Pulmonary Complications of Lung Cancer and Cancer Therapy: Manifestations and Management

Pulmonary Complications of Lung CancerPulmonary complications are a challenge for the pulmonologist and often present at diagnosis or during treatment.They arise from direct tumor effects, superimposed infections, or treatmentrelated injury.Recognizing these complications early is crucial to avoid delays in systemic therapy and to improve functional status and quality of life. Airway ObstructionCentral airway obstruction (CAO) can result from endoluminal tumor growth, extrinsic compression by lymphadenopathy, or peribronchial invasion, in about 30% patients with advanced lung cancer. 8CAO is occlusion of >50% of the trachea, mainstem IntroductIonLung cancer is the leading cause of cancer morbidity and mortality, accounting for an estimated 2.5 million new cases and over 1.8 million deaths worldwide. 1While advances in early detection, molecular diagnostics, and targeted therapies have improved outcomes for few patients, most are diagnosed at advanced stages when complications from both the malignancy and its treatment are prevalent. 2hese complications range from direct pulmonar y manifestations, such as airway obstruction, hemoptysis, malignant pleural effusion (MPE), and postobstructive pneumonia to systemic and paraneoplastic syndromes. 3,4In addition, chemotherapy, radiotherapy, and modern therapies, including immune checkpoint inhibitors (ICIs) and targeted agents-have introduced novel pulmonary and extrapulmonary toxicities, often requiring specialized diagnostic and management strategies. 5,6ulmonologists play a critical role in the care of lung cancer patients, particularly in the early identification and management of respiratory complications.Their expertise in bronchoscopy, interventional procedures, and respiratory physiology makes them key contributors to multidisciplinary thoracic oncology teams. 7Timely intervention for complications not only improves symptom burden and quality of life but also prevents treatment delays and reduce mortality.This review aims to provide a comprehensive overview of the major pulmonary complications associated with lung cancer, with a focus on current evidence-based approaches to diagnosis and management.By synthesizing current knowledge and highlighting practical strategies, we hope to support clinicians in delivering holistic, complication-aware care across the lung cancer continuum.