Other symptoms may be present at a later stage in relation to:
invasion of the chest wall, which essentially manifests itself as pain.
invasion of mediastinal structures: paralysis of the diaphragm due to invasion of the phrenic nerve; dysphonia due to invasion of the recurrent nerve;
dysphagia by direct infiltration of the esophagus or, more often, by lymph node compression; Superior Vena Cava syndrome due to obstruction of the vessel in question with the characteristic appearance of edema of the upper body districts or “mantle” due to direct infiltration or lymph node compression and associated secondary venous thrombosis.
pleural occupation: worsening dyspnea due to the presence of reactive or metastatic pleural effusion.infiltration of the brachial plexus and stellate ganglion (Pancoast tumor or superior sulcus): pain in the ipsilateral upper limb; Claude-Bernard-Horner syndrome (miosis, eyelid ptosis and enophthalmos).
In some cases, paraneoplastic syndromes may be present, associated with characteristic symptoms that can precede the diagnosis by many months and are represented by:Hypertrophic pulmonary osteo-arthropathy with a typical sign represented by digital hippocratism with “drumstick” fingers and “watch glass” nails;
Syndrome of inappropriate ADH secretion with symptoms characterized by nausea, vomiting and confusion due to a significant decrease in the concentration of sodium in the blood;Syndrome of inappropriate
ACTH secretion (Cushing’s Syndrome) characterized by the production of ACTH-like substances that cannot be suppressed by cortisone which manifests itself with progressive weakness, hyperglycemia, alkalosis, lowering of serum potassium concentrations;
Hypercalcemia due to increased production of parathyroid hormone and prostaglandin PGE2 by the neoplasm;Paraneoplastic myopathies and neuropathies characterized by myasthenic-like syndromes (muscle fatigue) due to the presence of IgG antibodies that interfere with the muscular endplate.
How is lung cancer diagnosed?
The diagnosis of lung cancer can occur accidentally (during tests performed for other reasons) or derives from a diagnostic path that starts from the clinical suspicion, although the symptoms of lung cancer only become characteristic in an advanced stage.
To identify the presence of lung cancer, the following are usually done:Imaging tests: chest X-ray and CT scan.Sputum cytology: observing the sputum produced during cough under a microscope can sometimes reveal the presence of lung cancer cells.
Biopsy and histological examination: a sample of cells taken during a biopsy performed in different ways is examined (by bronchoscopy, mediastinoscopy, percutaneous with CT scan). A biopsy sample may also be taken from lymph nodes or other areas where the cancer has spread, such as the liver.
The histological examination allows you to diagnose the type of tumor and determine the prognosis and guide treatment.Once lung cancer is diagnosed, you need to stage the cancer, that is, understand how extensive and how severe it is to decide which therapy is most appropriate.
Staging tests (to understand what stage the cancer is actually at) may include different imaging procedures such as CT, MRI, positron emission tomography (PET), and bone scans.Lung cancer stages are indicated by Roman numerals ranging from 0 to IV, with the lowest stages indicating cancer that is limited to the lung. At stage IV, the cancer is considered advanced and has spread to other areas of the body.
How are lung cancers treated?
Lung cancer treatment is based on a number of factors, such as general health status, type and stage of the cancer, and patient preferences.Usually a team of multidisciplinary specialists (usually consisting of oncologist, pathologist, pulmonologist, radiotherapist, radiologist, thoracic surgeon) works together to determine the best treatment options.
Surgery can be considered a valid option if the tumor is limited to the lungs. The surgeon removes lung cancer and a margin of healthy tissue. Procedures to remove lung cancer include:
wedge resection: to remove a small section of lung that contains the tumor and a margin of healthy tissue;segmental resection: a larger portion of the lung is removed, but not an entire lobe;Lobectomy: the entire lobe of a lung is removed;Pneumonectomy: An entire lung is removed.