What are the clinical manifestations of small cell lung cancer

We all know that small cell lung cancer is one of the basic types of lung cancer. It is also a type of lung cancer with a higher degree of malignancy. It belongs to undifferentiated cancer. Smokers are a high-risk group. So what are the clinical manifestations of small cell lung cancer? Let us learn about it together.

Smokers are the most susceptible group, and more than 90% of patients with small cell lung cancer have a history of smoking. The age of onset is 35-68 years old, with an average age of 60 years old, and there are more males than females.

Small cell lung cancer may be asymptomatic in the early stages. The most common symptoms at diagnosis are fatigue, cough, shortness of breath, weight loss, pain, and hemoptysis.

1. Symptoms and signs caused by the primary tumor

(I) Cough: This is a common early symptom, mostly an irritating dry cough. When the tumor causes bronchial stenosis, a persistent, high-pitched metallic cough may occur. The cough is often accompanied by a small amount of mucus sputum, and when secondary infection occurs, it may be combined with purulent sputum.

(ii) Hemoptysis: Most cases are blood in the sputum or intermittent bloody sputum. In a few cases, severe hemoptysis occurs due to erosion of large blood vessels.

(III) Chest tightness and shortness of breath: The tumor causes bronchial stenosis, or the tumor metastasizes to the hilar or mediastinal lymph nodes, and the enlarged lymph nodes compress the main bronchus or tracheal carina.

2. Symptoms and signs caused by tumor expansion in the chest cavity

(I) Chest pain: Tumors directly invade the pleura, ribs, or chest wall, causing varying degrees of chest pain. If the tumor invades the pleura, it will produce irregular dull pain or pain. If the tumor compresses the intercostal nerves, chest pain may affect their distribution area.

(ii) Superior vena cava syndrome: It is mostly caused by compression of the superior vena cava or, less commonly, blockage by a tumor thrombus in the cavity. It manifests as edema of the face, neck, and upper limbs, distended neck veins, congestion and varicose veins in the chest, and may be accompanied by dizziness, swelling of the head, and headache.

(III) Dysphagia: Tumors invade or compress the esophagus, causing dysphagia.

(iv) Choking and coughing: tracheoesophageal fistula or recurrent laryngeal nerve paralysis causes choking and coughing when drinking water or eating liquid food.

(V) Hoarseness: It occurs when the tumor directly compresses or metastasizes to lymph nodes compressing the recurrent laryngeal nerve (mostly on the left side).

(VI) Horner syndrome: Lung cancer located at the upper apex of the lung is called Pancoast cancer. When it compresses the C8 and T1 sympathetic nerve trunks, typical Horner syndrome occurs, with ptosis of the eyelid, constricted pupil, enophthalmos, and little or no sweating on the face and chest wall on the same side. When it invades the brachial plexus, local pain and limited shoulder joint movement occur, which is called Pancoast syndrome.

(VII) Lung infection: Inflammation that can occur repeatedly in the same area due to tumor blocking the airway is also called obstructive pneumonia.

3. Symptoms and signs caused by extrapulmonary metastasis

(i) Metastasis to lymph nodes: Supraclavicular lymph node metastasis is usually fixed and hard in texture. It gradually increases in size, increases in number, and fuses. It is usually painless.

(ii) Metastasis to the pleura: causing chest pain and pleural effusion, which is mostly bloody.

(III) Metastasis to bones: Most cases are insidious, with only 1/3 having local symptoms, such as pain and pathological fractures. When metastasis to the spine compresses the spinal nerve roots, the pain is persistent and worsens at night. Intraspinal metastasis can rapidly cause irreversible paraplegia syndrome in a short period of time.

(IV) Metastasis to the brain: Edema of intracranial lesions may cause intracranial hypertension, resulting in headache, nausea, and vomiting. The space-occupying effect may also lead to diplopia, ataxia, cranial nerve paralysis, weakness of one side of the limbs, and even hemiplegia.

(V) Metastasis to the pericardium: Pericardial effusion and even signs of pericardial tamponade may occur, with dyspnea, which is more obvious when lying flat, distended jugular veins, low blood pressure, decreased pulse pressure difference, systemic congestion, and decreased urine output.