Case history
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Kleincellige en niet-kleincellige longkanker: diagnose, behandeling en opvolgingPublished by: KCELast published: 2013Cancer du poumon à petites cellules et non à petites cellules : diagnostic, traitement et suiviPublished by: KCELast published: 2013Case 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 denies fevers, dyspnea, sore throat, rhinorrhea, chest pain, or hemoptysis. Medical history is significant for COPD and hypertension. Family history is noncontributory. He smoked one pack of cigarettes daily for 40 years but quit 5 years ago. No adenopathy is palpable on examination and breath sounds are diminished globally without focal wheezes or rales.
Other presentations
Lung cancer can present without symptoms. This is possibly 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] Cough is the most common symptom, followed by dyspnea. Hemoptysis typically consists of blood-tinged sputum, blood streaks in sputum, or small clots. It is a relatively uncommon symptom (compared with cough and dyspnea) but more specific for lung cancer. 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 (impingement 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.[4]
Lung cancer can also present as a superior sulcus tumor (sometimes called a Pancoast tumor), most commonly presenting with shoulder pain.[5] These tumors may also compress and invade the brachial plexus (causing weakness and/or atrophy of the intrinsic muscles of the hand, paresthesias, and/or pain in a C8/T1 distribution) or sympathetic chain (causing Horner syndrome, characterized by ptosis, miosis, and ipsilateral anhidrosis). Other presentations include clubbing, hypertrophic osteoarthropathy, hypercalcemia of malignancy, and symptoms or signs of metastases to other organs such as bones and the brain.
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