Lung Cancer Complications

How to recognize potential problems related to lung cancer

Lung cancer complications can range from blood clots and hypercalcemia to malignant pleural effusions and much more, but having an awareness of these conditions, and symptoms to watch for, can make a difference in getting the prompt care you will need. 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.


Malignant Pleural Effusion

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% of people with lung cancer at some time, 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 can 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 Fluid is then withdrawn to help with symptoms as well as to analyze under a microscope.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.

A different approach is to place a stent in the pleural space. The procedure is done in the hospital, but allows a person with lung cancer (or their family caregivers) to withdraw fluid at home periodically.

Much less commonly, the pleura may be removed (pleurectomy) so that fluid can no longer accumulate in the fluid space.


Blood Clots (Deep Venous Thrombosis) and Pulmonary Emboli

Blood clots in the legs or pelvis occur in 3% to 15% of people with lung cancer and can occur at any time. In fact, blood clots are sometimes the first symptom of lung cancer. 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

Risk factors include surgery, chemotherapy, travel, and inactivity. 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. If you will be traveling by plane or will be driving for an extended period of time, talk to your doctor about preventive measures for blood clots.


Blood clots are most often treated with blood thinners, and many people with lung cancer require treatment for an extended period of time.


Spinal Cord Compression

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. If the diagnosis is suspected, physicians will usually have a patient lie flat on their back until a work-up is done. The most common treatment is a combination of steroids and radiation therapy, though in some cases surgery may be required to stabilize the spine.


Superior Vena Cava Syndrome (SVC Syndrome)

A complication known as superior vena cava syndrome (SVC syndrome) occurs in around 2% to 4% of people with lung cancer, especially with tumors that arise in the upper portions of the lungs (superior sulcus tumors). 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.


The most common symptom is swelling of the face, but the arms and upper body may swell as well. Shortness of breath, difficulty swallowing, and hoarseness may also occur. On exam, a physician may see widening of the veins in the neck and chest.


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.


Pulmonary Hemorrhage

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%.

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



Hypercalcemia in cancer patients (an elevated level of calcium in the blood) is a common finding, occurring around 10% to 30% 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.


Febrile Neutropenia

Most people have heard that chemotherapy can reduce white blood cell counts (chemotherapy-induced neutropenia) which can 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.


Symptoms can vary depending on the site of the infection. For example, a bladder or kidney infection may present with back pain or painful urination in addition to a fever. Lung infections may present with a cough (or a worsening cough), production of yellow-green phlegm, worsening shortness of breath, etc.


When someone with a low white blood cell count presents with a fever, physicians often check for infections at multiple sites. This can include a urinalysis to look for a bladder infection, a chest X-ray or chest CT to look for evidence of pneumonia, sinus X-rays, blood cultures, and more. A complete blood count (CBC) is often done, but results can be difficult to interpret in those who have had recent chemotherapy. In this case, physicians often look at a blood smear to determine if immature white blood cells are present; a sign of infection.


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.

When to Call Your Doctor

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.


Heart Disease

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. Radiation therapy can also increase the risk of several types of heart disease.

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 your own advocate, ask questions, and don't dismiss any symptoms that worry you.


Depression and Suicide in Cancer Patients

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.

Depression vs. Grief

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% to 25% 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.

A Word From Verywell

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 slowly 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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