The most common symptoms of lung cancer are chronic and/or worsening cough, shortness of breath with exertion, weight loss, easy fatigability, and chest wall pain. Chronic cough is most often caused by cigarette smoking and chronic cough occurs in almost all patients with lung cancer. The appearance of chronic cough with or without sputum production should raise a suspicion of lung cancer.
Chronic cigarette smoking causes chronic bronchial irritation and inflammatory changes. This leads to increased mucous production which can be difficult to expectorate, thus leading to pulmonary infections. Squamous cell or epidermoid carcinomas tend to occur centrally and frequently partially occlude the airway (bronchus) leading to inability to raise secretions below the obstructing tumor. This frequently leads to post-obstructive pneumonia. It is caused by a tumor growing on the wall of a bronchus interfering with coughing up sputum.
Pneumonia is usually caused by an infectious agent (bacterial or viral). However, patients who are at high risk by history for developing lung cancer (as this patient was) and/or suspected of truly having a “post-obstructive” pneumonia caused by a tumor growing on the bronchial lining must have a timely repeat x-ray (usually at ~6 weeks) to demonstrate complete clearing of the pneumonic infiltrate or consolidation. A chest CT scan can also be done after allowing for resolution of the pneumonia by natural healing processes. If there is any residual infiltrate/consolidation/abnormality at a time when resolution should have occurred, a bronchoscopy and biopsies are indicated.
Symptoms of lung cancer medical expert witness specialties include oncology, internal medicine, radiology, pathology, lung transplant, thoracic surgery, internal medicine, family medicine, and hospitalist medicine.