What are the symptoms before death from lung cancer

Lung cancer originates from the bronchial mucosal epithelium. Tumors confined to the basement membrane are called carcinoma in situ. They can grow into the bronchial cavity and/or adjacent lung tissues, and can spread through lymphatic blood or bronchial metastasis. The growth rate and metastasis of the tumor are related to its biological characteristics such as histological type and degree of differentiation. What are the symptoms of lung cancer before death?

1. Lymph node metastasis

The most common metastasis is to the mediastinal lymph nodes and supraclavicular lymph nodes.

Enlarged lymph nodes beside the trachea or under the carina may compress the airway, causing chest tightness, shortness of breath, or even suffocation. Compression of the esophagus may cause difficulty in swallowing.

2. Pleural invasion and/or metastasis

The pleura is a common site of invasion and metastasis of lung cancer, including direct invasion and implantation metastasis. The clinical manifestations vary depending on the presence or absence of pleural effusion and the amount of pleural effusion. In addition to direct invasion and metastasis, the causes of pleural effusion also include lymph node obstruction and concomitant obstructive pneumonia and atelectasis.

The main manifestations of metastasis are dyspnea, cough, chest tightness and chest pain.

There may also be no symptoms at all; physical examination may show fullness and widening of the intercostals, decreased breath sounds, decreased vocal fremitus, solid percussion sounds, mediastinal shift, etc. Pleural effusion may be serous, serous-bloody or bloody, mostly exudate. The characteristics of malignant pleural effusion are rapid growth rate and mostly bloody.

Spontaneous pneumothorax may occur in extremely rare lung cancer, the mechanism of which is direct invasion of the pleura and obstructive emphysematous rupture, which is more common in squamous cell carcinoma and has a poor prognosis.

3. Superior vena cava syndrome

Direct invasion of the tumor or metastasis of the mediastinal lymph nodes compresses the superior vena cava, or embolism occurs in the cavity, causing it to narrow or block, resulting in obstruction of blood return and presenting a series of manifestations and signs, such as varicose veins in the neck and breasts, cough, chest pain, and difficulty swallowing, and often fainting or syncope when bending the waist.

The primary manifestation of superior vena cava syndrome is varicose veins.

The signs and symptoms of superior vena cava obstruction are related to its location.

If one side of the innominate vein is blocked, blood from the head, face, and neck can flow back to the heart through the innominate vein on the opposite side, and the clinical manifestations are mild. If the superior vena cava is blocked below the entrance of the azygos vein, in addition to the above-mentioned venous dilatation, there is also abdominal venous distension, and blood flows into the inferior vena cava via this route.

If the blockage develops rapidly, cerebral edema may occur with headache, drowsiness, irritability, and changes in consciousness.