PURPOSE: Most descriptions of the presentation of lung cancer (LC) are reported from the pre-CT era. Advances in imaging technology may have led to a change in the portion of patients with LC presenting without symptoms. LC screening has yet to be proven beneficial. This study was conducted to update information on modern presentation of LC and look for characteristics of asymptomatic individuals to help in the selection of populations to screen.
METHODS: Retrospective chart review of 288 patients with LC presenting within past 2 years.
RESULTS: Of the 288 patients (147 F/141 M; mean age: 65, range 39 to 86 yrs), 42 (14.6%) were asymptomatic on presentation and 144 (48%) had COPD. Common symptoms on presentation included: cough (42.1%), dyspnea (41%), hemoptysis (19%), weight loss (25%), and chest pain (12.5%). Compared to symptomatic patients, asymptomatic patients were less likely to have COPD (28.6% vs 50%, p=0.01), more likely to have previous cancer (21.4% vs. 7.3%, p=0.008), and have a higher FEV1 (2.6L vs. 2L, p=0.009). There was no significant difference between the groups in terms of smoking history or stage at presentation. Compared to patients with COPD, those without COPD had a lower incidence of cough (33% vs. 57%, p=<0.001), dyspnea (31% vs. 54%, p=<0.001), and weight loss (19% vs. 32%, p=0.013). They were more likely to be female (58% vs. 42%, p=0.023), and had cancer detection initially by a chest CT (26% vs. 16%, p=0.056). They were less likely to be diagnosed via bronchoscopy (52% vs. 66%, p<0.01) and had a shorter duration of symptoms (11 weeks vs. 15 weeks, p=0.004).
CONCLUSION: Despite advances in technology the presenting symptoms of LC have not changed over time. There are few unique features of asymptomatic patients or those with early stage LC that can help to guide patient selection for screening programs. Individuals with a prior history of malignancy may be one group to focus on.
CLINICAL IMPLICATIONS: Presenting features of LC have not changed with the advances in imaging technology.
DISCLOSURE: Chirag Pandya, None.