Clinical Examination Findings of Lung Cancer

Primary Pulmonary Symptoms and Signs

Cough is the most frequent presenting symptom, resulting from endobronchial irritation, parenchymal infiltration, or postobstructive pneumonia 1
Dyspnea accompanies endobronchial obstruction, parenchymal involvement, or pleural effusion 1
Hemoptysis, even in scant amounts with blood-streaked sputum, warrants concern especially in patients with smoking history and COPD—this may occur even with normal chest radiographs 1
Localized or unilateral wheezing reflects endobronchial obstruction and should prompt evaluation for neoplasm 1
Recurrent pneumonia in the same anatomic distribution or relapsing COPD exacerbations should raise suspicion for underlying malignancy 1
Nonspecific chest discomfort is common and often dismissed by patients 1
Pleuritic chest pain indicates invasion of the pleura or chest wall 1

Physical examination reveals facial edema and plethora, dilated neck veins, and prominent venous pattern on the chest wall—lung cancer is the most common cause of SVC syndrome 2, 3
Patients experience facial and neck swelling, and less commonly dysphagia, cough, headache, dizziness, and blurred vision 2, 4
Chest radiographs typically show widened mediastinum or right hilar mass but may appear normal 2, 3
Shoulder and arm pain from brachial plexus invasion and involvement of adjacent soft tissues, ribs, and vertebrae 2
Horner syndrome (unilateral ptosis, miosis, and lack of facial sweating) from sympathetic chain and stellate ganglion infiltration 2
Weakness, pain, and paresthesias in the arm and hand following the distribution of C8, T1, and T2 nerve roots 2
Hoarseness from left recurrent laryngeal nerve palsy due to its circuitous route under the aortic arch, which renders it susceptible to compression by tumor or malignant nodes 2
Elevated hemidiaphragm on chest radiograph from phrenic nerve dysfunction caused by tumor extension into the mediastinum 2
Pericardial effusion is the most common cardiac manifestation, occurring through direct extension or lymphatic spread 2, 3
Arrhythmias may result from pericardial involvement 4

Anorexia, weight loss, and fatigue are nonspecific but common in patients with distant metastases and associated with worse prognosis even within the same cancer stage 5
Bone pain and bony tenderness, most commonly involving vertebral bodies 5
Elevated serum calcium or alkaline phosphatase may be present 5
Headache, nausea, vomiting from increased intracranial pressure 5
Seizures or mental status changes from mass effect or irritation 5
Weakness and weight loss are typical presenting symptoms of liver metastases 5
Liver function tests typically remain normal until very advanced stages of involvement 5
Palpable supraclavicular or cervical lymphadenopathy may be the presenting sign of lymph node metastases 5
Hilar and mediastinal adenopathy is typically asymptomatic unless very bulky 5
Pleural effusion should always raise concern for malignancy in the context of known or suspected lung cancer 5

Approximately 25% of patients are asymptomatic at diagnosis, typically discovered incidentally on chest imaging performed for unrelated reasons 1, 2
These patients are more likely to have stage I or II disease with better prognosis 1, 2
Asymptomatic patients often have solitary pulmonary nodules or masses on chest radiographs or CT scans 2, 3