Lung cancer Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, Saarah T. Alkhairy M.D, Dildar Hussain, MBBS [2]

The majority of lung cancers present with advanced disease because the symptoms tend to occur later in the course of the disease. Patients experience non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, difficulty speaking, difficulty swallowing, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention. There are a variety of complications associated with lung cancer, such as pleural effusion, leg weakness, paresthesias, bladder dysfunction, seizures, hemiplegia, cranial nerve palsies, confusion, personality changes, skeletal pain, pleuritic pain, atelectasis, and bronchopleural fistula. The prognosis of lung cancer is poor if diagnosed at the advanced stages.

• The majority of lung cancers present with advanced disease because the symptoms tend to occur later in the course of the disease.^[1]
• Patients experience non-specific symptoms such as cough, hemoptysis, dyspnea, chest pain, difficulty speaking, difficulty swallowing, lack of appetite, weight loss, and fatigue from 3 weeks to 3 months before seeking medical attention.
• Depending on the duration of the presence of symptoms, the tumor cells may double 20 times.^[1]
• In more advanced disease, the tumor may spread to other organs such as the spinal cord, brain, and bone.
• These patients may develop symptoms such as leg weakness, paresthesias, bladder dysfunction, seizures, hemiplegia, cranial nerve palsies, confusion, personality changes, skeletal pain, and pleuritic pain.^[1]
• Once the cancer spreads to the other organs, it is most likely fatal.
• Most nonsmoking individuals with lung cancer present with advanced disease at diagnosis( unresectable stage III or metastatic stage IV). 10% – 25% have brain metastases at diagnosis, particularly in the presence of certain genomic alterations such as EGFR mutations.

General Complications

The complications associated with lung cancer are:^[2][3]

• Breathing difficulties

• Lung cancer patients can experience trouble in breathing especially when tumors grow and block the airways. Also, it is possible for fluid to build up in the lungs of the patients which can negatively affect breathing.

• Pneumonia

• If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. This can lead to accumulation of secretions behind the blockage, predisposing the patient to pneumonia.

• Hemoptysis

• Occasionally, lung cancer can cause bleeding in the airways which can result in hemoptysis.

• Pain

• It is possible that lung cancer will cause pain as well, especially if it spreads to the pleura or other areas of the body, like the bones.

• Pleural effusion

• Lung cancer can cause fluid to build up in the lungs which can cause breathing difficulties.

• Metastasis

• In many cases, lung cancer will spread to other parts of the body. Some of the more common places lung cancer metastasizes to are the bones, liver, brain, and adrenal glands.

• Horner’s syndrome

• Tumors in the apex of the lung, known as Pancoast tumors, may invade locally into the sympathetic nervous system leading to Horner’s syndrome.

• Superior vena cava syndrome
  • SVCS is a group of symptoms caused by obstruction of the superior vena cava. More than 60% of cases of superior vena cava obstruction are caused by malignancies, especially with a tumor outside the vessel compressing the vessel wall.

Surgical Complications

• Bronchopleural fistula

• It is when air leaks from a pneumonectomy bronchial stump.
• Approximately 2% of the patients that undergo a pneumonectomy experience this.
• It will most commonly occur approximately 7 to 10 days after surgery.

• Hemothorax

• Atelectasis
• Sputum retention

The prognosis of lung cancer is poor and it depends on the following factors:

• Whether or not the tumor can be removed by surgery
• Stage of the cancer
• Patient’s general health
• Whether the cancer has just been diagnosed or has recurred

Non-small Cell Lung Cancer Survival Rate by Stage^[4]

Small Cell Lung Cancer Survival Rate

• To view the prognosis among patients with small cell lung carcinoma, please click Here.

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