What are the Various Clinical Symptoms (Physical signs) in Bronchial Carcinoma?

The frequencies of the common symptoms of lung cancer on presentation are described below:

Pain and discomfort are often described as fullness and pressure in the chest. Sometimes the pain may be pleuritic owing to invasion of the pleura or ribs.

Commonly there are no abnormal physical signs. Enlarged supraclavicular lymph nodes are frequently found with small cell carcinoma.

There may be signs of a pleural effusion or of lobar collapse. Signs of an unresolved pneumonia or of associated underlying disease (eg, diffuse pulmonary fibrosis in asbestos) may be present.

Direct Spread:

The tumour may directly involve the pleura and ribs. Carcinoma in the apex of the lung can erode the ribs and involve the lower part of the brachial plexus(C8, T1 and T2), causing severe pain in the shoulder and down the inner surface of the arm (Pancoast’s tumour).

The sympathetic ganglion may also be involved, producing Horner’s syndrome. Further extension may involve the recurrent laryngeal nerve as it passes down the aortic arch, causing unilateral vocal cord paresis with hoarseness and a bovine cough, and rarely the tumour may cause spinal cord compression.

Bronchial carcinoma can also directly invade the phrenic nerve, causing paralysis of the diaphragm. It can involve the oesophagus, producing progressive dysphagia, and the pericardium, producing pericardial effusion and malignant dysrhynthmias.

It can also involve the superior vena cava, producing superior vena caval obstruction leading to early morning headache, facial congestion and oedema involving the upper limbs, the jugular veins are distended as the veins on the chest that form a collateral circulation with veins arising from the abdomen.

The following table gives the frequency of the common presenting symptoms of bronchial carcinoma:

Symptom Frequency (%)
Cough 41
Chest Pain 22
Cough and Pain 15
Coughing blood 7
Chest Infection 5
Malaise 5
Weight Loss 5
Shortness of breath 5
Hoarseness 5
Distant Spread 5
No symptoms 5

Symptoms due to tumour in the bronchus:

Cough:

This is the most common early symptom. Sputum is purulent if there is secondary bacterial infection. The bronchial carcinoma itself does not produce sputum, but patients often have associated chronic bronchitis which is also caused by cigarette smoking.

Haemoptysis:

This is a common symptom of carcinomas arising in large central bronchi but is less frequent in the peripheral tumours. Repeated slight Haemoptysis is a common and characteristic feature. Centrally situated tumours can invade large pulmonary vessels causing massive Haemoptysis, which is often fatal.

Breathlessness:

This may occur early when the tumour obstructs a large bronchus resulting in collapse of a lobe or lung. The large pleural effusion may also cause breathlessness of rapid onset.

Stridor:

This develops when spread of the tumour to the subcarinal and paratracheal glands causes compression of the main bronchi and lower end of trachea.

Bronchial obstruction often causes distal infection because there is interference with bronchial drainage. This permits the development of pneumonia which may either be slow to respond to treatment or recurs at the same site. A lung abscess can develop in the infected lung distal to a bronchial tumour.

 

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