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, dyspnea, sore throat, rhinorrhea, chest pain, or hemoptysis. Past medical history is significant for chronic obstructive pulmonary disease and hypertension. Family history is noncontributory. He smoked 1 pack of cigarettes daily for 40 years but quit 5 years ago. No adenopathy was palpable on exam 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 fibers 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 tumor growth within the lung, including cough, dyspnea, chest pain, and/or hemoptysis.[3][4] Hemoptysis typically consists of blood-tinged sputum. Massive hemoptysis is rare. Invasion of the pleura or chest wall can cause chest pain. Obstruction of major airways can cause dyspnea, wheezing, or postobstructive 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 esophagus), or superior vena cava syndrome, typically characterized by upper extremity and facial edema, orthopnea, 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 syndrome.[5]
Finger clubbing and hypertrophic osteoarthropathy are less common in SCLC compared with non-small cell lung cancer.[4]
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