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
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
at initial presentation: limited disease
at initial presentation: extensive disease
relapse within 6 months
relapse after 6 months
Contributors
Authors
Rebecca Suk Heist, MD, MPH

Associate Professor of Medicine
Harvard Medical School
Thoracic Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
RSH has received honoraria for consulting from Novartis, Abbvie, Daichii Sankyo, and EMD Serono. RSH's institution (not RSH) has received research funding from Agios, Abbvie, Exelixis, Daichii Sankyo, Novartis, Lilly, Mirati, Corvus, Incyte, and Genentech Roche.
Catherine B. Meador, MD, PhD
Clinical Fellow in Thoracic Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
CBM declares that she has no competing interests.
Acknowledgements
Dr Rebecca Suk Heist and Dr Catherine B. Meador 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 topic.
Disclosures
LG, ARC, CRK, and LBM declare that they have no competing interests.
Peer reviewers
Alan Neville, MD
Professor
Assistant Dean
Undergraduate Program
McMaster University
Hamilton
Ontario
Canada
Disclosures
AN declares that he has no competing interests.
Differentials
- Non-small cell lung cancer
- Pneumonia/bronchitis
- Carcinoid tumour
More DifferentialsGuidelines
- Guidelines and advice: lung cancer
- National Cancer Institute small cell lung cancer treatment (PDQ®) – health professional
More GuidelinesPatient leaflets
Lung cancer: questions to ask your doctor
Bronchoscopy
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer