Clinical Features

• Cough, hemoptysis

• Progressive dyspnea

• Wheezing

• Chest pain

• Constitutional symptoms (weight loss, fever, weakness)

• Signs and symptoms of tumor infiltration and/or compression of neighboring structures

  • Superior vena cava syndrome (SVC syndrome): Compression of the superior vena cava impairs the venous backflow to the right atrium, resulting in venous congestion in the head, neck, and upper extremities.

  • Hoarseness: paralysis of the recurrent laryngeal nerve

  • Dyspnea and diaphragmatic elevation: paralysis of the phrenic nerve

  • Dullness on percussion, reduced breath sounds: malignant pleural effusion on the affected side

  • Postobstructive pneumonia

  • Dysphagia: esophageal compression

• Over half of all patients diagnosed with lung cancer have metastatic disease at the time of presentation. [1]

• The symptoms of metastatic disease are site-specific

  • Brain: headaches, seizures, focal motor deficits, behavioral changes (see “Brain metastases”)

  • Liver: typically asymptomatic, but may manifest with nausea, jaundice, ascites (see “Metastatic liver disease”)

  • Adrenal gland: typically asymptomatic

  • Bones: bone pain, elevated serum alkaline phosphatase and calcium

“Lung cancer loves to BLAB:” the most common sites of metastasis from lung cancer are the Brain, Liver, Adrenals, and Bones.