Case history
Case history
A 65-year-old man presents with a 2-month history of a dry persistent cough and 4.5 kg unintentional weight loss. He reports no history of fevers, dyspnoea, sore throat, rhinorrhoea, chest pain, or haemoptysis. Past medical history is significant for chronic obstructive pulmonary disease and hypertension. Family history is non-contributory. He smoked 1 pack of cigarettes daily for 40 years but quit 5 years ago. No adenopathy was palpable on examination and breath sounds were diminished globally without focal wheezes or rales.
Other presentations
Lung cancer can present without symptoms. This is due to the large functional reserve of the lungs and lack of pain fibres within the lung parenchyma. Consequently, lung cancer can present as an incidental mass on chest x-ray or computed tomography. Eventually, patients develop symptoms from local tumour growth within the lung, including cough, dyspnoea, chest pain, and/or haemoptysis.[3][4] Haemoptysis typically consists of blood-tinged sputum. Massive haemoptysis is rare. Invasion of the pleura or chest wall can cause chest pain. Obstruction of major airways can cause dyspnoea, wheezing, or post-obstructive pneumonia. A pneumonia that does not rapidly clear with antibiotics is cause for concern for lung cancer, especially in patients with a tobacco history.
Lung cancer often spreads to mediastinal lymph nodes. Symptoms from mediastinal adenopathy are relatively rare. However, bulky adenopathy can cause hoarseness (impingement of the recurrent laryngeal nerve), paralysis of the diaphragm (impingement of the phrenic nerve), difficulty swallowing (extrinsic compression of the oesophagus), or superior vena cava syndrome, typically characterised by upper extremity and facial oedema, orthopnoea, cough, and venous distension of the neck and chest wall.[5]
SCLC is associated with paraneoplastic syndromes such as Lambert-Eaton myasthenic syndrome, peripheral neuropathy, syndrome of inappropriate antidiuretic hormone secretion, and Cushing's syndrome.[5]
Finger clubbing and hypertrophic osteoarthropathy are less common in SCLC compared with non-small cell lung cancer.[4]
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