Small cell carcinoma of the lung physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of [[metastases]]. | Many authors have concluded that performing a complete assessment, with a detailed history and [[physical examination]], is useful for identifying patients with a higher likelihood of [[metastases]]. | ||
==Physical Examination== | ==Physical Examination== | ||
The physical examination of the small cell lung cancer is described below: | The [[physical examination]] of the small cell lung cancer is described below:<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref><ref name="pmid18316005">{{cite journal| author=Sher T, Dy GK, Adjei AA| title=Small cell lung cancer. | journal=Mayo Clin Proc | year= 2008 | volume= 83 | issue= 3 | pages= 355-67 | pmid=18316005 | doi=10.4065/83.3.355 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18316005 }} </ref><ref name="pmid17873166">{{cite journal |vauthors=Spiro SG, Gould MK, Colice GL |title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition) |journal=Chest |volume=132 |issue=3 Suppl |pages=149S–160S |date=September 2007 |pmid=17873166 |doi=10.1378/chest.07-1358 |url=}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
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===Head=== | ===Head=== | ||
* Moon facies (suggestive of [[Cushing's syndrome]]) may be present | * [[Moon facies]] (suggestive of [[Cushing's syndrome]]) may be present | ||
* [[Swelling]] of the face, neck, trunk, and arms (suggestive of [[superior vena cava syndrome]]) may be present | * [[Swelling]] of the face, neck, trunk, and arms (suggestive of [[superior vena cava syndrome]]) may be present | ||
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* Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) may be present | * Yellow discoloration of the [[sclera]] (suggestive of [[jaundice]] due to liver [[metastasis]]) may be present | ||
* Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) may be present | * Conjunctival [[pallor]] (suggestive of [[anemia of chronic disease]]) may be present | ||
*[[Miosis]], ipsilateral [[ptosis]] and lack of facial sweating (suggestive of [[Horner's syndrome]]) may be present | *[[Miosis]], ipsilateral [[ptosis]] and lack of [[facial]] sweating (suggestive of [[Horner's syndrome]]) may be present | ||
===Throat=== | ===Throat=== | ||
| Line 40: | Line 40: | ||
* Unilateral decreased air entry may be present | * Unilateral decreased air entry may be present | ||
* Unilateral [[wheeze]] may be present | * Unilateral [[wheeze]] may be present | ||
* Decreased air entry in the bases of the lungs and/or [[crackles]] (suggestive of [[ | * Decreased air entry in the bases of the [[lungs]] and/or [[crackles]] (suggestive of [[pleural effusion]]) may be present | ||
===Abdomen=== | ===Abdomen=== | ||
| Line 48: | Line 48: | ||
*[[Digital clubbing]] may be present | *[[Digital clubbing]] may be present | ||
*[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) may be present | *[[Bone]] [[tenderness]] (suggestive of [[bone]] [[metastasis]]) may be present | ||
*[[Osteoarthropathy]] may be present: painful symmetrical arthropathy of the knees, wrist | *[[Osteoarthropathy]] may be present: [[painful]] symmetrical [[arthropathy]] of the [[knees]], [[wrist]] and new periosteal [[bone]] formation. | ||
===Neurological=== | ===Neurological=== | ||
* [[Weakness]] of the proximal muscles of lower extremities, abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]]) may be present<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Weakness]] of the proximal [[muscles]] of [[lower extremities]], abnormal [[gait]], [[autonomic dysfunction]], and [[paresthesia]] (suggestive of [[Lambert-Eaton syndrome]]) may be present<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Altered mental status]], [[seizures]], [[memory loss]], space and time [[disorientation]], with or without [[dementia]] (suggestive of [[limbic encephalitis]] and [[encephalomyelitis]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | * [[Ataxia]], [[dysarthria]], severe [[vertigo]] (suggestive of [[paraneoplastic cerebellar degeneration]]) may occur<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref> | ||
* Focal neurologic | * [[Focal neurologic signs]], [[seizures]], [[confusion]], and [[personality changes]] (suggestive of [[brain]] [[metastasis]]) | ||
===Skin=== | ===Skin=== | ||
Revision as of 14:07, 29 March 2018
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Small Cell Carcinoma of the Lung Microchapters |
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Differentiating Small Cell Carcinoma of the Lung from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Guillermo Rodriguez Nava, M.D. [2]
Overview
Many authors have concluded that performing a complete assessment, with a detailed history and physical examination, is useful for identifying patients with a higher likelihood of metastases.
Physical Examination
The physical examination of the small cell lung cancer is described below:[1][2][3]
Vital Signs
- Fever (in up to 20% of patients with lung cancer)
- Hypertension (can be present in case of Cushing's syndrome)
General Appearance
- Cachexia (weight loss and anorexia) may be present
- Central obesity (suggestive of Cushing's syndrome) may be present
- Jaundice (suggestive of liver metastasis) may be present
- Pale skin (suggestive of anemia of chronic disease) may be present
- Cyanosis (suggestive of severe dyspnea) may be present
- Lymphadenopathy (> 1 cm) may be present
- Dehydration (suggestive of hypercalcemia) may be present
Head
- Moon facies (suggestive of Cushing's syndrome) may be present
- Swelling of the face, neck, trunk, and arms (suggestive of superior vena cava syndrome) may be present
Eyes
- Yellow discoloration of the sclera (suggestive of jaundice due to liver metastasis) may be present
- Conjunctival pallor (suggestive of anemia of chronic disease) may be present
- Miosis, ipsilateral ptosis and lack of facial sweating (suggestive of Horner's syndrome) may be present
Throat
- Hoarseness ( suggestive of compression of the recurrent laryngeal nerve) may be present
Lungs
- Unilateral decreased air entry may be present
- Unilateral wheeze may be present
- Decreased air entry in the bases of the lungs and/or crackles (suggestive of pleural effusion) may be present
Abdomen
- Hepatomegaly (> 13 cm span) (suggestive of liver metastasis) may be present
Musculoskeletal system
- Digital clubbing may be present
- Bone tenderness (suggestive of bone metastasis) may be present
- Osteoarthropathy may be present: painful symmetrical arthropathy of the knees, wrist and new periosteal bone formation.
Neurological
- Weakness of the proximal muscles of lower extremities, abnormal gait, autonomic dysfunction, and paresthesia (suggestive of Lambert-Eaton syndrome) may be present[1]
- Altered mental status, seizures, memory loss, space and time disorientation, with or without dementia (suggestive of limbic encephalitis and encephalomyelitis) may occur[1]
- Ataxia, dysarthria, severe vertigo (suggestive of paraneoplastic cerebellar degeneration) may occur[1]
- Focal neurologic signs, seizures, confusion, and personality changes (suggestive of brain metastasis)
Skin
- Acquired tylosis may be present
- Tripe palms may be present[4]
- Erythema gyratum repens (rare)
References
- ↑ 1.0 1.1 1.2 1.3 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
- ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.
- ↑ Spiro SG, Gould MK, Colice GL (September 2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
- ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.