Non-small Cell Lung Cancer

Signs and Symptoms

In approximately 5% of cases, usually of early-stage disease, no symptoms are evident and the initial presentation is a chance radiographic finding (e.g. X-ray) during routine examination for an unrelated condition. The clinical features of advanced lung cancer are usually caused by local development of the tumour in the lung and include bronchial obstruction (growth into the major air passages), invasion of the mediastinum (tumour growth into the central compartment of the chest), metastasis via the blood and lymphatic vessels, and disturbances of other body functions, in particular the endocrine, metabolic and neural systems.

The symptoms that present commonly in the clinic include the following:

Persistent cough. This is the most common initial symptom of lung cancer, but is often overlooked because it is also an indication of many other disorders. Patients over 40 years-old with a persistent cough or any patient who reports a change in the habit of their cough, should be referred for a chest X-ray.
Expectoration of sputum. The ‘bringing-up’ of sputum can be caused by spread of the tumour or by an infection. The cytological examination of sputum (identification of cells in the sample) is a useful non-invasive diagnostic tool that is particularly effective in the detection of centrally located tumours that are larger than 2cm.
Haemoptysis. The coughing-up of blood occurs as the only presenting symptom in 5% of patients.
Wheeze and stridor. Although these are two separate symptoms they both indicate the potential obstruction of a major airway.
Dyspnoea. Shortness of breath is an inevitable result of disease progression and increases with stage as a consequence of the volume of lung that is involved, increased risk of lung collapse and ensuing restriction of the airways. Progressive deterioration of the breathing may also signify malignant pleural, or less commonly pericardial, effusion (the abnormal collection of fluids).
Chest discomfort or pain. Chest discomfort occurs in up to 40% of patients at diagnosis. Discomfort or pain is usually ill-defined and may not be constant. Invasion of the ribs or vertebrae is often described as a gnawing, local pain.
Lack of energy or loss of interest in normal pursuits. These are significant symptoms that may be overlooked. The overall sensation of general ill-health is common in advanced undiagnosed lung cancer.
Symptoms of metastasis. The presenting symptoms can often result from metastatic spread to the lymph nodes, bones (particularly the ribs vertebrae, humeri and femora), liver, brain and skin.