What are the early symptoms and manifestations of lung cancer? The most feared signs of advanced lung cancer

Primary bronchogenic carcinoma, also known as lung cancer, is a malignant tumor that originates from the bronchial mucosa or glands. The incidence of lung cancer ranks first among tumors. Due to insufficient early diagnosis, the prognosis is poor. It is one of the most threatening malignant tumors to human health and life. Currently, with the advancement of diagnostic methods, the development of new drugs and planned treatment plans, the survival rate has improved.

Long-term heavy smoking is an important risk factor for lung cancer. For those who smoke more than 40 cigarettes a day for many years, the incidence of squamous cell lung cancer and undifferentiated lung cancer is 4 to 10 times higher than that of non-smokers.

The clinical manifestations of lung cancer are relatively complex. The presence, severity, and early or late onset of symptoms and signs are closely related to the size, type, development stage, location, presence or absence of complications, and whether the tumor has metastasized.

Symptoms caused by the primary tumor

cough

Cough is the most common early symptom, usually an irritating dry cough with little or no sputum. It is often difficult to control with general cough suppressants. When the tumor causes bronchial stenosis, the cough may worsen. Lung cancer cough is often persistent, with a high-pitched metallic sound or an irritating choking cough. Alveolar cell carcinoma may have a large amount of mucus sputum, which increases in sputum volume when accompanied by infection and is mucopurulent.

Blood in sputum or hemoptysis

Blood in sputum or hemoptysis is also a common symptom of lung cancer, which is more common in central lung cancer. Because tumor tissue is rich in blood supply and brittle in texture, blood vessels rupture and cause bleeding during severe coughing. Hemoptysis may also be caused by local tumor necrosis or vasculitis. The characteristics of lung cancer hemoptysis are intermittent or continuous, repeated small amounts of blood in sputum, or small amounts of hemoptysis. If larger blood vessels rupture, large cavities form, or tumors rupture into the bronchial and pulmonary blood vessels, it can cause massive hemoptysis.

Shortness of breath, wheezing

When the tumor grows toward the inside of the bronchus, or metastasizes to the hilar lymph nodes, causing the enlarged lymph nodes to compress the main bronchus or bulge or cause partial obstruction, there may be chest tightness, shortness of breath, difficulty breathing, and occasionally wheezing.

fever

Tumor tissue necrosis can cause fever, which is mostly caused by obstructive pneumonia caused by the tumor and is not well treated with antibiotics.

Weight loss

Weight loss is one of the common symptoms of malignant tumors, which can easily lead to weight loss due to tumor toxins and consumption.

Symptoms caused by extrapulmonary and intrathoracic extension

Chest pain

About 25% of patients have chest pain as the first symptom. It often manifests as irregular dull pain or pain in the chest. In most cases, peripheral lung cancer invades the parietal pleura or chest wall, which can cause sharp and intermittent pleural pain, and gradually develop into constant drilling pain. Mild chest discomfort that is difficult to locate is sometimes related to central lung cancer invading the mediastinum or involving blood vessels and peripheral bronchial nerves. Continuous, sharp and severe chest pain that is not easily controlled by drugs often indicates that there is extensive pleural or chest wall invasion. Persistent pain in the shoulders or chest and back indicates that there may be tumor invasion near the mediastinum on the inner side of the lung lobe.

Difficulty swallowing

When the tumor invades or compresses the esophagus, it can cause difficulty in swallowing.

Pleural effusion

A small number of patients may develop varying degrees of pleural effusion, which usually indicates that tumor metastasis has involved the pleura or lymphatic drainage is obstructed.

Hoarseness

Hoarseness generally indicates direct mediastinal invasion or lymph node enlargement involving the ipsilateral recurrent laryngeal nerve, resulting in left vocal cord paralysis. Vocal cord paralysis can also cause varying degrees of upper airway obstruction.

Superior vena cava obstruction syndrome

It is caused by obstruction of the superior vena cava, manifested by congestion and edema of the head, face and upper body, swelling of the neck, and dilation of the jugular vein.

Horner syndrome

Lung cancer at the apex of the lung can easily compress the sympathetic nerves of the neck, causing ptosis of the eyelid on the affected side, constriction of the pupil, enophthalmos, and little or no sweating on the forehead and chest wall on the same side. Tumors can also compress the brachial plexus nerves, causing burning pain mainly in the axilla, radiating to the inner side of the upper limb, and worsening pain at night.

Symptoms caused by extrathoracic metastasis

Central nervous system metastasis

Increased intracranial pressure, headache, nausea, vomiting, abnormal mental state. Rare symptoms include epileptic seizures, hemiplegia, cerebellar dysfunction, etc. In addition, encephalopathy and cerebellar cortical lesions are also common.

Bone metastasis

It can cause bone pain and pathological fractures. Most of them are osteolytic lesions, and a few are osteoblastic. After the tumor metastasizes to the spine, it can compress the spinal canal, causing local compression and obstruction symptoms. In addition, metastasis to the joints may even cause joint effusion.

Abdominal metastasis

Some small cell lung cancers can metastasize to the pancreas, manifesting as pancreatitis or obstructive jaundice. Other types of lung cancer can also metastasize to the gastrointestinal tract, adrenal glands, retroperitoneal lymph nodes, etc. Most of them have no clinical symptoms and require instrument detection and diagnosis.

Lymph node metastasis

The most common lymph nodes are mediastinal and supraclavicular lymph nodes, which are usually on the same side as the lesion, and a few may be on the opposite side. They are usually hard, single or multiple nodules, and may sometimes be the first complaint leading to medical attention. Enlarged lymph nodes near 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 dysphagia.

Extrathoracic manifestations

Hypertrophic pulmonary osteoarthritis

It often affects the distal ends of the long bones of the upper and lower limbs, causing clubbing of the fingers (toes) and hypertrophic osteoarthritis.

Ectopic gonadotropin

It is relatively rare, mostly large cell lung cancer, and the main manifestations are male breast development and proliferative osteoarthropathy.

secrete adrenocorticotropic hormone-like substance

It is more common in lung adenocarcinoma and small cell lung cancer. The clinical symptoms are roughly similar to Cushing's syndrome, and may include progressive muscle weakness, peripheral edema, hypertension, diabetes, hypokalemic alkalosis, etc. It is characterized by rapid progression of the disease, severe mental disorders, and skin pigmentation, while central obesity, polycythemia, and purple striae are mostly not obvious.

Syndrome of inappropriate antidiuretic hormone secretion

It is caused by the secretion of a large amount of ADH or polypeptide substances with antidiuretic effect by cancer tissue. Its main clinical features are hyponatremia, accompanied by low osmotic pressure (1.200) of serum and extracellular fluid and water intoxication. It is more common in small cell lung cancer.

Neuromuscular syndrome

It is caused by the secretion of arrow-like substances by the tumor. It manifests as voluntary muscle weakness and extreme fatigue. It is more common in small cell undifferentiated carcinoma. Other symptoms include peripheral neuropathy, spinal root ganglion cell and nerve degeneration, subacute cerebellar degeneration, cortical degeneration, polymyositis, etc., which may cause pain and weakness in the extremities, dizziness, nystagmus, ataxia, difficulty walking and dementia.

Hypercalcemia

It can be caused by bone metastasis or excessive secretion of parathyroid hormone and related proteins by the tumor, which is common in squamous cell carcinoma. Patients often show symptoms of lethargy, anorexia, nausea, vomiting, physical loss and mental changes. Blood calcium levels can be restored after tumor removal.

Carcinoid syndrome

It is caused by the secretion of 5-hydroxytryptamine by the tumor. Typical symptoms include abnormalities in the skin, cardiovascular, gastrointestinal tract and respiratory function, specifically manifested as bronchospastic asthma, skin flushing, paroxysmal tachycardia and watery diarrhea.

The cause and pathogenesis of lung cancer are not yet clear, but are usually related to the following factors:

Smoking

Smoking is the primary cause of the progressive increase in lung cancer mortality. The harmful substances in smoke are carcinogenic, especially squamous cell carcinoma and undifferentiated small cell carcinoma. Similarly, passive smoking or environmental smoking is also one of the causes of lung cancer. The risk of cancer progressively decreases during the 2-15 years of quitting smoking, and the incidence rate thereafter is equivalent to that of a lifelong non-smoker.

Occupational carcinogens

Occupational factors that have been confirmed to cause lung cancer in humans include: asbestos, arsenic, nickel, chromium, cymbals, coal tar, mustard gas, trimethyl ether, heating products of tobacco, radon and radon protons produced by the decay of radioactive substances such as uranium and radium, ionizing radiation, microwave radiation, etc. These factors can increase the risk of lung cancer by 3-20 times.

Air pollution

This includes pollution from both the indoor microenvironment and the outdoor macroenvironment. Indoor passive smoking, burning fuel, cooking, and air pollution in large cities are all risk factors for lung cancer.

Ionizing radiation

Large doses of ionizing radiation can cause lung cancer, and different rays have different effects. In the general population, ionizing radiation comes partly from nature, and partly from medical irradiation and X-ray diagnosis.

Diet and Nutrition

The risk of lung cancer increases when people consume less β-carotene vegetables and fruits. People with low serum β-carotene levels have a high risk of lung cancer.

Other causes

Tuberculosis is one of the causes of lung cancer. The risk of lung cancer in patients with tuberculosis is 10 times that of normal people. In addition, viral infection, fungal infection, etc. may also play a certain role in the occurrence of lung cancer.

Heredity, genetic changes

Research has now found that lung cancer may be caused by external factors through internal factors. The above external factors can induce malignant transformation of cells and irreversible genetic changes. These genetic changes are long-term, multi-step, and random, including the activation of oncogenes, the inactivation of inhibitory genes, and the inhibition of cell apoptosis, which leads to uncontrolled cell growth.

Avoiding exposure to factors that are associated with lung cancer, such as smoking and air pollution, and strengthening labor protection in occupational exposure can reduce the risk of lung cancer. Currently, there is no effective chemical prevention measure for lung cancer. Not smoking and quitting smoking early are the most effective prevention methods.

The treatment plan for lung cancer is mainly determined by the histology of the tumor. Usually, small cell lung cancer has already metastasized when it is discovered, and it is difficult to cure it through surgery. It mainly relies on comprehensive treatments such as chemotherapy or radiotherapy. In contrast, non-small cell lung cancer can be localized and can be cured by surgery, but it responds poorly to chemotherapy.

Non-small cell lung cancer

Localized lesions

Operation

Surgical treatment of lung cancer is mainly suitable for early and middle stage (stage I-II) lung cancer, stage IIIa lung cancer and some selective stage IIIb lung cancer where the tumor is confined to one side of the chest cavity.

For patients who can tolerate it, surgery can be considered if their age, cardiopulmonary function, and anatomical location are appropriate. Preoperative chemotherapy can reduce the stage of disease in many patients who were previously inoperable and make them eligible for surgery.

Radical radiotherapy

Radical radiotherapy is generally not considered for patients with distant metastasis, malignant pleural effusion or heart involvement. Radiotherapy rays can damage the lung parenchyma and other organs in the chest, such as the spinal cord, heart and esophagus. Patients with severe underlying lung diseases also need to be careful.

Radical comprehensive treatment

For superior sulcus tumors with Hornery syndrome, combined radiotherapy and surgery can be used for treatment. For patients with stage IIIa lung cancer, surgery plus postoperative chemoradiotherapy, neoadjuvant chemotherapy plus surgery, or neoadjuvant chemotherapy plus surgery can be selected.

Disseminated disease

Most inoperable non-small cell lung cancers have a poor prognosis and are treated with appropriate chemotherapy and radiotherapy, or supportive treatment.

Chemotherapy

Combination chemotherapy can increase survival rate, relieve symptoms and improve quality of life. Common drugs include cisplatin, carboplatin, vinorelbine, gemcitabine, paclitaxel, docetaxel and pemetrexed. Currently, the recommended treatment for first-line chemotherapy is a combination of platinum-containing doublet chemotherapy. Second-line chemotherapy regimens mostly recommend docetaxel or pemetrexed monotherapy. Regardless of the first-line or second-line treatment regimen, supportive treatment is required, and the chemotherapy dose should be adjusted according to the lowest granulocyte count.

Radiation therapy

Radiotherapy can be considered for patients whose primary tumors obstruct the bronchus and cause obstructive pneumonia, upper respiratory tract infection, or superior vena cava obstruction. Preventive treatment can also be considered for asymptomatic patients to prevent the development of intrathoracic lesions. Cardiac tamponade can be treated with pericardial puncture and radiotherapy, and intracranial and spinal cord compression and brachial plexus involvement can also be relieved by radiotherapy. Usually a course of treatment is 2-4 weeks, with a dose of 30-40Gy.

Targeted therapy

Molecular targeted therapy targets specific molecules in tumor cells, and uses molecular targeted drugs to specifically block the biological function of the target, reversing the malignant biological behavior of tumor cells at the molecular level, thereby inhibiting tumor growth or even regressing the tumor. Representative drugs include epidermal growth factor receptor-tyrosine kinase inhibitors and monoclonal antibodies, tufitinib, erlotinib, etc. It can be considered for patients who have failed chemotherapy or cannot tolerate chemotherapy.

Treatment of metastatic disease

Radiotherapy can be considered when there is brain metastasis. For tracheal tumor recurrence after surgery or radiotherapy, laser treatment through fiberbronchoscope can relieve 80%-90% of patients.

Small cell lung cancer

Chemotherapy

It has a good effect on untreated or recurrent small cell lung cancer. Chemotherapy drugs that can be used for first-line treatment include: etoposide, irinotecan, cisplatin, carboplatin, etc. Combination regimens such as: etoposide plus cisplatin or carboplatin, once every 3 weeks, for a total of 4-6 cycles. Patients who progress or do not respond after treatment should switch to new chemotherapy drugs.

Radiation therapy

For patients with clear brain metastases, whole brain high-dose radiotherapy (40Gy) can be given. For patients with complete remission, preventive brain radiation can be performed, which can significantly reduce brain metastases.

Comprehensive treatment

Most limited-stage small cell lung cancers can be treated with a combination of etoposide plus platinum chemotherapy and concurrent radiotherapy. Although there will be acute and chronic toxicity of radiotherapy and chemotherapy, it can reduce the local treatment failure rate and improve survival.

Biological response modifiers

Biological response modifiers provide a new treatment for small cell carcinoma, and low-dose interferon is used intermittently three times a week. Transfer factor and levamisole can increase the body's tolerance to chemotherapy and radiotherapy in the treatment of lung cancer, improving the treatment effect.

Chinese Medicine Treatment

There are many prescriptions in traditional Chinese medicine that can work synergistically with Western medicine in the treatment of lung cancer, reducing the response to radiotherapy and chemotherapy and improving the body's resistance to disease.

Lung cancer-Qi and blood stasis syndrome

The cough is not smooth, the chest is tight and short of breath, the chest pain is in a certain place, like a needle or a thorn, or there is dark red blood in the sputum, dark purple lips, dark tongue or ecchymosis, thin tongue coating, and thin and stringy or thin and astringent pulse.

Treatment method: Promote blood circulation and dissipate blood stasis, promote qi circulation and resolve stagnation.

Prescription: Taohong Siwu Decoction with added ingredients.

Lung cancer-phlegm-dampness accumulation in the lungs syndrome

Cough, sputum, shortness of breath, thick and sticky sputum, white sputum or a mixture of yellow and white sputum, chest tightness and pain, poor appetite and loose bowel movements, fatigue, dark tongue, white and greasy yellow tongue coating or thick and greasy yellow tongue coating, and a wiry and slippery pulse.

Treatment method: Promote qi and eliminate phlegm, strengthen the spleen and dry dampness.

Prescription: Erchen Decoction combined with Trichosanthes, Xiebai and Banxia Decoction with modifications.

Lung cancer-Yin deficiency and toxic heat syndrome

Cough with no or little sputum, or with blood in the sputum, or even continuous hemoptysis, chest pain, restlessness, poor sleep, low-grade fever, night sweats, or severe fever that lasts for a long time, thirst, hard stools, red tongue, thin yellow tongue coating, and thin or rapid pulse.

Treatment method: Nourish yin, clear away heat, detoxify and disperse nodules.

Prescription: Adenophora and Ophiopogon Decoction combined with Wuwei Xiaodu Drink with modifications.

Lung cancer-Qi and Yin deficiency syndrome

Cough with little sputum, or thin and sticky sputum, low and weak cough, shortness of breath, fatigue, pale complexion, thin body, aversion to wind, spontaneous sweating or night sweats, dry mouth and less drinking, red or pale tongue, and weak pulse.

Treatment method: Invigorate Qi and nourish Yin.

Prescription: Shengmai Yin with modifications.

High-protein foods

In the early stages of lung cancer, it has little effect on a person's digestive function. At this time, it is necessary to seize the time to supplement a large amount of high-protein food to promote the synthesis of a large amount of autoimmune protein, improve physical fitness, enhance resistance, and slow down the proliferation and expansion of lung cancer tumors.

Common high-protein foods: milk, beans, lean animal meat, etc.

High-fiber foods

After a certain period of development, lung cancer will cause changes in taste, loss of taste, and even anorexia. At this time, you should pay attention to choosing some high-fiber foods. This kind of food can stimulate the taste buds, enhance appetite, increase the intake of high-energy and high-protein foods, and also enhance your own immunity and delay tumor expansion.

Common high-fiber foods include vegetables and fruits.

Lung moistening and cough relieving foods

The main symptom of lung cancer is the formation of tumors in the lungs. In severe cases, a large amount of viscous fluid will be secreted. Therefore, during the treatment of lung cancer, it is best to eat some foods that moisten the lungs and relieve coughs to alleviate the symptoms.

Common foods that moisten the lungs and relieve coughs include: water chestnuts, lotus seeds, yam, lily, white fungus, etc.

High vitamin foods

Most vitamins have strong antioxidant properties and have a certain killing effect on cancer cells. Therefore, eating more of these foods during the treatment of lung cancer can enhance the treatment effect and delay the expansion and proliferation of cancer cells.

Common high-vitamin foods include: carrots, oranges, persimmons, spinach, celery, fungus, shiitake mushrooms, broccoli, tomatoes, etc.

High-calorie foods

Cancer cells proliferate N times faster than normal cells and are more active. Therefore, they require a large amount of calories to maintain their survival and avoid severe malnutrition of their own normal cells during the proliferation of cancer cells, which causes weight loss and a rapid decline in physical fitness, which is not conducive to the treatment of lung cancer.

Common high-calorie foods include: animal fat, cheese, various sweets and pastries, and sugary drinks, etc.

Patients with lung cancer must pay attention to their diet. There are many foods that cannot be eaten. The following mainly lists the foods that cannot be eaten by lung cancer.

Do not eat fishy, ​​greasy food

Patients with lung cancer have poor immunity and weak digestive function, so they should not eat fishy and greasy foods, such as hairtail, yellow croaker, black fish, shrimp, crab, eel, fatty meat, etc. On weekdays, they can eat more light and refreshing foods with less oil or no oil.

Do not eat smoked food

Smoked fish and smoked meat are smoked products with unique flavor and spicy smell, which are loved by people. However, eating too much smoked food can easily induce the growth of cancer cells, especially for patients who already have lung cancer. When food is smoked by high-temperature fireworks, it will be contaminated to a certain extent, and the content of benzopyrene (a carcinogen) in the food will increase greatly. In addition, the fat in meat will also form benzopyrene after being smoked at high temperature. Therefore, eating smoked food will accelerate the growth of cancer cells in patients with lung cancer.

Do not eat spicy food

Patients with lung cancer should not eat spicy or irritating foods. Spicy or irritating foods can irritate the trachea, damage the tracheal mucosa, and cause local congestion and edema in the trachea, which can easily lead to choking and coughing in lung cancer patients, and even cause mucosal rupture and bleeding. Spicy and irritating foods include: chili peppers, peppercorns, garlic, mustard, pepper, ginger, etc.

No smoking

Cigarettes contain more than 20 toxic substances, including nicotine, which are carcinogenic. Patients with lung cancer have weakened respiratory function and low respiratory immunity. Smoking can cause bronchi dilation, leading to congestion and edema of the respiratory tract, increased secretions in the airways, and thus aggravate symptoms of coughing, hemoptysis, and dyspnea.

No alcohol allowed

The alcohol in wine can stimulate the secretion of pituitary hormones in the human body, causing excessive accumulation of pituitary hormones in the body and promoting the growth of cancer cells, thereby accelerating the growth rate of cancer cells in patients with lung cancer.

No caffeine

Caffeine is an alkaloid extracted from certain foods. Moderate consumption can relieve fatigue and excite nerves. It is mainly used clinically to treat neurasthenia and coma recovery. However, large doses or long-term consumption can also cause damage to the human body, especially for patients with lung cancer, it is more likely to promote the growth of cancer cells.