Diagnosis of Lung Cancer – Help From The American Family Physician With Additional Resources

The following are excerpts from Lung Cancer: Diagnosis, Treatment Principles, and Screening (1):

The initial evaluation of a patient with suspected lung
cancer begins with a history and physical examination;
complete blood count; measurement of alkaline phosphatase,
hepatic transaminase, and calcium levels; chemistries
(electrolytes, blood urea nitrogen, creatinine); and
chest radiography.22

Normal findings on a chest radiograph
do not rule out lung cancer because a small tumor
can be hidden within the mediastinum or elsewhere in
the chest.

If suspicion remains high because a likely alternative
diagnosis is not identified on the chest radiograph,
contrast-enhanced computed tomography (CT) should
be performed, followed by positron emission tomography
if necessary.17,19,22

In 2010, approximately 200,000 persons in the United States were diagnosed with lung cancer, and nearly 160,000 persons died of the disease.1,2

Radon, a naturally occurring radioactive gas found in some homes, is estimated to cause 21,000 cases of lung cancer
per year.12 Any home can have elevated radon levels, but the highest levels are found in the Northern and Midwestern regions of the United States.13

fig1

Tobacco use causes 80% to 90% of all lung
cancers.6,7

A person’s risk of lung cancer can be calculated using a validated online tool available at [http://www.diseaseriskindex.harvard.edu/update/hccpquiz.pl?lang=english&func=start&quiz=lung]

Patients with lung cancer are almost always symptomatic
at diagnosis.17 Symptoms can be caused by the primary
tumor (e.g., cough, hemoptysis); intrathoracic spread
(e.g., Horner syndrome, superior vena cava obstruction);
and distant metastases (e.g., bone pain). Tables 2 18
and 3 17 summarize these symptoms. Symptoms can also
be caused by paraneoplastic syndromes (Table 4 17), such
as the syndrome of inappropriate antidiuretic hormone.

fig2

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Resources:

(1) Lung Cancer: Diagnosis, Treatment Principles, and Screening [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Am Fam Physician. 2015;91(4):250-256.

(2) Executive Summary: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [PubMed Abstract] [Full Text HTML]. Chest. 2013 May;143(5 Suppl):7S-37S. doi: 10.1378/chest.12-2377.

(3) Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?
Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Chest. 2013 May;143(5 Suppl):e93S-120S. doi: 10.1378/chest.12-2351.

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