Question

lung cancer

52 year old female smoker with a history of emphysema comes in for routine yearly checkup.

Over the past year she has experienced a mild increase in her chronic dyspnea, with a dramatic worsening over the past 4 months.

she has begun coughing more frequently.

base on this limited history, what is your differential diagnosis ?

what questions about her symptoms would you like to ask this patients ?

patient is now dyspneic on walking to her bathroom and back, denies change in her chronic production of scant sputum, denies fever and hemoptysis. has had increasing discomfort in her left chest with deep breathing and cough, denies substernal chest pain, palpitatio or edema, admits to a 10 pound weight loss over he past year

what questions about her past medical history would you like to ask ?

Answer 1

common symptoms of lung cancer are:

• A cough that does not go away or gets worse
• Coughing up blood or rust-colored sputum (spit or phlegm)
• Chest pain that is often worse with deep breathing, coughing, or laughing
• Hoarseness
• Weight loss and loss of appetite
• Shortness of breath
• Feeling tired or weak
• Infections such as bronchitis and pneumonia that don’t go away or keep coming back
• New onset of wheezing

• Some lung cancers can make hormone-like substances that enter the bloodstream and cause problems with distant tissues and organs, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes. Sometimes these syndromes can be the first symptoms of lung cancer. Because the symptoms affect organs other than the lungs, patients and their doctors may suspect at first that a disease other than lung cancer is causing them.

  Some of the more common paraneoplastic syndromes associated with lung cancer are:

• SIADH (syndrome of inappropriate anti-diuretic hormone): In this condition, the cancer cells make a hormone (ADH) that causes the kidneys to retain water. This lowers salt levels in the blood. Symptoms of SIADH can include fatigue, loss of appetite, muscle weakness or cramps, nausea, vomiting, restlessness, and confusion. Without treatment, severe cases may lead to seizures and coma.
• Cushing syndrome: In this condition, the cancer cells may make ACTH, a hormone that causes the adrenal glands to secrete cortisol. This can lead to symptoms such as weight gain, easy bruising, weakness, drowsiness, and fluid retention. Cushing syndrome can also cause high blood pressure and high blood sugar levels (or even diabetes).
• Nervous system problems: Lung cancer can sometimes cause the body’s immune system to attack parts of the nervous system, which can lead to problems. One example is a muscle disorder called the Lambert-Eaton syndrome, in which the muscles around the hips become weak. One of the first signs may be trouble getting up from a sitting position. Later, muscles around the shoulder may become weak. A rarer problem is paraneoplastic cerebellar degeneration, which can cause loss of balance and unsteadiness in arm and leg movement, as well as trouble speaking or swallowing.
• High blood calcium levels (hypercalcemia): This can cause frequent urination, thirst, constipation, nausea, vomiting, belly pain, weakness, fatigue, dizziness, confusion, and other nervous system problems
• Excess growth or thickening of certain bones: This is often in the finger tips, and can be painful.