Last reviewed: 11 Apr 2021
Last updated: 08 Feb 2018



History and exam

Key diagnostic factors

  • cough
  • dyspnea
  • hemoptysis
  • chest pain
  • weight loss

Other diagnostic factors

  • age 65 to 70 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 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
  • CBC
  • LFTs
  • serum sodium
  • renal function
  • lung function tests

Treatment algorithm


Rebecca Suk Heist

Assistant Professor of Medicine

Harvard Medical School

Thoracic Oncology

Massachusetts General Hospital




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 reviewersVIEW ALL


Assistant Dean

Undergraduate Program

McMaster University





AN declares that he has no competing interests.

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