Last reviewed: November 2017
Last updated: December  2017

Summary

Definition

History and exam

Key diagnostic factors

  • cough
  • dyspnea
  • hemoptysis
  • chest and/or shoulder pain
  • weight loss

Other diagnostic factors

  • male sex
  • fatigue
  • pulmonary exam abnormalities
  • hoarseness
  • confusion
  • personality changes
  • nausea and vomiting
  • headache
  • dysphagia
  • bone pain and/or fractures
  • weakness, paresthesias, and/or pain in C8/T1 distribution
  • seizures
  • cervical or supraclavicular adenopathy
  • Horner syndrome
  • facial swelling
  • dilated neck or chest/abdominal wall veins
  • finger clubbing
  • hypertrophic pulmonary osteoarthropathy

Risk factors

  • cigarette smoking
  • environmental tobacco exposure
  • chronic obstructive pulmonary disease
  • family history
  • radon gas exposure
  • asbestos exposure
  • older age

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • contrast-enhanced CT scan of lower neck, thorax, and upper abdomen
Full details

Investigations to consider

  • sputum cytology
  • bronchoscopy
  • biopsy
  • diagnostic thoracentesis and/or pleural biopsy
  • sampling of the mediastinal lymph nodes: mediastinoscopy and endobronchial ultrasound
  • video-assisted thoracoscopic surgery (VATS)
  • thoracoscopy
  • MRI or CT of brain
  • MRI of thoracic inlet
  • PET-CT
  • bone scan
  • contrast-enhanced CT liver and adrenals
  • pulmonary function tests (PFT)
  • CBC
  • LFTs
  • serum calcium
  • electrolytes and renal function
  • electrocardiogram and echocardiogram
  • epidermal growth factor receptor (EGFR) mutation testing
  • anaplastic lymphoma kinase (ALK) testing
  • ROS1 testing
Full details

Emerging tests

  • programmed death-ligand 1 (PD-L1) testing
  • BRAF testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Respiratory Physician

Nottingham University Hospitals

Honorary Professor of Medicine

University of Nottingham

Respiratory Medicine Unit

David Evans Research Centre

City Hospital Campus

Nottingham

UK

Disclosures

DRB has received a lecture fee from Pierre-Fabre and educational grants from Boehringer Ingelheim Ltd, Irwin Mitchell, Roche, and Siemans; DRB has received assistance for travel to an international meeting from OncImmune Ltd.

Consultant Medical Oncologist

Department of Medicine

Royal Marsden Hospital

London

UK

Disclosures

SP has been paid as a consultant to Eli Lilly and has acted as consultant to AstraZeneca, Boehringer Ingelheim, Clovis Oncology, BMS, MSD, Pfizer, Novartis, and Ariad. SP has received research grants from Pierre Fabre, Otsuka, and Boehringer Ingelheim. SP has received assistance for travel from Boehringer Ingelheim, MSD, and Pfizer.

Professor David R. Baldwin and Dr Sanjay Popat would like to gratefully acknowledge Dr Mick Peake, Dr Chris Kelsey, and Dr Lawrence Marks, previous contributors to this monograph. MP has received lecture fees: AstraZeneca Pharmaceuticals, Lilly Oncology Ltd, Pierre-Fabre, GSK Ltd, and Roche Pharmaceuticals Ltd. MP has also received educational grants to attend scientific conferences from Roche Pharmaceuticals Ltd and Boehringer Ingelheim Ltd. CK and LM declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Disclosures

AN declares that he has no competing interests.

Assistant Attending Surgeon

Thoracic Service

Memorial Sloan Kettering Cancer Center

New York

NY

Disclosures

JH declares that he has no competing interests.

Consultant Medical Oncologist

University College Hospital

London

UK

Disclosures

SML declares that he has no competing interests.

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