CLINICAL PRESENTATION



Clinical presentation may be related to tumor location within the chest, metastatic spread, or extrapulmonary paraneoplastic manifestations. Most patients present with weight loss and symp­toms related to local involvement such as cough (75 per cent) that has changed in character, hem­optysis (50 per cent) that is rarely life-threatening, dyspnea (60 per cent), chest pain (40 per cent), and a marked increase in sputum production with bronchoalveolar carcinoma. Pancoast’s syndrome refers to apical tumors that involve the brachial plexus and often leads to Horner’s syndrome re­sulting from invasion of the inferior cervical gan­glion. Compression and obstruction of the supe­rior vena cava, usually by oat cell tumor, causes facial and upper extremity edema, dyspnea, stri­dor, and symptoms related to increased intra­cranial pressure. Partial obstruction of a bronchus may lead to unilateral, persistent wheezing, whereas complete obstruction causes postob-structive pneumonia. Recurrent laryngeal nerve involvement, typical of a left hilar mass, causes hoarseness. Phrenic nerve entrapment by a me­diastinal mass causes diaphragmatic paralysis. Fi­nally, direct spread of the tumor to the pleural or pericardial space will result in effusions. Bron­chogenic carcinoma is frequently discovered only after it metastasizes to other organs. The brain, liver, bone, and lymph nodes are common sites,and the evaluation of tumor found in these lo­cations, in a smoker, should include a search for a primary lung neoplasm. In 10 to 50 per cent of patients, bronchogenic carcinoma produces one or more paraneoplastic syndromes. These may manifest themselves as neuromuscular, skeletal, endocrine, hematologic, cutaneous, or cardiovas­cular abnormalities