Expansion
Local invasion, distant spread and hormone secretion
Expansion
Local
- Cough, haemoptysis, breathlessness, chest pain, recurrent or slowly resolving pneumonia
- Hoarseness, from left recurrent laryngeal nerve involvement
- Diaphragmatic paralysis, from phrenic nerve involvement
- Superior vena cava obstruction: facial and arm swelling, distended veins, Pemberton’s sign
- Pancoast tumour at the apex: Horner’s syndrome, T1 brachial plexus pain and wasting, rib destruction
- Dysphagia, from oesophageal compression
Metastatic: bone pain and hypercalcaemia, brain, liver, adrenal.
Paraneoplastic, which are highly examinable and split by cell type:
- Small cell: SIADH (hyponatraemia), ectopic ACTH (Cushing’s, with hypokalaemic alkalosis), Lambert-Eaton myasthenic syndrome, cerebellar degeneration
- Squamous cell: PTH related peptide causing hypercalcaemia, and hypertrophic pulmonary osteoarthropathy
- Adenocarcinoma: thrombophlebitis migrans (Trousseau’s sign), clubbing
“Small cell secretes ADH and ACTH; squamous secretes PTHrP.”
Red flags for urgent referral: haemoptysis, or unexplained cough, breathlessness, chest pain, weight loss or appetite loss in anyone over 40, particularly smokers.