Unusual symptoms of lung cancer — a case report

Abstract

Lung cancer remains a major oncological problem, both in Poland and worldwide. A quick and accurate diagnosis is the key element in improving survival outcomes in oncology. Unusual and uncharacteristic signs and symptoms hinder adequate diagnostic proceedings. The case report presented below is an example of diagnostic difficulties arising from an unusual constellation of symptoms and their effect on patient’s outcomes. Additionally, we shortly discuss the potential medical conclusions that might be drawn from the described case. A 56-year-old male patient, a long-time smoker, was consulted by a primary care physician due to persistent abdominal pain. Initial proceedings provided no decisive diagnosis. The patient was referred to hospital for an extended diagnostic work-up. However, the additionally performed procedures added no further evidence and no insight into the diagnosis. Unfortunately, neither chest X-ray nor abdomen ultrasonography was performed. After four months the patient presented with a generalised metastatic spread to skin, along with a clear deterioration of performance status. Finally, the diagnosis of large-cell neuroendocrine carcinoma of the right lung was made. The patient received two courses of a palliative cisplatin-based chemotherapy, shortly after which he progressed. Further treatment included only palliative radiotherapy and hospice care. Improvement in both the diagnosis and treatment of lung cancer require adherence to the current guidelines and close cooperation with a primary care physician. When possible, the least uncomfortable procedures should be undertaken to preserve the patient’s quality of life. However, if no clear diagnosis is obtained despite a suspicion of neoplastic diseases, repeating of a full diagnostic work-up may be considered. Further attention should be given to the development of effective preventative programmes and the creation of work-groups devoted to dealing with rare symptoms of neoplastic diseases.