Small cell carcinoma of the lung physical examination
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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.
Physical Examination=
The physical examination of the small cell lung cancer is described below:[1][2][3]
Vital Signs
- 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
- Central obesity (suggestive of Cushing's syndrome) may be present
- Jaundice (suggestive of liver metastasis) may be present
- Pale skin (suggestive of anemia of chronic disease) may be present
- Cyanosis (suggestive of severe dyspnea) may be present
- Lymphadenopathy (> 1 cm) may be present
- Dehydration (suggestive of hypercalcemia) may be present
Head
- 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
Eyes
- 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
Shown below is an image depicting ptosis in a patient with Horner's syndrome.
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Horner's Syndrome
Throat
- Hoarseness ( suggestive of compression of the recurrent laryngeal nerve) may be present
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
Abdomen
- Hepatomegaly (> 13 cm span) (suggestive of liver metastasis) may be present
Musculoskeletal system
- Digital clubbing may be present
- Bone tenderness (suggestive of bone metastasis) may be present
- 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.
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Clubbing
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Clubbing
Neurological
- Weakness of the proximal muscles of lower extremities, abnormal gait, autonomic dysfunction, and paresthesia (suggestive of Lambert-Eaton syndrome) may be present[2]
- Altered mental status, seizures, memory loss, space and time disorientation, with or without dementia (suggestive of limbic encephalitis and encephalomyelitis) may occur[2]
- Ataxia, dysarthria, severe vertigo (suggestive of paraneoplastic cerebellar degeneration) may occur[2]
- Focal neurologic symptoms, seizures, confusion, and personality changes (suggestive of brain metastasis)
Skin
- Acquired tylosis may be present
- Tripe palms may be present[4]
- Erythema gyratum repens (rare)
References
- ↑ Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (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.
- ↑ 2.0 2.1 2.2 2.3 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.
- ↑ 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.
- ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.