In the future, with the progression of the blastomatous process and its transition to the ribs, the nature of the pain changes. They become permanent, very intense, aggravated by physical exertion, moving in bed, and even with deep breathing. Tumor destruction of the rib can lead to its pathological fracture. then pains begin to cause the greatest torment, are not eliminated by analgesics, and even local blockades with anesthetics, which are sometimes resorted to in such cases, help for a very short time. Such patients seek to take a forced position — to press, to limit as much as possible the movements of the corresponding half of the chest. Their breathing becomes superficial, frequent.

When the tumor is located in the lower lobe of the lung in patients with advanced stages of the disease, it switches to the diaphragm. Symptoms of such a lesion are expressed in the appearance of precisely not localized pains in the lower parts of the chest cavity. sometimes they intensify, radiating upward in the shoulder girdle, resembling some manifestations of cholecystitis. Organic mobility of the corresponding half of the diaphragm can lead to increased participation in the act of breathing of the intercostal muscles, which can be noted in lean patients or people of low nutrition.

In 31.5% of patients with advanced stages of lung cancer, when the blastomatous process spreads beyond the lung, the mediastinal pleura with diaphragmatic or vagus nerves passing here was involved. Such a lesion is accompanied by the appearance of peculiar symptoms. The involvement of the phrenic nerve in the tumor process leads to paralysis of the corresponding half of the diaphragm, its loss of mobility with an unusually high standing dome of the muscle. Depending on the degree and level of damage to the vagus nerve trunk and its large branches within the chest cavity, some patients develop unpleasant, often very painful sensations in the heart. They experience episodes of heart palpitations, often a violation of the rhythm of heart contractions, perceived as a feeling of “freezing, cardiac arrest”.

The transition of the tumor to the pericardium occurs in patients with lung cancer in the advanced stages of the development of the disease, often – such a lesion was noted in 60% of patients with extrapulmonary spread. The clinical symptoms of the lesion are usually vague, often similar to those arising when the mediastinal pleura is involved in the process. Only in the terminal period of the development of the disease can signs be observed indicating the appearance of increasing exudative pericarditis.

Further spread of the tumor beyond the pericardium — to the cardiac muscle was observed in 10% of patients with advanced lung cancer. The most common for such a lesion is tumor growth along the large vessels of the lung: the upper and lower pulmonary veins, pulmonary artery. In this case, damage to blood vessels directly in the corresponding departments of the heart occurs equally often intravasally and perivasally. Then patients note the appearance of prolonged episodes of extrasystole and atrial fibrillation or pain, reminiscent of angina pectoris. It is not possible to establish signs characterizing the violation of blood flow in the large vessels of the lung in connection with their defeat by a tumor against the background of other, usually by this time, health disorders.

Dissemination of the tumor along the visceral pleura, similar pathological changes on the parietal and mediastinal surface of the pleural sheet, causes the appearance of peculiar complaints in patients. At first, they are pathognomonic and similar to the appearance of signs of dry pleurisy, and after a short time – effusion. In the initial period of such a lesion, pain is usually disturbed by deep breathing and movement. With the accumulation of exudate in the pleural cavity, separating its visceral and parietal leaves, the pain goes away. For a short period of time, relative well-being sets in, followed by a deterioration in well-being with distinctive clinical manifestations. This is caused by a progressive increase in the amount of exudate in the pleural cavity with the collapse of the tumor affected by the tumor, the appearance and increase of respiratory disorders. The steady tendency to increase such pleurisy is its characteristic feature. In significant volumes, it leads not only to compression of the lung, but also to the mediastinal organs, significantly shifting it to the healthy side. Such patients occupy a forced position — they sit or lie with the raised upper half of the body, and avoid the slightest physical stress.

The transition of individual tumor metastases from the parietal pleura to the anatomical structures of the chest wall, including the ribs, leads to the appearance of especially painful pains that are not always clearly local, polytopic. They are especially pronounced in the most affected areas of the ribs; as a rule, they do not correspond to the location of the primary tumor in a particular lobe of the lung.