Small cell carcinoma of the lung physical examination: Difference between revisions

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==Overview==
==Overview==


Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of [[metastases]].
Many authors have concluded that performing a complete assessment, with a detailed history and [[physical examination]], is useful for identifying patients with a higher likelihood of [[metastases]]. Fever is reported in 20% of the patients. Patients may present with [[Weight loss|weight loss,]] [[cachexia]] and [[anorexia]]. Upon [[auscultation]] unilateral decreased air entry, unilateral [[wheeze]], and decreased air entry in the bases of the [[lungs]] and/or [[crackles]] (suggestive of [[pleural effusion]]) may be present. The [[musculoskeletal system]] may show the signs of [[digital clubbing]], [[bone]] [[tenderness]], (suggestive of [[bone]] [[metastasis]]) and [[osteoarthropathy]] may be noted.


==Physical Examination<ref name===
==Physical Examination==
The physical examination of the small cell lung cancer is described below:"pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref><ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid18316005">{{cite journal| author=Sher T, Dy GK, Adjei AA| title=Small cell lung cancer. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 3 | pages= 355-67 | pmid=18316005 | doi=10.4065/83.3.355 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18316005  }} </ref>
The [[physical examination]] findings of small cell lung cancer are described below:<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid18316005">{{cite journal| author=Sher T, Dy GK, Adjei AA| title=Small cell lung cancer. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 3 | pages= 355-67 | pmid=18316005 | doi=10.4065/83.3.355 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18316005  }} </ref><ref name="pmid17873166">{{cite journal |vauthors=Spiro SG, Gould MK, Colice GL |title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition) |journal=Chest |volume=132 |issue=3 Suppl |pages=149S–160S |date=September 2007 |pmid=17873166 |doi=10.1378/chest.07-1358 |url=}}</ref>


===Vital Signs===
===Appearance of the Patient===
*[[Fever]] (in up to 20% of patients with [[lung cancer]])
 
*[[Hypertension]] (can be present in case of [[Cushing's syndrome]])


===General Appearance===
*[[Cachexia]] ([[weight loss]] and [[anorexia]]) may be present
*[[Cachexia]] ([[weight loss]] and [[anorexia]]) may be present
* Central [[obesity]] (suggestive of [[Cushing's syndrome]]) may be present
* Central [[obesity]] (suggestive of [[Cushing's syndrome]]) may be present
Line 25: Line 21:
* [[Dehydration]] (suggestive of [[hypercalcemia]]) may be present
* [[Dehydration]] (suggestive of [[hypercalcemia]]) may be present


===Head===
===Vital Signs===
* Moon facies (suggestive of [[Cushing's syndrome]]) may be present
*[[Fever]] (in up to 20% of the patients)
* [[Swelling]] of the face, neck, trunk, and arms (suggestive of [[superior vena cava syndrome]]) may be present


===Eyes===
*[[Hypertension]] (can be present in case of [[Cushing's syndrome]])
* Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) may be present
 
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) may be present
===Skin===
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating (suggestive of [[Horner's syndrome]]) may be present


Shown below is an image depicting ptosis in a patient with [[Horner's syndrome]].
* Acquired [[tylosis]] may be present
*[[Tripe palms]] may be present<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207  }} </ref>
*[[Erythema gyratum repens]] (rare)


<div align="left">
===HEENT===
<gallery heights="175" widths="175">
Image:Eyes horners2.jpg|Horner's Syndrome
</gallery>
</div>


===Throat===
*[[Moon facies]] (suggestive of [[Cushing's syndrome]]) may be present
*[[Swelling]] of the face, neck, trunk, and arms (suggestive of [[superior vena cava syndrome]]) may be present
*Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) may be present
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) may be present
*[[Miosis]], ipsilateral [[ptosis]] and lack of [[facial]] sweating (suggestive of [[Horner's syndrome]]) may be present
*[[Hoarseness]] ( suggestive of compression of the [[recurrent laryngeal nerve]]) may be present
*[[Hoarseness]] ( suggestive of compression of the [[recurrent laryngeal nerve]]) may be present
===Neck===
* [[Swelling]]


===Lungs===
===Lungs===
* Unilateral decreased air entry may be present
* Unilateral decreased air entry may be present
* Unilateral [[wheeze]] may be present
* Unilateral [[wheeze]] may be present
* Decreased air entry in the bases of the lungs and/or [[crackles]] (suggestive of [[Pleural effusion]]) may be present
* Decreased air entry in the bases of the [[lungs]] and/or [[crackles]] (suggestive of [[pleural effusion]]) may be present
 
===Heart===
 
* [[Circulatory system|Cardiovascular]] [[Physical examination|examination]] of [[Patient|patients]] with small cell lung cancer is usually normal


===Abdomen===
===Abdomen===
*[[Hepatomegaly]] (> 13 cm span) (suggestive of liver [[metastasis]]) may be present
*[[Hepatomegaly]] (> 13 cm span) (suggestive of liver [[metastasis]]) may be present


===Musculoskeletal system===
===Back===
*[[Digital clubbing]] may be present
 
*[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) may be present
* [[Human back|Back]] examination of [[Patient|patients]] with small cell lung cancer is usually normal
*[[Osteoarthropathy]] may be present: painful symmetrical arthropathy of the knees, wrist, and knees, and periosteal new [[bone]] formation.


Shown below is an image depicting [[digital clubbing]].
===Genitourinary===


<div align="left">
* [[Genitourinary system|Genitourinary]] [[Physical examination|examination]] of [[Patient|patients]] with small cell lung cancer is usually normal
<gallery heights="175" widths="175">
Image:Clubbing.Nail.jpg|Clubbing
Image:clubbing.jpg|Clubbing
</gallery>
</div>


===Neurological===
===Neuromuscular===
* [[Weakness]] of the proximal muscles of lower extremities, abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]]) may be present<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
*[[Weakness]] of the proximal [[muscles]] of [[lower extremities]], abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]]) may be present<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
* [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
* [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
* [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
* [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
* Focal neurologic symptoms, [[seizures]], [[confusion]], and personality changes (suggestive of [[brain]] metastasis)
*[[Focal neurologic signs]], [[seizures]], [[confusion]], and [[personality changes]] (suggestive of [[brain]] [[metastasis]])
 
===Extremities===


===Skin===
*[[Digital clubbing]] may be present
* Acquired [[tylosis]] may be present
*[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) may be present
* [[Tripe palms]] may be present<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207  }} </ref>
*[[Osteoarthropathy]] may be present: [[painful]] symmetrical [[arthropathy]] of the [[knees]], [[wrist]] and new periosteal [[bone]] formation
*[[Erythema gyratum repens]] (rare)


==References==
==References==

Latest revision as of 22:19, 4 September 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Guillermo Rodriguez Nava, M.D. [2]

Overview

Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of metastases. Fever is reported in 20% of the patients. Patients may present with weight loss, cachexia and anorexia. Upon auscultation unilateral decreased air entry, unilateral wheeze, and decreased air entry in the bases of the lungs and/or crackles (suggestive of pleural effusion) may be present. The musculoskeletal system may show the signs of digital clubbing, bone tenderness, (suggestive of bone metastasis) and osteoarthropathy may be noted.

Physical Examination

The physical examination findings of small cell lung cancer are described below:[1][2][3]

Appearance of the Patient

Vital Signs

  • Fever (in up to 20% of the patients)

Skin

HEENT

Neck

Lungs

  • Unilateral decreased air entry may be present
  • Unilateral wheeze may be present
  • Decreased air entry in the bases of the lungs and/or crackles (suggestive of pleural effusion) may be present

Heart

Abdomen

Back

  • Back examination of patients with small cell lung cancer is usually normal

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ 1.0 1.1 1.2 1.3 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
  2. ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.
  3. ↑ Spiro SG, Gould MK, Colice GL (September 2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
  4. ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.


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