Lung Cancer.pdf

2 CLINICAL EXAMINATION OF
PATIENTS WITH SUSPECTED
LUNG CANCER
Frank V. Fossella
Chapter Overview ......................................................................................... 25
Introduction ................................................................................................... 26
History and Physical Examination ............................................................. 26
Symptoms and Signs Due to Local Effects ........................................... 26
Symptoms and Signs Due to Distant Metastases ................................ 27
Symptoms and Signs Due to Paraneoplastic Disorders ..................... 28
Laboratory Studies ........................................................................................ 29
Radiographic Imaging .................................................................................. 29
Chest Radiography ...................................................................................29
Computed Tomography of the Chest ................................................... 30
Computed Tomography of the Abdomen ............................................ 30
Additional Radiographic Studies .......................................................... 30
Pulmonary Function Tests ........................................................................... 32
Histologic Confirmation of Diagnosis ....................................................... 32
Sputum Cytology ..................................................................................... 32
Fine-Needle Aspiration ........................................................................... 32
Flexible Fiber-Optic Bronchoscopy ....................................................... 33
Transthoracic Needle Aspiration Biopsy .............................................. 34
Key Practice Points ....................................................................................... 33
Suggested Readings ...................................................................................... 34
Chapter Overview
In patients with suspected lung cancer, the goals of the clinical examination
are to confirm the histologic diagnosis, establish the extent of disease
for the purpose of treatment planning, and identify any associated
symptoms or complications of the disease that might warrant immediate
attention. The basic components of the clinical examination are a history
and physical examination, routine blood work, chest radiography, computed
tomography of the chest, additional imaging studies as needed, diagnostic
biopsy, and, in patients with operable disease, preoperative testing
to ensure a reasonably low risk of postsurgical complications. The most