Small cell carcinoma of the lung physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Guillermo Rodriguez Nava, M.D. [2]

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. Fever is reported in 20% of the patients. Patients may present with weight loss, cachexia and anorexia. Upon auscultation unilateral decreased air entry, unilateral wheeze, and decreased air entry in the bases of the lungs and/or crackles (suggestive of pleural effusion) may be present. The musculoskeletal system may show the signs of digital clubbing, bone tenderness, (suggestive of bone metastasis) and osteoarthropathy may be noted.

The physical examination findings of small cell lung cancer are described below:^[1][2][3]

• 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

• Fever (in up to 20% of the patients)

• Hypertension (can be present in case of Cushing’s syndrome)

• Acquired tylosis may be present
• Tripe palms may be present^[4]
• Erythema gyratum repens (rare)

• 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
• 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
• Hoarseness ( suggestive of compression of the recurrent laryngeal nerve) may be present

• Swelling

• 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

• Cardiovascular examination of patients with small cell lung cancer is usually normal

• Hepatomegaly (> 13 cm span) (suggestive of liver metastasis) may be present

• Back examination of patients with small cell lung cancer is usually normal

• Genitourinary examination of patients with small cell lung cancer is usually normal

• 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)

• 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

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