Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- cough
- dyspnoea
- haemoptysis
- chest and/or shoulder pain
- weight loss
Other diagnostic factors
- male sex
- fatigue
- pulmonary examination abnormalities
- hoarseness
- confusion
- personality changes
- nausea and vomiting
- headache
- dysphagia
- bone pain and/or fractures
- weakness, paraesthesias and/or pain in C8/T1 distribution
- seizures
- cervical or supraclavicular adenopathy
- Horner's syndrome
- facial swelling
- dilated neck or chest/abdominal wall veins
- finger clubbing
- hypertrophic pulmonary osteoarthropathy
Risk factors
- cigarette smoking
- environmental tobacco exposure
- chronic obstructive pulmonary disease (COPD)
- family history
- radon gas exposure
- older age
- asbestos exposure
Diagnostic investigations
1st investigations to order
- chest x-ray
- contrast-enhanced CT scan of lower neck, thorax, and upper abdomen
Investigations to consider
- sputum cytology
- bronchoscopy
- biopsy
- diagnostic thoracentesis and/or pleural biopsy
- sampling of the mediastinal lymph nodes: mediastinoscopy and endobronchial ultrasound (EBUS)
- video-assisted thoracoscopic surgery (VATS)
- thoracoscopy
- MRI or CT of brain
- MRI of thoracic inlet
- CT with contrast and/or fluorodeoxyglucose (FDG)-PET
- bone scan
- contrast-enhanced CT liver and adrenals
- pulmonary function tests (PFT)
- FBC
- LFTs
- serum calcium
- electrolytes and renal function
- electrocardiogram and echocardiogram
- epidermal growth factor receptor (EGFR) mutation testing
- anaplastic lymphoma kinase (ALK) testing
- ROS proto-oncogene 1 (ROS1) testing
- programmed death-ligand 1 (PD-L1) testing
- B-Raf proto-oncogene (BRAF) testing
- neurotrophin tyrosine receptor kinase (NTRK) fusion testing
- Mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping mutations
- re-arranged during transfection (RET) gene mutations testing
- KRAS proto-oncogene (KRAS) point mutations testing
- ERBB2 (HER2) mutations testing
Treatment algorithm
Contributors
Authors
Alex A. Adjei, MD, PhD, FACP
Chairman, Taussig Cancer Institute
M. Frank Rudy and Margaret Domiter Rudy Distinguished Chair in Translational Cancer Research
Cleveland Clinic
Cleveland
OH
Disclosures
AAA declares that he has no competing interests.
Dr Fen Wang, MD
Peking University Shenzhen Hospital
Shenzhen
Guangdong
China
Disclosures
FW declares that she has no competing interests
Acknowledgements
Professor Alex A. Adjei and Dr Fen Wang would like to gratefully acknowledge Professor David R. Baldwin, Dr Sanjay Popat, Dr Mick Peake, Dr Chris Kelsey, and Dr Lawrence Marks, previous contributors to this topic.
Disclosures
DRB declares that he has no competing interests. SP has been paid and acted as a consultant to BMS, Eli Lilly, Roche, Takeda, AstraZeneca, Chugai, Novartis, Pfizer, MSD, EMD Serono, Guardant Health, AbbVie, Boehringer Ingelheim, and Tesaro; SP has received research grants from Pierre Fabre, Otsuka, and Boehringer Ingelheim; SP has received assistance for travel from Boehringer Ingelheim, MSD, and Pfizer. MP has received lecture fees from AstraZeneca Pharmaceuticals, Lilly Oncology Ltd, Pierre-Fabre, GSK Ltd, and Roche Pharmaceuticals Ltd; MP has also received educational grants to attend scientific conferences from Roche Pharmaceuticals Ltd and Boehringer Ingelheim Ltd. CK and LM 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.
James Huang, MD
Assistant Attending Surgeon
Thoracic Service
Memorial Sloan Kettering Cancer Center
New York
NY
Disclosures
JH declares that he has no competing interests.
Siow Ming Lee, PhD, FRCP
Consultant Medical Oncologist
University College Hospital
London
UK
Disclosures
SML declares that he has no competing interests.
Use of this content is subject to our disclaimer