Lung cancer often presents late with a worsening cough or chest pain reported. The chest pain is described as ‘fullness’ and ‘pressure’ in the chest. Other presenting symptoms include haemoptysis, malaise, weight loss, dyspnoea and hoarseness. The table shows the frequency with which symptoms are reported at presentation.⁴² The symptoms depend on the type of cancer and it’s stage, obstructive features may arise from benign or malignant tumours, and paraneoplastic disorders may also be present. Paraneoplastic diseases are thought to be caused by the release of hormones and proteins such as the anti-Hu antibodies, anti-amphysin antibodies amongst others. ^43,44 Patients can (infrequently) present with symptoms of these paraneoplastic diseases such as sensory neuropathy, encephalitis, encephalomyelitis, subacute cerebellar degeneration, myelopathies, neuropathies, Eaton-Lamberts syndrome, myasthenic syndrome, polymyopathy, ectopic adrenocorticotrophin syndrome, SIADH and hypercalcaemia.

Symptoms may result from the local invasion of lung cancers; involving the oesophagus to cause dysphagia, or the Superior Vena Cava causing facial oedema and distension of the superficial veins of the head and neck. Symptoms from distant metastases may also be present, such as neurological defect or personality change with brain metastases.

On examination there are not often any abnormal signs. There may be enlarged supraclavicular lymph nodes (particularly in small cell carcinoma), pleural effusion or lobar collapse, unresolved pneumonia or signs of associated disease such as COPD or pulmonary fibrosis. Particular attention should be paid to the social history, particularly smoking and employment, to evaluate lung cancer risk factors.