region of the apex of the lung with involvement of the 8th cervical and 1-2th chest nerves, intense pain in the shoulder is observed on the affected side with radiation to the forearm and hand. Often, Horner and Pencost syndromes are combined in one patient.
Lymphogenous spread of lung cancer with lesions of the regional lymph nodes can lead to the development of the superior vena cava syndrome, which is clinically manifested by pericardial effusion, arrhythmias, and heart failure. Tumor obstruction of the lymphatic tract is characterized by the appearance of pleural effusion.
Extrathoracic metastasis during autopsy can be confirmed in 50% of patients with epidermoid cancer and in 95% of patients with small cell lung cancer. Of greatest clinical importance are: metastases to the brain, to the bone, accompanied by persistent pain and pathological fractures, metastases to the bone marrow, to the liver, to the supraclavicular, and especially to the axillary and inguinal lymph nodes.
Paraneoplastic syndromes are observed in patients already at the onset of the disease or are a clinical manifestation of tumor recurrence. The pathogenesis of most paraneoplastic reactions (anorexia, weight loss, fever, cachexia) remains unclear.
Endocrine syndromes are diagnosed in 12% of patients with lung cancer. The occurrence of hypercalcemia, hypophosphatemia occurs due to ectopic production of parathyroid hormone in epidermoid lung cancer, hyponatremia due to secretion of antidiuretic hormone in small cell lung cancer, Cushing's syndrome as a result of ectopic secretion of ACTH in small cell lung cancer.
Damage to the connective tissue of the bones is characterized by a club-shaped thickening of the nail phalanges of the fingers (“drumsticks” syndrome) and hypertrophic pulmonary osteoarthropathy, which is more often observed with adenocarcinoma.
Neurological disorders are rare. In small cell lung cancer, myasthenic syndrome, peripheral neuropathy, and polymyositis are observed.
Coagulopathic, thrombotic and hematologic disturbances are characterized by migrating thrombophlebitis (Trus-co syndrome), thrombotic endocarditis, DIC with increased bleeding, anemia, granulocytosis, blastemia.
Lesions of the skin and kidneys are rare and are manifested by dermo-tomyositis, papillary-pigmentary dystrophy of the skin and nephrotic syndrome, glomerulonephritis.
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