Dr. Karp's Korner
Dr. Daniel Karp, from the University of Texas M.D. Anderson is our medical advisor to the board. With extensive experience in the field of thoracic medicine Dr. Karp along with other colleagues from M.D. Anderson will periodically write an article and bring the latest in research to our website. Please visit the site often to hear the latest in developments regarding lung cancer and the inroads that M.D. Anderson is having in the fight against this deadly disease.
SYMPTOMS OF LUNG CANCER
It is truly unfortunate that most patients with lung cancer are diagnosed only after the cancer has spread to lymph nodes or elsewhere in the body. Approximately 10% of lung cancers are found through screening or inadvertently and many of these can be successfully removed and cured surgically. A small tumor in the center of the lung is unlikely to produce symptoms until it has spread to central lymph nodes or some other area. An important exception would be those uncommon lung cancers that produce some substance or hormone that produces a distant effect (paraneoplastic syndrome). Those include swelling of the fingertips (clubbing), muscle weakness (myasthenic syndrome), and steroid excess (Cushing’s Syndrome).
However for the large majority of patients, the diagnosis of lung cancer is made following some symptom or finding that prompts a chest x-ray and chest CT scan. Common symptoms such as breathing difficulty, shortness of breath, or worsening cough can be very non-specific and occur in persons with colds, flu, or bronchitis and consequently, many patients will receive antibiotics and other treatments which can result in a delay of weeks or even months.
Other symptoms such as fatigue, skeletal pain, or weight loss can produce a diagnostic dilemma and even cause the best physicians to pursue other avenues of investigation such as endocrine problems, arthritis, a pulled muscle, consequences of aging, or even severe stress or emotional issues.
Many vascular symptoms can masquerade as another unrelated problem. These include facial swelling from vena cava obstruction (allergy or drug reaction), leg swelling (heart problems), or stroke or seizure due to the all too common brain metastasis.
Finally, some symptoms are dramatic and severe such as pain on taking a deep breath, coughing up blood, marked hoarseness, wheezing, or swallowing difficulty and warrant a thoracic evaluation as an urgent matter.
It is important to remember that a chest x-ray and and/or a CT scan is an important part of any comprehensive medical evaluation. It is certainly appropriate to administer a course of antibiotics for any findings that suggest a pneumonia or bronchitis. Nevertheless, it is important to obtain imaging studies in most middle aged patients with any severe medical issue – especially those experiencing a change in their breathing pattern. For our next Karp Korner we will explore the diagnostic studies that make up the appropriate investigation “package” for a newly diagnosed patient.