Summary
Definition
History and exam
Key diagnostic factors
- cough
- dyspnea
- hemoptysis
- chest pain
- weight loss
Other diagnostic factors
- age 65 to 74 years
- male sex
- fatigue
- pulmonary exam 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 tests
1st tests to order
- chest x-ray
- CT chest, liver, and adrenal glands
Tests to consider
- bronchoscopy
- biopsy
- thoracentesis
- thoracoscopy
- MRI or CT of brain
- bone scan
- mediastinoscopy
- positron emission tomography (PET)
- bone marrow aspirate and biopsy
- CBC
- 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
Catherine B. Meador, MD, PhD
Attending Physician
Center for Thoracic Cancers
Instructor in Medicine
Harvard Medical School
Massachusetts General Hospital
Boston
MA
Disclosures
CBM declares that she has no competing interests.
Acknowledgements
Dr Catherine B. Meador would like to gratefully acknowledge Dr Leena Gandhi, Dr Alvin R. Cabrera, Dr Christopher R. Kelsey, Dr Lawrence B. Marks, and Dr Rebecca Suk Heist, previous contributors to this topic.
Disclosures
LG, ARC, CRK, and LBM declare that they have no competing interests. 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.
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 tumor
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- Guidelines and advice: lung cancer
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