What are the symptoms of lung cancer in an adult patient with unintentional weight loss, elevated inflammatory markers, and a slightly elevated complete blood count (CBC)?

Symptoms of Lung Cancer in Adults with Weight Loss and Elevated Inflammatory Markers

In an adult patient presenting with unintentional weight loss, elevated inflammatory markers, and elevated CBC, lung cancer most commonly manifests with cough (65% of cases), followed by hemoptysis (25-33%), dyspnea (17%), and chest pain (17.9%), though approximately 25% of patients remain asymptomatic at diagnosis. 1

Primary Pulmonary Symptoms to Assess

Your patient's presentation warrants immediate evaluation for the following cardinal respiratory symptoms:

• Cough is the most common symptom, occurring in 65% of patients at diagnosis, resulting from endobronchial irritation, parenchymal infiltration, or postobstructive pneumonia 1
• Hemoptysis occurs in 25-33% of patients and warrants immediate concern for endobronchial tumor—even scant blood-streaking should raise suspicion, particularly in smokers with COPD, as it may occur despite normal chest radiography 1
• Dyspnea affects approximately 17% at presentation and may accompany postobstructive pneumonia or pleural involvement 1
• Chest pain (17.9% of patients) is often nonspecific initially, but pleuritic pain suggests pleural invasion 1
• Localized or unilateral wheezing reflects endobronchial obstruction and should prompt evaluation for neoplasm 1

Systemic Symptoms Consistent with Your Patient's Presentation

The combination of weight loss and elevated inflammatory markers is highly concerning:

• Weight loss occurs in 8.3-33% of patients, with an odds ratio of 2.1 for lung cancer diagnosis within 6 months prior to presentation 1
• Fatigue presents in 4.8% of patients initially, with an odds ratio of 1.6 for diagnosis 6 months prior 1
• Anorexia and loss of appetite are common systemic manifestations, with appetite loss being the most frequent symptom across all tumor sites (38% of patients) 1, 2
• Anemia from chronic disease or bone marrow involvement may explain the elevated CBC findings 1

The presence of systemic symptoms like weight loss is associated with worse prognosis even within the same cancer stage 3

Symptoms of Intrathoracic Spread to Evaluate

As you proceed with evaluation, assess for these signs of local tumor extension:

• Hoarseness from recurrent laryngeal nerve palsy (more common with left-sided tumors), causing vocal cord paresis and predisposing to aspiration 1
• Pancoast syndrome from superior sulcus tumors includes shoulder/arm pain (brachial plexus invasion), Horner syndrome (ptosis, miosis, anhidrosis), and C8-T1-T2 distribution weakness and paresthesias 1
• Superior vena cava syndrome presents with facial and neck swelling, dilated neck veins, prominent chest wall venous pattern, and occasionally dysphagia, cough, headache, or blurred vision 1
• Dysphagia from subcarinal adenopathy compressing the mid-esophagus 1
• Phrenic nerve dysfunction manifesting as elevated hemidiaphragm 1

Symptoms of Distant Metastases

Given the systemic nature of your patient's presentation, evaluate for metastatic disease:

• Bone pain (5.9% initially, odds ratio 2.7 at 6 months pre-diagnosis) suggesting skeletal metastases to vertebral bodies or other bones 1, 3
• Headaches potentially indicating brain metastases, which may also present with nausea, vomiting, seizures, or mental status changes 3
• Confusion, nausea, constipation, and weakness from various paraneoplastic syndromes 1

Patients with distant metastases often have nonspecific systemic symptoms of anorexia, weight loss, or fatigue, with the most common metastatic sites being lymph nodes, liver, adrenal glands, bone, brain, and pleura 4, 3

Clinical Context and Diagnostic Approach

The majority of patients with lung cancer present symptomatically with advanced stage disease (stage IIIB or IV), while approximately 25% are asymptomatic at diagnosis (typically with earlier-stage disease). 1

For your patient with isolated involuntary weight loss and elevated inflammatory markers:

• Routine blood tests (complete blood count, erythrocyte sedimentation rate, and biochemical profile including liver enzymes and lactate dehydrogenase) typically provide the first diagnostic clue, leading to more targeted procedures 5
• Chest radiograph should be the initial imaging study, as unexplained pleural effusion should always raise concern for malignancy, and central tumors may cause mechanical airway obstruction with associated atelectasis or parenchymal consolidation 4
• If chest radiograph is negative but suspicion remains high, proceed to chest CT scan 6

Critical Pitfall to Avoid

In patients with nonspecific systemic symptoms such as weight loss, the chest radiograph will be helpful in focusing attention quickly on the lungs as the most likely primary site 4. However, liver metastases are often accompanied by symptoms of weakness and weight loss but typically are not associated with abnormal liver function tests until liver involvement is very advanced 4, 3. Therefore, normal liver function tests do not exclude metastatic disease.