Lung Cancer Complications

Lung cancer complications are fairly common, but having an awareness of these conditions, and symptoms to watch for, can make a difference in getting the prompt care you will need. From blood clots, to hypercalcemia, to malignant pleural effusions, having a little knowledge can go a long way in making sure you get the best care possible when you need it.. Certainly, life is stressful enough with lung cancer with adding more worries, but these complications may not only reduce your quality of life but can be life-threatening if left unchecked.

As you read through these potential complications, talk to your family about what symptoms may mean an emergency with lung cancer. Then talk about your wishes and plan a strategy in case such an emergency should occur.

1

Malignant Pleural Effusion

A malignant pleural effusion is a complication of lung cancer
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A malignant pleural effusion refers to the presence of a pleural effusion (collection of fluid in the pleural space) in which cancer cells are present. This complication occurs in roughly 30 percent of people with lung cancer and defines a cancer as stage 4 (metastatic) lung cancer.

Doctors may suspect a pleural effusion based on your symptoms or an imaging study such as a chest x-ray, CT scan of your chest, or MRI.

The most common symptom is shortness of breath, but other symptoms may be present as well. These include a cough which is often positional (the cough gets better or worse depending on the position you are sitting or lying in) and chest pain.

If a doctor suspects a pleural effusion, based on symptoms and imaging studies, she may suggest a thoracentesis. In this procedure, a long needle is inserted through the chest wall and into the pleural space (the area between the pleural membranes lining the lungs.) Fluid is then withdrawn to help with symptoms as well as to analyze under a microscope. 

The presence of cancer cells in pleural fluid diagnoses a malignant pleural effusion, but not all pleural effusions in people with lung cancer are malignant. In contrast, more than half of effusions, even in people with advanced lung cancer, are benign.

For many people with malignant pleural effusions, the effusion quickly recurs after treatment. If this is affecting your quality of life your doctor may recommend a procedure called a pleurodesis. In this procedure, a chemical (talc) is inserted through a thoracotomy tube into the pleural space. The talc then causes inflammation, eventually causing the 2 layers of the pleura to scar together so that fluid may no longer accumulate in the space.

2

Blood Clots (Deep Venous Thrombosis) and Pulmonary Emboli

Blood clots can be a complication of lung cancer
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Blood clots in the legs or pelvis occur in 3 percent to 15 percent of people with lung cancer and can cause significant problems. Clots that are present in the leg can cause pain and swelling, which can become life-threatening if the clot breaks away and travels to the lungs (pulmonary emboli).

Risk factors include surgery, chemotherapy, inactivity, and travel whether by car or by plane. Simply having cancer increases the risk.

Symptoms may include redness or swelling in the calves or legs, but in at least a third of people with lung cancer, there is an absence of symptoms. When pulmonary emboli develop, people may develop sharp chest pain and severe shortness of breath.

Keep in mind that blood clots are not reserved for people with long-standing and advanced cancer. In fact, the incidence of blood clots is high even in those newly diagnosed with lung cancer, and these clots are sometimes the first symptom of the disease.

3

Spinal Cord Compression

Spinal cord compression can be a complication of lung cancer
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Spinal cord compression may occur in people with lung cancer when the cancer spreads to bone (bone metastases) causing weakening and collapse of the bones of the spine. 

Symptoms usually begin with pain in the neck or lower back and may progress to weakness and loss of sensation in the extremities. If the spinal cord is damaged in the lower spine, a medical emergency called cauda equina syndrome may develop. When this occurs, people may develop loss of bladder and bowel function in addition to severe pain. Emergency treatment is needed to preserve as much function as possible.

4

Superior Vena Cava Syndrome (SVC Syndrome)

Superior vena cava syndrome can be a complication of lung cancer
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A complication known as superior vena cava syndrome (SVC syndrome) occurs in around 2 percent to 4 percent of people with lung cancer, especially with tumors that arise in the upper portions of the lungs. These tumors can press on the superior vena cava, the large vein that returns blood from the upper body to the heart obstructing blood flow and resulting in characteristic symptoms.

These symptoms may include swelling of the face, arms, and upper body, widening of the veins in the neck and chest, shortness of breath, difficulty swallowing, and hoarseness.

Treatment is aimed at reducing the pressure from the tumor, often through the use of chemotherapy or radiation, and using blood thinners to prevent clotting.

Emergency treatment is needed if superior vena cava syndrome develops. Don't wait. Call 911.

5

Pulmonary Hemorrhage

Man coughing, at home
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Lung tumors can bleed internally in the lungs, but also into the bronchi. The symptom of coughing up blood with lung cancer can be a medical emergency, and even a small amount of blood should be investigated thoroughly. As little as a teaspoon of blood is considered a medical emergency.

Massive hemoptysis (coughing up blood) is considered anything over 100 cc of blood, or 1/3 of a cup. When this occurs the mortality rate may be as high as 30 percent.

With emergent care, physicians are often able to locate the source and stop the bleeding, but time is critical. Don't wait. Call 911.

6

Hypercalcemia

Hypercalcemia is a common complication of advanced cancer
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Hypercalcemia in cancer patients (an elevated level of calcium in the blood) is a common finding, occurring in 10 percent to 15 percent of people with advanced cancer.

Symptoms of hypercalcemia in cancer patients may include muscle and joint pain and spasms, nausea, weakness, and confusion. Untreated, this condition can result in coma, and eventually death.

There are a few different ways in which people with cancer can develop hypercalcemia. One is through the release of calcium from bone metastases. This can be worsened by kidney dysfunction when the kidneys are unable to remove calcium from the blood properly. Some tumors may also release substances that act to stimulate the release of calcium from bones. Even though the symptoms are non-specific and can be confused with other conditions, the diagnosis is fairly easy to make with a simple blood test.

Treatment options depend on the level of calcium in the blood and may include IV fluids, steroids, drugs known as bisphosphonates, and sometimes dialysis when symptoms are severe.

7

Febrile Neutropenia

A fever combined with a low white blood cell count can be a complication of chemotherapy
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Most people have heard that chemotherapy can reduce white blood cell counts (chemotherapy-induced neutropenia) which pose a risk of infection, but it's not always known how serious this can be. We do have some excellent antibiotics available now to combat neutropenia (a type of low white blood cell count caused by chemotherapy) induced infections, but far too many people are not treated until it's too late.

Treating these infections often requires a combination of broad-spectrum antibiotics, and it's critical that a physician is aware you are on chemotherapy if you present with an infection.

Some oncologists recommend calling with any signs of infection or a temperature of 101.5 F or higher. That said, everyone with lung cancer is different, and for some people even a very low-grade fever should prompt a call. Make sure to ask your oncologist for specific guidelines on symptoms to watch for, and when to call.

It's also important to educate yourself about how you can lower your infection risk. For example, there are some foods that should be avoided, animals that should not be touched, and more.

8

Heart Disease

U.S. Hospitals Expand Specialty Care Centers FAYETTEVILLE, NC - AUGUST 04: Heart patient Maxine Bennett talks to a nurse from her bed at Cape Fear Valley Heart and Vascular Center August 4, 2010 in Fayetteville, North Carolina. Health care providers around the country are increasingly specializing their care by creating distinct treatment centers for various disorders and acquiring the latest high-tech medical equipment.
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Both radiation therapy to the chest and some chemotherapy drugs can predispose to heart disease, and cardiac (heart) concerns are one of the most important long-term side effects of chemotherapy.

Different medications can predispose to different types of heart conditions, whether coronary artery disease, valve disorders, or heart failure.

Talk to your doctor and ask about your risk of heart disease related to your treatments. Are there any particular symptoms that you should watch for? Are there any tests you should have in order to monitor your heart? The field of cardiac oncology is blossoming, but many people remain uninformed about the potential for these complications. Be our own advocate, ask questions, and don't dismiss any symptoms that worry you.

9

Depression and Suicide in Cancer Patients

Depression and suicide can be a complication of lung cancer

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Depression may not sound like an emergency complication relative to some of the other problems discussed here, but it is. Not only does depression in cancer patients reduce quality of life, but a 2011 study found that depressive symptoms early on in the treatment of advanced non-small cell lung cancer was associated with lower overall survival from the disease.

It can be difficult to separate clinical depression from grief. Who doesn't feel down upon learning they have cancer? Yet depression goes one step further. Symptoms of concern include a sense of hopelessness, helplessness, poor energy, and poor concentration.

Overall 15 percent to 25 percent of people with cancer experience depression. This number appears to be even higher for people with lung cancer, as the stigma of the disease can lead to despair.

In addition to depression, suicide is an important concern for people with cancer. The risk of suicide is much greater in men, especially older men. What may surprise you is that depression and suicide aren't usually something that's considered just when treatment has failed. In fact, the greatest risk of suicide appears to be in the first year, especially the first week following a diagnosis. In light of this, what should you know about cancer and suicide?

It can be disconcerting and frankly depressing to review all of the potential complications of lung cancer. It's important to note that most people do not have all of these complications and many people will have none. We review these not to cause distress, but to hopefully improve awareness so that any complications you have can be addressed as soon as possible. Treatments and survival rates are improving for advanced lung cancer, but with people living longer, there is also a greater potential for problems along the way.

While many people hate to burden their loved ones talking about potential problems, doing so can help your family help you if the need should arise. Hopefully, it will be a discussion that never needs to be acted upon.

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