Lung cancer is the leading cause of cancer death in the US, and most cases are linked to smoking. It is divided into non-small cell and small cell types, and the stage and tumor markers guide treatment.
Key symptoms
- New or changing cough
- Coughing up blood
- Weight loss, fatigue and poor appetite
- Chest pain or shortness of breath
- Hoarse voice or bone pain
What you find on exam
- Weight and general appearance
- Lymph nodes above the collarbone
- Digital clubbing
- Signs of fluid or airway blockage on lung exam
- Facial swelling (superior vena cava syndrome) or a drooping eyelid (Horner syndrome)
Tests
- Chest X-ray, then CT chest with contrast
- Biopsy by bronchoscopy, CT-guided needle or lymph node sampling
- Staging with PET-CT and brain MRI
- Tumor markers (EGFR, ALK, PD-L1) in non-small cell cancer
- Calcium and sodium to look for paraneoplastic effects
Treatment basics
- Early non-small cell cancer: surgery (lobectomy) or stereotactic radiation
- Advanced disease: targeted therapy, immunotherapy or chemotherapy based on markers
- Small cell cancer: chemotherapy with immunotherapy, plus radiation
- Smoking cessation and palliative care from the start
- Screening: yearly low-dose CT from 50 to 80 years with 20 pack-years, smoking now or quit within 15 years
Red flags
- Large amount of blood coughed up
- Facial and arm swelling with breathlessness
- New back pain with leg weakness (spinal cord compression)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.