History

Fact Explanation
Asymptomatic Minority of patients can be asymptomatic especially in early stages. [3] Adenocarcinoma is known to present late because of its peripheral location. Patients can be asymptomatic till the carcinoma is found incidentally. [15]
Risk factors for the development of lung carcinoma These include smoking, occupational exposure to asbestos, radon, arsenic, chromium, nickel, vinyl chloride, and ionizing radiation. Presence of chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and tuberculosis also play a role in development of bronchial carcinoma. [3,9]
Cough and or hemoptysis Cough is the most common presenting complain. Characteristicly cough changes from hacking cough to a paroxysmal cough. [1] Squamous cell carcinomas usually present this way. [3]
Stridor Due to bronchial obstruction. [1]
Symptoms of lower respiratory tract infection Pneumonia results due to obstruction of the air way due to the tumor. Patients complain of fever, chest pain, cough and shortness of breath. [16]
Breathlessness [2] Airway obstruction and associated pleural effusion may result in breathlessness. [3]
Symptoms of paraneoplastic syndrome Paraneoplastic syndrome occurs in small cell carcinoma. Hypercalcemia, syndrome of inappropriate antidiuretic hormone, Cushing's syndrome (ectopic ACTH production), finger clubbing, and hypertrophic pulmonary osteoarthropathy can manifest in paraneoplastic syndrome. [3]
Nonspecific symptoms These include fatigue, anorexia, and weight loss. [3]
Chest discomfort or pain Chest discomfort is due to direct pressure effects of the tumor. [3] Infiltration of the intercostal nerves and the parietal pleura cause chest pain.
Dysphagia [3] Compression of the esophagus due to the expanding tumor produces dysphagia. Pericardial infiltration and effusion may also contribute to dysphagia.
Horner’s syndrome (Pancoast's tumor) [3,4] Compression of the cervical sympathetic trunk produces Horner’s syndrome. Patients present with referred pain over the scapula, weak and atrophic hand muscles.
Diplopia [3] This is due to metastatic deposits in extraocular muscles. [4]
Symptoms due to phrenic nerve paralysis [5] Tumor invasion of the phrenic nerve causes nerve paralysis. Most patients are asymptomatic at rest, dyspnea on exertion and decreased exercise tolerance can be the presenting complains.
Symptoms due to pleural effusion Malignant pleural effusion presents with dyspnea. [6]
Recurrent laryngeal nerve paralysis Due to compression by the tumor or displaced structures, direct infiltration of the recurrent laryngeal nerve. [7]
Superior vena cava obstruction Due to compression of the superior vena cava. Patients present with shortness of breath, swelling of the face and or arm and distended veins in the upper chest and arms. [8,10]
Pain in the upper arm Compression of the brachial plexus by an apical tumor causes shooting pain in the ipsilateral upper arm.
Bone pain and fractures Malignant metastasis in the bone result in bone pain and pathological fractures.
Symptoms of brain secondary Patients present with confusion, seizures, personality change, early morning nausea and vomiting which is relieved by vomiting.
Symptoms due to malignant pericardial effusion Non-specific chest pain is a common complain. Patients often complain of retro-sternal chest pain which is relieved by bending forwards. [11]
Palpable lymphadenopathy Due to metastatic deposits.
Thromboembolism (Trousseau syndrome) This is commonly seen in adenocarcinoma. Recurrent deep vein thrombosis and pulmonary embolism occur. [12] Deep vein thrombosis produces acute lower limb pain and swelling. Sometimes severe vascular compromise (phlegmasia cerulea dolens) occurs causing severe ischemic pain. [13] Pulmonary embolism causes cough and or hemoptysis with dyspnea, syncope, fever and severe chest pain. [14]
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. CONGLETON J, MUERS M.F. The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy. Respir Med. [online] 1995 Apr;89(4):291-6. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7597269
  3. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  4. VELTEN IM, GUSEK-SCHNEIDER GC, TOMANDL B. Diplopia as first symptom of a bronchogenic carcinoma. Klin Monbl Augenheilkd [online] 2000 Jul;217(1):52-4. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10949817
  5. JAMAL AKHTAR, MOHAMMED AZFAR SIDDIQUI,NAFEES AHMAD KHAN,MD ARIF ALAM. Right Phrenic Nerve Palsy: A Rare Presentation of Thoracic Aortic Aneurysm. Malays J Med Sci. [online] Jul 2013; 20(4): 98–101. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773361/
  6. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  7. HARO E. M, SEBASTIÁN Q. F.,RUBIO G. M. Vocal Cord Paralysis and Staging Bronchogenic Carcinoma. Arch Bronconeumol. [online] 2004;40 (7):333-4. [viewed 30 April 2014] Available from: DOI: 10.1016/S1579-2129(06)60313-3
  8. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  9. KAN YONEMORI, HIDEO KUNITOH, IKUO SEKINE. Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker. Nature Clinical Practice Oncology. [online] 2006: 3, 399-403. [viewed 30 April 2014] Available from: doi:10.1038/ncponc0534
  10. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  11. JAUME SAGRISTÀ-SAULEDA, AXEL SARRIAS MERCÉ, JORDI SOLER-SOLER. Diagnosis and management of pericardial effusion. World J Cardiol. [online] May 26, 2011; 3(5): 135–143. [viewed 4 May 2014] Available from: doi: 10.4330/wjc.v3.i5.135
  12. SATO T, TSUJINO I, NISHIMURA M. Trousseau's syndrome associated with tissue factor produced by pulmonary adenocarcinoma. Thorax. [online] Nov 2006; 61(11): 1009–1010. [viewed 4 May 2014] Available from: doi: 10.1136/thx.2004.031492
  13. SHANNON M. BATES, JEFFREY S. GINSBERG. Treatment of Deep-Vein Thrombosis. N Engl J Med [online] 2004; 351:268-277. [viewed 4 May 2014] Available from: DOI: 10.1056/NEJMcp031676
  14. ADAM TORBICKI, ARNAUD PERRIER, STAVROS KONSTANTINIDES, GIANCARLO AGNELLI et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. [online] 2008: 29 (18): 2276-2315. [viewed 4 May 2014] Available from: doi: 10.1093/eurheartj/ehn310
  15. ISOHATA N, NARITAKA Y, SHIMAKAWA T, ASAKA S, KATSUBE T, KONNO S, MURAYAMA M, SHIOZAWA S, YOSHIMATSU K, AIBA M, IDE H, OGAWA K. Occult lung cancer incidentally found during surgery for esophageal and gastric cancer: a case report. Anticancer Res. [online] 2008; 28(3B):1841-7. [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/18630469
  16. AKINOSOGLOU KS, KARKOULIAS K, MARANGOS M. Infectious complications in patients with lung cancer. Eur Rev Med Pharmacol Sci. [online] 2013 Jan;17(1):8-18. [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23329518

Examination

Fact Explanation
Fever [8] Patients can be febrile due to concurrent infection.
Examination of the respiratory system Wheezing in a localized area is due to bronchial obstruction. [1] Malignant pleural effusions produce reduced chest expansion, stony dull percussion note, and absent breath sounds over the affected segment. [4]
Finger clubbing [8] This is one of the para-malignant disorder of bronchial carcinoma.
Palpable lymph nodes Metastatic deposits to the lymph nodes. [6]
Signs of Horner’s syndrome [2,3] Patients will have ptosis, miosis, anhidrosis, and enophthalmos.
Signs of superior vena cava obstruction [5,7] These include distended neck and facial veins and positive Pemberton's sign.
Signs of increased intracranial pressure Examination of the optic fundus will show papilledema. Focal neurological signs can present in some.
Signs of pericardial effusion Malignant pericardial effusion produces muffled heart sounds. Some patients have distended jugular veins. [10]
Cachexia [8] In advanced disease sever loss of appetite results in significant loss of weight.
Signs of deep vein thrombosis Lower limb is swollen and tender. Severe vascular compromise causes pale or cyanosed limb. [9]
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. VELTEN IM, GUSEK-SCHNEIDER GC, TOMANDL B. Diplopia as first symptom of a bronchogenic carcinoma. Klin Monbl Augenheilkd [online] 2000 Jul;217(1):52-4. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10949817
  4. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  5. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  6. KAN YONEMORI, HIDEO KUNITOH, IKUO SEKINE. Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker. Nature Clinical Practice Oncology. [online] 2006: 3, 399-403. [viewed 30 April 2014] Available from: doi:10.1038/ncponc0534
  7. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  8. RASSAM J W, ANDERSON G. Incidence of paramalignant disorders in bronchogenic carcinoma. Thorax. [online] Feb 1975; 30(1): 86–90. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC470249/
  9. SHANNON M. BATES, JEFFREY S. GINSBERG. Treatment of Deep-Vein Thrombosis. N Engl J Med [online] 2004; 351:268-277. [viewed 4 May 2014] Available from: DOI: 10.1056/NEJMcp031676
  10. WILLIAM C. LITTLE, GREGORY L. FREEMAN. Pericardial Disease. Circulation. [online]2006; 113: 1622-1632. [viewed 4 May 2014] Available from: doi: 10.1161/CIRCULATIONAHA.105.561514

Differential Diagnoses

Fact Explanation
Lower respiratory tract infection Aspiration Pneumonia, bacterial or viral pneumonia are differential diagnoses of bronchial carcinoma.
Benign lung tumors PET scan and histological examination will help in differentiating the two. [2]
Small cell lung carcinoma Patients often have rapid onset symptoms. Histology and immunohistochemical studies will confirm the diagnosis. [5]
Bronchitis Causes hemoptysis due to mucosal inflammation, edema and rupture of superficial blood vessels. [1]
Pleural effusion Parapneumonic effusion, tuberculosis, Hydatid disease, connective tissue and autoimmune disease, chylothorax, empyema and mesothelioma are other causes of pleural effusion. Pleural fluid analysis helps in differentiation. [3]
Superior vena cava (SVC) syndrome Other than bronchial carcinoma breast and mediastinal neoplasms can cause SVC syndrome. Thrombosis of the SVC may also result inSVC syndrome. [4]
Tuberculosis Patients present with cough, hemoptysis loss of appetite and loss of weight.
References
  1. JACOB L. B., ROBERT W. P. Hemoptysis: Diagnosis and Management. Am Fam Physician. [online] 2005 Oct 1;72(7):1253-1260. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2005/1001/p1253.html
  2. TIRA BUNYAVIROCH, EDWARD COLEMAN. PET Evaluation of Lung Cancer. J Nucl Med [online] March 2006: 47 (3) 451-469. [viewed 30 April 2014] Available from: http://jnm.snmjournals.org/content/47/3/451.full
  3. NAJIB M. R., STEPHEN J. C., ROBERT J. O. D. Pleural effusion: a structured approach to care. Br Med Bull [online] 2004: 72 (1): 31-47. [viewed 30 April 2014] Available from: doi: 10.1093/bmb/ldh040
  4. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  5. VAN MEERBEECK JP, FENNELL DA, DE RUYSSCHER DK. Small-cell lung cancer. Lancet. [online] 2011 Nov 12;378(9804):1741-55. [viewed 4 May 2014] Available from: doi: 10.1016/S0140-6736(11)60165-7.

Investigations - for Diagnosis

Fact Explanation
Chest X-ray Localized emphysema is an early sign. [1] Also shows malignant pleural effusions of more than 500ml. [3]
CT scan [3] Enable visualizing the primary rumor and distant metastasis.
PET scanning [3] As the CT, PET scan visualizes the tumor and distant metastasis.
Bronchoscopy Visualizes the lesion. Biopsy specimen can be obtained by bronchial washings and brushings for confirmation of the diagnosis. [1,2]
Exploratory thoracotomy Not routinely done. [1]
Pleural fluid full report A blood stained, exudate (pleural fluid protein is more than 30g/l), with pH less than 7.3 (due to increased lactic acid levels) is suggestive of a malignancy. Pleural fluid is rich in lymphocytes and malignant cells. [4] Pleural fluid amylase levels are elevated in adenocarcinoma. [3]
Histology Differentiate the adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and large cell carcinoma. Thoracotomy and biopsy is used in the diagnosis of early non–small cell carcinoma. [2]
Video-assisted thoracoscopy [2] Aids in visualization of the tumor and biopsy specimens can be obtained.
Sputum cytology Enables detection of malignant cells. [2]
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  4. NAJIB M. R., STEPHEN J. C., ROBERT J. O. D. Pleural effusion: a structured approach to care. Br Med Bull [online] 2004: 72 (1): 31-47. [viewed 30 April 2014] Available from: doi: 10.1093/bmb/ldh040

Investigations - Fitness for Management

Fact Explanation
Lung function test [1] If the forced expiratory volume in first second (FEV1) or carbon monoxide diffusion in the lung (DLCO) is less than 80% of the predicted, postresection pulmonary reserve should be estimated with ventilation-perfusion scan should be estimated to plan the definitive management. [2]
Complete blood count [2] Bone marrow infiltration can cause pancytopenia. Poor appetite may have led to iron deficiency anemia.
Serum electrolytes[2] Assesses the renal function.
Serum calcium [2] Paraneoplastic syndrome may cause hypercalcemia.
Liver function test This includes the assessment of hepatic transaminases and alkaline phosphatase levels. Some drugs are metabolized in the liver and liver function may be deranged in the presence of metastasis. [2]
References
  1. CONGLETON J, MUERS M.F. The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy. Respir Med. [online] 1995 Apr;89(4):291-6. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7597269
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html

Investigations - Followup

Fact Explanation
Chest X-ray Even after successful treatment bronchial carcinoma may recur. Patients should be followed up for at least for two years. [1]
References
  1. CHRISTOPHE DODDOLI, PASCAL THOMAS, OLIVIER GHEZ, ROGER GIUDICELLI, PIERRE FUENTES. Surgical management of metachronous bronchial carcinoma. Eur J Cardiothorac Surg [online] 2001: 19(6): 899-903. [viewed 30 April 2014] Available from: doi: 10.1016/S1010-7940(01)00690-X

Investigations - Screening/Staging

Fact Explanation
Computerized tomography (CT) Tumor size can be estimated. CT is helpful in detecting local invasion of the tumor and lymph node metastasis. Can detect small pleural effusions that are not detectable from a chest X-ray. [1] Low dose CT is the investigation of choice for screening of lung cancer. Current smokers or people who have quit smoking with in past 15 years who are in the age group of 55 to 74 years should be screened. [4]
PET scanning [3] Findings are similar to CT. imaging studies aid in staging the disease. Stage I (up to T2N0M0) implies to small carcinoma which has no lymph node spread (tumor size 3 cm or less in diameter is Stage IA, T1N0M0. Tumor size of more than 3 cm in diameter which may invade pleura and or extend into main bronchus, however remains 2 cm or more distal to carina and causing segmental atelectasis or pneumonitis is Stage IB, T2N0M0). When the adjacent lymph nodes are involved it is Stage II. (Positive ipsilateral peribronchial or hilar nodes and intrapulmonary nodes is Stage IIA, T1N1M0. Invasion of adjacent structures, chest wall, diaphragm, pleura, or pericardium and main bronchus less than 2 cm distal to carina or in the presence of lung atelectasis the tumor is staged as Stage IIB, T2N1M0 and T3N0M0) Stage IIB and onwards are categorized as locally advanced tumor. Involvement of the adjacent organs or distant lymph nodes are categorized as Stage III, which includes T1N2M0, T2N2M0, T3N1M0, T3N2M0 and T1-4N3M0. T1-4N3M0 is Stage IIIB and all the other belongs to Stage IIIA. N2 is the involvement of ipsilateral mediastinal or subcarinal nodes and N3 is the involvement of contralateral nodes or any supraclavicular nodes. T4N1-3M0 (stage IIIB) and upwards is categorized as advanced tumor. Presence of distant metastasis is Stage IV (T1-4N1-3M1). [6,3]
Diagnostic thoracentesis [1] Pleural fluid is obtained for the assessment of cell counts, total protein, lactate dehydrogenase, glucose, pH, amylase, and cytology.
Pleural Biopsy Detects pleural deposits. [1]
Pericardial fluid aspiration This enables the confirmation of malignant pleural effusion. [5]
Bone scan [3] Evaluates bone metastasis. Especially useful in small cell carcinoma because it usually presents with metastatic disease.
MRI of the head Visualizes cerebral metastasis. [3]
Indirect laryngoscopy Detects vocal cord paralysis. Involvement of the recurrent laryngeal nerve is staged as T4. [2]
References
  1. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  2. HARO E. M, SEBASTIÁN Q. F.,RUBIO G. M. Vocal Cord Paralysis and Staging Bronchogenic Carcinoma. Arch Bronconeumol. [online] 2004;40 (7):333-4. [viewed 30 April 2014] Available from: DOI: 10.1016/S1579-2129(06)60313-3
  3. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  4. Screening for lung cancer. U.S. Preventive Services Task Force Recommendation Statement [online] [viewed 3 May 2014] Available from: http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm
  5. JAUME SAGRISTÀ-SAULEDA, AXEL SARRIAS MERCÉ, JORDI SOLER-SOLER. Diagnosis and management of pericardial effusion. World J Cardiol. [online] May 26, 2011; 3(5): 135–143. [viewed 4 May 2014] Available from: doi: 10.4330/wjc.v3.i5.135
  6. Lung cancer - non-small cell. [online] [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004462/

Management - General Measures

Fact Explanation
Cessation of smoking Smoking is a main causative factor for the development of lung carcinoma. [3] Counseling and nicotine replacement therapy whenever necessary will be helpful. [2]
Management of malignant pleural effusions Therapeutic thoracentesis and fluid aspiration will provide symptomatic relief. Chemical pleurodesis will prevent the recurrences. [4]
Management of superior vena cava obstruction Stent placement or balloon dilatation can establish the patency of the vein. [1]
Management of malignant pericardial effusion Pericardiocentesis is done if the patient is in hemodynamic compromise. [7]
Management of deep vein thrombosis and pulmonary embolism Patients should be anti coagulated, initially with low molecular weight heparin followed by warfarin. [5,6]
Treatment of respiratory tract infection Lower respiratory tract infection is a common complication either due to tracheal obstruction and aspiration due to the tumor or secondary to immune suppression due to treatment. [8]
References
  1. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. DOLL R, PETO R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health. [online] 1978 Dec;32(4):303-13. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/744822
  4. KONSTANTINOS ZAROGOULIDIS, PAUL ZAROGOULIDIS, KAID DARWICHE, KOSMAS TSAKIRIDIS, NIKOLAOS MACHAIRIOTIS at al. Malignant pleural effusion and algorithm management. Journal of Thoracic Disease [online] 2013: 5 (4) [viewed 30 April 2014] Available from: doi: 10.3978/j.issn.2072-1439.2013.09.04
  5. SHANNON M. BATES, JEFFREY S. GINSBERG. Treatment of Deep-Vein Thrombosis. N Engl J Med [online] 2004; 351:268-277. [viewed 4 May 2014] Available from: DOI: 10.1056/NEJMcp031676
  6. ADAM TORBICKI, ARNAUD PERRIER, STAVROS KONSTANTINIDES, GIANCARLO AGNELLI et al. Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. [online] 2008: 29 (18): 2276-2315. [viewed 4 May 2014] Available from: doi: 10.1093/eurheartj/ehn310
  7. JAUME SAGRISTÀ-SAULEDA, AXEL SARRIAS MERCÉ, JORDI SOLER-SOLER. Diagnosis and management of pericardial effusion. World J Cardiol. [online] May 26, 2011; 3(5): 135–143. [viewed 4 May 2014] Available from: doi: 10.4330/wjc.v3.i5.135
  8. AKINOSOGLOU KS, KARKOULIAS K, MARANGOS M. Infectious complications in patients with lung cancer. Eur Rev Med Pharmacol Sci. [online] 2013 Jan;17(1):8-18. [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23329518

Management - Specific Treatments

Fact Explanation
Surgical resection of the tumor (lobectomy and pneumonectomy) Stage I, II and resectable tumors of Stage IIIA can be resected surgically. [1]
Chemotherapy After surgical resection chemotherapy is indicated as an adjunct to the primary treatment. Stage IIIA unresectable tumors or Stage IIIB tumors should receive chemotherapy with concurrent or subsequent radiotherapy. Cisplatin is commonly used. [1,2]
Radiotherapy Useful to control the primary tumor and skeletal metastasis. [1] Often chemoradiation therapy either as neoadjuvant therapy to surgery or after the surgical resection of the primary tumor is used for better outcome. [5,6]
Surgical resection of the metastasis Resectable brain metastasis can be surgically removed in stage IIIB and IV. This is combined with removal of the T1 primary tumor. [1]
Molecular targeted therapy There are identified genetic mutations in non-small cell lung carcinoma, especially in adenocarcinomas. These mutations cause downstream signaling of epidermal growth factor receptors. Reversible tyrosine kinase inhibitors, gefitinib and erlotinib are proven to counteract those mutated receptors. [3,4]
References
  1. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  2. KAN YONEMORI, HIDEO KUNITOH, IKUO SEKINE. Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker. Nature Clinical Practice Oncology. [online] 2006: 3, 399-403. [viewed 30 April 2014] Available from: doi:10.1038/ncponc0534
  3. HABER D.A., BELL D.W., SORDELLA R., et al. Molecular targeted therapy of lung cancer: EGFR mutations and response to EGFR inhibitors. Cold Spring Harb Symp Quant Biol. [online] 2005;70:419-26. [viewed 4 May 2014] Available from: doi:10.1101/sqb.2005.70.043
  4. MA PC. Personalized targeted therapy in advanced non-small cell lung cancer. Cleve Clin J Med. [online] 2012 May; 79. [viewed 4 May 2014] Available from: doi: 10.3949/ccjm.79.s2.12.
  5. KIM AW, FABER LP, WARREN WH, BASU S, WIGHTMAN SC, WEBER JA, BONOMI P, LIPTAY MJ. Pneumonectomy after chemoradiation therapy for non-small cell lung cancer: does "side" really matter? Ann Thorac Surg. [online] 2009 Sep;88(3):937-43. [viewed 4 May 2014] Available from: doi: 10.1016/j.athoracsur.2009.04.102.
  6. BAAS P, BELDERBOS JS, VAN DEN HEUVEL M. Chemoradiation therapy in nonsmall cell lung cancer. Curr Opin Oncol. [online] 2011 Mar;23(2):140-9. [viewed 4 May 2014] Available from: doi: 10.1097/CCO.0b013e328341eed6.