Last reviewed: 22 Mar 2021
Last updated: 08 Feb 2018
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cough
- dyspnoea
- haemoptysis
- chest pain
- weight loss
Other diagnostic factors
- age 65 to 70 years
- male sex
- fatigue
- pulmonary examination abnormalities
- hoarseness
- confusion
- personality changes
- nausea and vomiting
- headache
- dysphagia
- bone pain and/or fractures
- seizures
- cervical or supraclavicular adenopathy
- facial swelling
- dilated neck or chest/abdominal wall veins
- finger clubbing
- hypertrophic osteoarthropathy
Risk factors
- cigarette smoking
- environmental tobacco exposure
- radon gas exposure
- asbestos exposure
Diagnostic investigations
1st investigations to order
- chest x-ray
- CT chest, liver, and adrenal glands
- sputum cytology
Investigations to consider
- bronchoscopy
- biopsy
- thoracentesis
- thoracoscopy
- MRI or CT of brain
- bone scan
- mediastinoscopy
- positron emission tomography (PET)
- bone marrow aspirate and biopsy
- FBC
- LFTs
- serum sodium
- renal function
- lung function tests
Treatment algorithm
Contributors
Authors

Assistant Professor of Medicine
Harvard Medical School
Thoracic Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
RSH has received honoraria for consulting from Boehringer-Ingelheim and Ariad.
Dr Rebecca Suk Heist would like to gratefully acknowledge Dr Leena Gandhi, Dr Alvin R. Cabrera, Dr Christopher R. Kelsey, and Dr Lawrence B. Marks, previous contributors to this monograph. LG, ARC, CRK, and LBM declare that they have no competing interests.
Peer reviewers
Professor
Assistant Dean
Undergraduate Program
McMaster University
Hamilton
Ontario
Canada
Disclosures
AN declares that he has no competing interests.
Use of this content is subject to our disclaimer