Chest pain chest pain or discomfort is a common symptom in early stage lung cancer

Chest pain chest pain or discomfort is a common symptom
that may occur even in early stage lung cancer, without
frank evidence of invasion of the pleura, chest wall, or mediastinum.
the origin of such discomfort is unclear because
the lung parenchyma is not supplied with pain fibers. patients
may develop retrosternal pain from hilar and mediastinal adenopathy
or at times from pericardial involvement. pain from
pleural involvement or rib metastasis is usually more localized
and severe than the nonspecific chest pain associated with lung
cancer. appropriate analgesics, including narcotics, should be
used along with definitive antitumor therapy.
it is not unusual for patients with chest pain to undergo
evaluation for coronary artery disease, including cardiac catheterization.
given the prevalence of coronary artery disease
among smokers, it is not surprising that such patients have
been discovered to have lung cancer from a chest radiograph
performed prior to or after coronary artery bypass surgery.
dyspnea dyspnea is a fairly common symptom in patients
with lung cancer. most lung cancer patients have dyspnea
during the course of their disease. 27 dyspnea could be
from various causes, including the tumor itself or the underlying
chronic lung disease, and/or could be multifactorial
(table 23. 2). patients could also experience dyspnea from the
complications of radiation therapy administered with or without
chemotherapy. incidence of dyspnea is often higher when
pain and anxiety are high. 28
management of dyspnea requires proper identification
and treatment of the underlying etiology, with recognition
that the tumor is not always the primary cause of the dyspnea.
symptomatic management of dyspnea includes judicious use
of oxygen, opioids, and sedatives. use of oxygen is clearly beneficial
in the treatment of hypoxic patients with dyspnea. 29, 30
the role of oxygen, in treating dyspnea in patients who are not
hypoxic, is unclear. there are studies that suggest that oxygen
may be helpful in patients with nonhypoxic dyspnea, 31, 32 and
based on this limited data, it is appropriate to offer a trial of
oxygen in all cancer patients with dyspnea.
opioids have been used to relieve dyspnea for many years.
there is a concern about the potential of inducing respiratory
failure with opioid use, particularly in patients with preexisting
respiratory impairment. 33 however, studies in cancer patients
suggest that opioids do not compromise respiratory function
when titrated correctly. 34, 35 respiratory depression is more
a function of rate of change of the dose of opioids and the
history of previous exposure to opioids. 36 opioids administered
through both parenteral and oral routes appear to be beneficial
in relieving dyspnea. 37 nebulized morphine was also assessed
but was found to be no better than nebulized saline, when
the data of randomized trials were analyzed. 37 sedatives and
tranquilizers have also been used to relieve dyspnea. evidence
supports the use of promethazine or chlorpromazine alone or
in combination with morphine for the treatment of dyspnea,
but the evidence for the use of benzodiazepines is lacking. 38–41
systemic steroids should be considered in patients with acute
exacerbation of copd and in patients with treatment-related
lung toxicity.
dyspnea is an extremely distressing symptom for the patient
and the family. relief of dyspnea to the maximum extent
possible should be a primary goal of the treating physician.
education regarding complimentary methods such as breathing
and relaxation techniques has been shown to be helpful for
patients dealing with dyspnea. 42 it is also important to educate
the patient and the family about measures that can be taken to
relieve dyspnea such as anticipatory administration of opioids,
taking frequent rests during physical activities, and sitting near
an open window or in front of a fan.