Clinical Presentation
-Cough, dyspnoea, chest pain, heamoptysis, and hoarseness of voice.

If Invasion or obstruction of vital thoracic organs occur
-Superior vena cavae obstruction
-Pleural/ pericardial effusion
-Pancoast syndrome
-Paralysis of the recurrent laryngeal nervehoarseness of voice
-Phrenic nerve palsy paralysis of ipsilateral hemidiaphragm
-Horner’s syndrome
-Dysphagia oesophageal compression
-Intense and radiating neuropathic pain in the ipsilateral upper extremity due to superior sulcus tumour compression of the brachial plexus roots.

Metastatic Disease
-metastasize to liver, adrenal glands, bone, brain and regional lymph nodes.
-Bone pain, seizures, hemiplegia and hepatomegaly.

General Presentation
-Drastic/ significant weight loss, malaise, fatigue and anorexic.

Para-neoplastic Syndrome
-syndrome of Inappropriate Anti-diuretic Hormone (SIADH)
-Hypercalcaemia
-Gynecomastia and galactorrhea large cell carcinoma
-Cushing Syndrome small cell carcinoma
-Neurological Syndrome
- Eaton- Lambert Syndrome manifestation of small cell carcinoma due to defective acetycholine release at neuromuscular junction proximal muscle weakness and reduction of tendon reflexes. Can be accompanied by xerostomia (mouth dryness), sexual impotence and peripheral neuropathy.



Superior Vena Cava Syndrome
-characterized by gradual, insidious compression of the superior vena cava, can be life-threatening
-thin wall coupled with low intravascular pressurerelative easy to be compress possible thrombus formation and increase venous pressure interstitial oedema and retrograde collateral flow.
-Causes early morning headache, facial congestion, dusky skin colouration and oedema in upper limbs, and distended jugular veins.
-90% associated with malignancy (bronchogenic carcinoma)

Horner’s Syndrome
-Interruption of the sympathetic ganglion chain causing miosis (constricted pupil), partial ptosis and loss of hemifacial sweating.
-Pancoast tumour in apical of lungs compressing on the sympathetic chain

Pleural/ Pericardial Effusion
- infiltration into parietal pleura/ pericardial sac.
Metabolic (universal at some stage)
Loss of weight
Lassitude
Anorexia
Endocrine (10%) (usually small-cell carcinoma)
Ectopic adrenocorticotrophin syndrome
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
Hypercalcaemia (usually squamous cell carcinoma)
Rarer: hypoglycaemia, thyrotoxicosis, gynaecomastia
Neurological (2-16%)
Encephalopathies - including subacute cerebellar degeneration
Myelopathies - motor neurone disease
Neuropathies - peripheral sensorimotor neuropathy
Muscular disorders - polymyopathy, myasthenic syndrome (Eaton-Lambert syndrome)
Vascular and haematological (rare)
Thrombophlebitis migrans
Non-bacterial thrombotic endocarditis
Microcytic and normocytic anaemia
Disseminated intravascular coagulopathy
Thrombotic thrombocytopenic purpura
Haemolytic anaemia
Skeletal
Clubbing (30%)
Hypertrophic osteoarthropathy (± gynaecomastia) (3%)
Cutaneous (rare)
Dermatomyositis
Acanthosis nigricans
Herpes zoster