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Chest X-ray,
Thoracic CT,
Fiberbronchoscopy,with biopsy,
Fine-needle aspiration from a pulmonary nodules,
Ultrasonography – pulmonary/abdominal.
PET,
Mediastinoscopy for mediastinal limph nodes,
VATS for diagnosis of small pulmonary nodules.
Clinical presentation of lung cancer
Cough, 29-87%
Hemoptysis- 9-57%
Chest pain 6-60%
Dyspnea 3-58%
Wheezing or stridor 2-14%
Pleural effusion 7%
Dysphagia 2%
Superior vena cava syndrome 4-11%
Pancoast syndrome 3-5%
Phrenic nerve paralysis 1%
Symptoms from metastatic disease
Liver mts,
Metabolic:
- hypercalcemia,
- Cushing syndrome,
- carcinoid syndrome,
-gynecomastia,
-elevated growth hormone level,prolactin,follicle-
stimulating hormone,luteinizing
hormone,antidiuretic hormone production.
- hypoglicemia,
-hypertiroidism
Paraneoplastic syndomes
Neurologic
-encephalopathy,
- subacute cerebrall degeneration
- peripheral neuropathy,
- polymiosytis,
- autonomic neuropathy,
- myoclonus.
Paraneoplastic syndromes
Skeletal
- clubbing
- pulmonary hypertrophic osteoartropathy
Hematologic
- anemia,
-leukemoid reactions
-trombocytosis,
-trombocytopenia,
-eosinophilia,
-pure red cell aplasia,
-disseminated intravascular coagulation
Paraneoplastic syndromes
NSCLC
Comprehensive clinical evaluation
*T4 = 1. defined
2. indeterminate : VATS surgery.
** LN Positive = sample LN= a)N2 Positive- unresectable
and induction protocol b)N3 Positive- unresectable
*** LN Negative = Surgery
Clinical examination positive suspect M1.
*Organ specific= specific scan=a) negative scan
=follow chest CT sequence, b) positive
scan= treat M1.
**Organ nonspecific findings= scan succesive
organs= a)negative scan= follow chest CT
sequence,
b) positive scan= treat M1.