Editing Lung cancer (section)

== Presentation and initial evaluation ==

* Cardiorespiratory symptoms
* Check cervical and supraclavicular lymph nodes (suggests N3 disease)
* Check for paraneoplastic syndromes 
** Small cell cancer frequently causes neurologic syndromes
** Other cancers may cause hypertrophic osteoarthropathy
* Pancoast syndrome: shoulder and arm pain, Horner syndrome (miosis, ptosis, anhidrosis, enophthalmos) and occasionally paraesthesias in ulnar distribution of the hand
** Caused by local extension of cancer at the apex of the lung into the thoracic inlet
** Much more common in NSCLC than SCLC or benign disease
** Pain from C8 and T1 nerve roots
** Typically, ribs 1, 2, and 3 are involved and require resection; the bony spine and intra-foraminal spaces can also be involved
** Need MRI to determine resectability
** Probably need neoadjuvant chemoradiotherapy