The clinical presentation may be nonspecific, but cough, hemoptysis, dyspnea and chest pain are lung-related symptoms that are reported in variable percentages [4]. In up to 25% of cases, however, an asymptomatic course is observed, which significantly impedes the ability to make the diagnosis [6].

• Weight Loss

  On admission, the patient presented with weight loss, cough and hemoptysis. The fiberoptic bronchoscopy revealed a soft tissue mass, with a partial occlusion of the left upper bronchus, which resembled bronchogenic carcinoma. [ncbi.nlm.nih.gov]

  He had dysphagia, weight loss and hoarseness of voice. Lab tests potassium of 2.5 mmol/l, with normal sodium, urea, creatinine. Bicarbonate 35 mmol/l. [endocrine-abstracts.org]

  The cause of the marked weakness and weight loss which may accompany a small, localized malignancy is not clear. [jamanetwork.com]

  Initial review of symptoms was unremarkable for cough, shortness of breath, or weight loss. Figure 1: Initial presentation of swollen, painful, left small finger distal phalanx. [healio.com]

  General symptoms Fever, anorexia, nausea, weight loss lassitude and tiredness are the general symptoms of lung cancer. Local symptoms Cough is the most common early symptoms; sputum is purulent if secondary infection. [m.theindependentbd.com]

• Fatigue

  Systemic effects (anorexia, weight loss, weakness and profound fatigue). · History of smoking. Examination · Patient 1 has clubbing and tar staining of the fingers. -Dull percussion note at the apex with absent breath sounds. [syrianclinic.com]

  Even when symptoms—such as coughing and fatigue—do occur, people think they are due to other causes. For this reason, early-stage lung cancer (stages I and II) is difficult to detect. [lungcancer.org]

  The early symptoms of lung adenocarcinoma may instead be signs such as: Unexplained weight loss Fatigue Shortness of breath, especially with exercise Causes Most people are familiar with smoking as a cause of lung cancer, but there are other important [lungcancer.about.com]

  These are some of the most common symptoms of lung cancer: persistent or worsening cough wheezing coughing up blood and mucus chest pain that gets worse when you take a deep breath, laugh, or cough shortness of breath hoarseness weakness, fatigue frequent [healthline.com]

• Fever

  A 14-year-old Korean boy was admitted with cough, hemoptysis, and fever. A chest X-ray showed a solitary pulmonary mass and pneumonitis. Bronchial biopsy by fiberoptic bronchoscopy revealed a poorly differentiated small cell carcinoma. [ncbi.nlm.nih.gov]

  The hemoptysis is usually mild and often associated with a purulent sputum (thick, opaque, yellowish-white discharge), low-grade fever and occasionally, wheezing. [healthcommunities.com]

  He later developed pneumonia In alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents. and fever. The patient expired soon thereafter. [peir.path.uab.edu]

  General symptoms Fever, anorexia, nausea, weight loss lassitude and tiredness are the general symptoms of lung cancer. Local symptoms Cough is the most common early symptoms; sputum is purulent if secondary infection. [m.theindependentbd.com]

  There was no history of haemoptysis, fever, hoarseness of voice, or weight loss. On inspection, there was a swelling arising from sternal area measuring 2.5 × 2.0 cm in the region of the sternal angle. [ccij-online.org]

• Anemia

  General survey revealed anemia and clubbing, but there was no cyanosis, edema, and engorged neck vein. [hindawi.com]

  Poor prognosis is associated with increased serum creatinine level, severe anemia and younger age at the time of diagnosis. [dbpia.co.kr]

  Physical examination may be normal or may reveal the following: Anemia, finger clubbing, enlarged lymph nodes Decreased breath sounds due to underlying malignant pleural effusion Wheezing due to accompanying the chronic obstructive pulmonary disease Facial [lecturio.com]

  […] antibodies; SOX protein antibody; SCLC associated; treated with 3,4-diaminopyridine), Peripheral neuropathy, Subacute cerebellar degeneration, Cortical degeneration Hematological: Trosseau’s syndrome (Migratory thrombophlebitis), Marantic endocarditis, DIC, Anemia [epomedicine.com]

  Peripheral lymphadenopathy was noted in 31 (42.5%) of the young patients, anemia in 23 (31.5%), clubbing in 19 (26%), superior vena cava syndrome in 7 (9.6%), and Horner's syndrome in 2 (2.7%). [cancerjournal.net]

• Cough

  Symptoms may include cough, dyspnea, hemoptysis and chest pain and the diagnosis is made using clinical, imaging and histopathologic criteria. [symptoma.com]

  On admission, the patient presented with weight loss, cough and hemoptysis. The fiberoptic bronchoscopy revealed a soft tissue mass, with a partial occlusion of the left upper bronchus, which resembled bronchogenic carcinoma. [ncbi.nlm.nih.gov]

• Pneumonia

  In-hospital mortality due to postoperative pneumonia was 7 cases (31.8%). In the postoperative pneumonia group, microorganisms were isolated in 10 cases (45.5%). [ncbi.nlm.nih.gov]

  He later developed pneumonia In alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents. and fever. The patient expired soon thereafter. [peir.path.uab.edu]

  Obstructive collapse 23. 2ry pneumonia Criteria of 2ry pneumonia: 1. Consolidation collapse. 2. Consolidation with no air bronchogram. 3. Consolidation with hilar mass. 4. [slideshare.net]

  (bacterial pneum., Pneumocystis carinii) Cysts - Lymphocytic interstitial pneumonia Thin-walled cysts Pneumocystis carinii Emfysem:Alfa 1-antitripsin-mangel Eksempler Sygdomme med linere eller retikulre forttninger Pulmonal dem Pulmonal lymfangiektasi [vdocuments.mx]

• Pleural Effusion

  The patient also had axillary lymphnode metastasis on the same side as the chest swelling with a contralateral pleural effusion. [ncbi.nlm.nih.gov]

  Annals of Laboratory Medicine. 2013; 33(3): 225-228 [Pubmed] 5 Myelomatous pleural effusion-A case report J. Miller,P.A. [dx.doi.org]

  We also assessed the frequency of additional findings including pleural effusion (38%), pericardial thickening (38%), displacement or narrowing of either the tracheobronchial tree (68%) or major vessels (68%), and hepatic masses (24%). [ajronline.org]

  Breathlessness: (due to large pleural effusion or tumour occludes a large bronchus). Stridor: (Tumour compress the main bronchi). [m.theindependentbd.com]

• Hoarseness

  He had dysphagia, weight loss and hoarseness of voice. Lab tests potassium of 2.5 mmol/l, with normal sodium, urea, creatinine. Bicarbonate 35 mmol/l. [endocrine-abstracts.org]

  […] syndrome (Obstruction of SVC by tumor; more commin in SCLCl 2-4%)Impaired venous return (causing edema) from: Arms: limb edema Periorbital area: periorbital edema Ocular mucosal membranes: chemosis (visual disturbance) Pharynx and larynx: stridor and hoarseness [epomedicine.com]

  Mediastinal spread (hoarseness with left-sided lesions due to recurrent laryngeal nerve palsy; obstruction of the superior vena cava with right-sided tumours or associated lymphadenopathy; elevation of the hemidiaphragm as result of phrenic nerve paralysis [syrianclinic.com]

  […] segment RUL o Pancoast tumor=superior sulcus tumor (4%) o Squamous cell most often o SVC obstruction (5%) § Most often small cell · Associated clinical findings o Horner's syndrome § Pancoast tumor o Elevated hemidiaphragm § Phrenic nerve paralysis o Hoarseness [learningradiology.com]

  Pressure symptoms: Esophagus ---dysphagia Trachea ---- stridor, change of the voice, hoarsness Recurrent laryngeal nerve----- hoarsness of voice C. Superior vena cava obstruction: Caused by partial or complete obstruction of SVC. [slideshare.net]

• Hemoptysis

  Symptoms may include cough, dyspnea, hemoptysis and chest pain and the diagnosis is made using clinical, imaging and histopathologic criteria. [symptoma.com]

  The underlying cause of hemoptysis in chronic lung inflammation such as tuberculosis is an enlarged bronchial and/ or non-bronchial arteries. Bronchial artery embolization is a well known and effective way of treatment for hemoptysis. [go.gale.com]

  English, Spanish] Author information 1 Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. [email protected] Abstract A 45-year-old smoker was referred for evaluation of recent onset streaky hemoptysis [ncbi.nlm.nih.gov]

  Causes of Hemoptysis There are many underlying disorders that can cause hemoptysis (coughing up blood), ranging from heart problems to trauma to infections to lung disease. Worldwide, tuberculosis is the most common cause of hemoptysis. [healthcommunities.com]

• Dysphagia

  · Pain - either local or metastatic. · Breathlessness due to bronchial obstruction. · Dysphagia. · Haemoptysis. · Superior venal caval obstruction. · Pancoast's tumour. · Before and after operation in selected patients. [syrianclinic.com]

  He had dysphagia, weight loss and hoarseness of voice. Lab tests potassium of 2.5 mmol/l, with normal sodium, urea, creatinine. Bicarbonate 35 mmol/l. [endocrine-abstracts.org]

  CLINICAL FEATURES • Local Tumour effects Hoarse voice (tumour invasion of the left recurrent laryngeal nerve) Dysphagia Raised hemidiaphragm (phrenic nerve paralysis) SVCO Horner’s syndrome (miosis, ptosis, enophthalmos, anhydrosis) due to apical [slideshare.net]

  […] tumor; more commin in SCLCl 2-4%)Impaired venous return (causing edema) from: Arms: limb edema Periorbital area: periorbital edema Ocular mucosal membranes: chemosis (visual disturbance) Pharynx and larynx: stridor and hoarseness Walls of GI tract: dysphagia [epomedicine.com]

  […] often small cell · Associated clinical findings o Horner's syndrome § Pancoast tumor o Elevated hemidiaphragm § Phrenic nerve paralysis o Hoarseness § Recurrent laryngeal nerve (left>right) o SVC obstruction § Small cell ca o Pleural effusion (10%) o Dysphagia [learningradiology.com]

• Dysphagia

  · Pain - either local or metastatic. · Breathlessness due to bronchial obstruction. · Dysphagia. · Haemoptysis. · Superior venal caval obstruction. · Pancoast's tumour. · Before and after operation in selected patients. [syrianclinic.com]

  He had dysphagia, weight loss and hoarseness of voice. Lab tests potassium of 2.5 mmol/l, with normal sodium, urea, creatinine. Bicarbonate 35 mmol/l. [endocrine-abstracts.org]

  CLINICAL FEATURES • Local Tumour effects Hoarse voice (tumour invasion of the left recurrent laryngeal nerve) Dysphagia Raised hemidiaphragm (phrenic nerve paralysis) SVCO Horner’s syndrome (miosis, ptosis, enophthalmos, anhydrosis) due to apical [slideshare.net]

  […] tumor; more commin in SCLCl 2-4%)Impaired venous return (causing edema) from: Arms: limb edema Periorbital area: periorbital edema Ocular mucosal membranes: chemosis (visual disturbance) Pharynx and larynx: stridor and hoarseness Walls of GI tract: dysphagia [epomedicine.com]

  […] often small cell · Associated clinical findings o Horner's syndrome § Pancoast tumor o Elevated hemidiaphragm § Phrenic nerve paralysis o Hoarseness § Recurrent laryngeal nerve (left>right) o SVC obstruction § Small cell ca o Pleural effusion (10%) o Dysphagia [learningradiology.com]

• Chest Pain

  Symptoms may include cough, dyspnea, hemoptysis and chest pain and the diagnosis is made using clinical, imaging and histopathologic criteria. [symptoma.com]

  There was no radiation of chest pain. Chest pain was suddenly increased for last five days and the patient was admitted in the emergency department with a suspicion of acute myocardial infarction (AMI). [hindawi.com]

  A 30-year-old man patient was admitted to our clinic with complaints including cough, dyspnea, and chest pain. He had been diagnosed with pulmonary Langerhans' cell histiocytosis (LCH) 9 years previously. [ncbi.nlm.nih.gov]

  pain (20%) – common in peripheral tumor Tumour involving pleural surface causing pleuritic chest pain Also due to mediastinal involvement Mediastinal involvement Superior vena cava syndrome (Obstruction of SVC by tumor; more commin in SCLCl 2-4%)Impaired [epomedicine.com]

  Chest wall invasion C.P: Focal chest pain. Radiological manifestations: CXR: Bone destruction. Chest wall mass. [slideshare.net]

• Tachycardia

  Myocardial invasion results in myocardial ischemia and angina pectoris, brady- or tachyarrhythmias (e.g., unexplained tachycardia, atrial flutter, atrial fibrillation, heart block, complete or incomplete, atrioventricular rhythm, and premature beats), [hindawi.com]

• Bone Pain

  pain Lymph node: supraclavicular (scalene node) Epidural and bone: spinal cord compression syndromes [epomedicine.com]

  Pain and nerve entrapment.  Pleural pain usually indicates malignant pleural invasion  Intercostal nerve involvement causes pain in the distribution of a thoracic dermatome. 20. [slideshare.net]

  pain - due to bone involvement. [m.theindependentbd.com]

  These include seizures, headache, personality changes, bone pain, abdominal pain, and jaundice. The common metastatic sites include lymph nodes, bones, liver, central nervous system (brain and spinal cord), and adrenal glands. [lecturio.com]

• Shoulder Pain

  Wheeze or stridor Shoulder pain (due to diaphragm involvement) Pleural effusion (due to direct tumour extension or pleural metastases) 14. [slideshare.net]

  Pancoast tumors can derange the brachial plexus, resulting in shoulder pain, and plae pressure on afferent SNS fibers that travel above the lung apex and control ocular functions, resulting in "Horner's Syndrome" characterized by a triad of miosis, ptosis [pathwaymedicine.org]

  […] or cervical spine obtained to investigate a complaint of shoulder pain. [alpfmedical.info]

• Peripheral Neuropathy

  Subacute motor neuronopathy 1.Peripheral neuropathy is the most common neurologic paraneoplastic syndrome. [slideshare.net]

  - Parathormone or prostaglandin E (hypercalcemia) - Calcitonin (hypocalcemia) - Gonadotropin (gynecomastia) - Serotonin (carcinoid syndrome) Other paraneoplastic syndromes include myopathy, peripheral neuropathy, acanthosis nigricans, and hypertrophic [histopathology-india.net]

  neuropathy, superior vena cava syndrome (compression/invasion of SVC causes venous congestion, circulatory compromise, dusky head, arm edema) Spread and classification Spreads along bronchus distally and proximally, into lung parenchyma to mediastinum [pathologyoutlines.com]

  neuropathy, Subacute cerebellar degeneration, Cortical degeneration Hematological: Trosseau’s syndrome (Migratory thrombophlebitis), Marantic endocarditis, DIC, Anemia, Granulocytosis, Leukoerythroblastosis Cutaneous: Acanthosis nigricans Renal: Nephrotic [epomedicine.com]

  Thymoma: Encephalomyelitis, Cerebellar degeneration, peripheral neuropathy Anti-Yo Ab Breast and Gyn Cancers: Cerebellar degeneration Anti-Amiphiphysin Ab……SCLC: Stiff –Person syndrome Anti –VGCC…..LEMS …SCLC Primary tumor (T) involvement is as follows [dralirezasabetpour.com]

• Cerebellar Ataxia

  Neurological examination revealed left cerebellar ataxia. Neuroimaging showed multiple cerebellar metastases with cerebellar hemorrhage adjacent to the tentorium. [ncbi.nlm.nih.gov]

A thorough physical examination must be performed, but imaging studies are necessary to make a preliminary diagnosis [3]. Chest X-ray, CT, or MRI can identify the location of the tumor and bronchoscopy with subsequent histopathological examination, guided by findings from imaging studies, is mandatory in order to identify the underlying subtype [7].

• Atelectasis

  On quantitative analyses, the T1 retention indexes of the tumor and atelectasis were 29.7 and 42.0. The mean SUVs of FDG of the tumor and the atelectasis were 8.92 and 1.28. T1-SPECT could not distinguish the atelectasis from the carcinoma. [ncbi.nlm.nih.gov]

  Atelectasis and Postobstructive Pneumonitis Atelectasis results from endobronchial obstruction or extrinsic compression of a bronchus. [alpfmedical.info]

• Mediastinal Mass

  Mass lesion or coin shadow…..fig 1 2. Mediastinal widening due to enlargement of lymph nodes ……fig 5 3. Rib erosion and rib fracture….fig 3 4. Phrenic nerve paralysis in the presence of mediastinal mass 5. Presence of pleural effusion….fig 6 6. [slideshare.net]

  A: A large smooth round right mediastinal mass ( arrow) is visible on chest radiograph. B: In another patient, a low-attenuation subcarinal bronchogenic cyst (arrow) is visible. The cyst wall is invisible. FIG. 8.53. W. Richard Webb, Charles B. [educalingo.com]

• Pulmonary Infiltrate

  The most frequent thoracic involvement by MM is pulmonary infiltrate secondary to an infectious process. [dx.doi.org]

• Cavitary Lesion

  The classic manifestation is a cavitary lesion in a proximal bronchus. This type is characterized histologically by the presence of keratin pearls and can be detected with cytologic studies because it has a tendency to exfoliate. [emedicine.medscape.com]

• Hyponatremia

  […] malignant tumors (9, 10), and particularly in the various forms of carcinomatous neuropathies (11-13), only one instance of orthostatic hypotension associated with carcinoma was found in the literature (14), and in that case renal sodium wastage and hyponatremia [annals.org]

  SIAD is characterized by hyponatremia, hypoosmolality, and less than a maximally diluted urine. Secretion of vasopressin by the tumor and inappropriate thirst are the causes of the syndrome. [journals.lww.com]

  (Na Hyp0-osmotic plasma (Plasma osmolality Hyperosmotic urine (Urine osmolality >500 mOsm/kg) Hypernatremic urine (Urinary Na >20 mEq/L) Ectopic secretion of ADH → retain free water in collecting ducts Euvolemic hyponatremia and concentrated urine Mild [epomedicine.com]

  Endocrine: Inappropriate ADH secretion causing hyponatremia Ectopic ACTH secretion (Cushing's syndrome) Hypercalcaemia Carcinoid syndrome Gynaecomastia b. [m.theindependentbd.com]

  10x increased risk chronic obstructive pulmonary disease Staging non-small cell lung cancer staging small cell lung cancer staging Associations Various paraneoplastic syndromes can arise in the setting of lung cancer: endocrine/metabolic SIADH causing hyponatremia [radiopaedia.org]

• Calcium Increased

  […] secretion of PTHrP → acts like parathyroid hormone to increase bone resorption and renal calcium reabsorption → hypercalcemia Associated with squamous cell carcinoma Clinical features: Stones, Bones, Groans, Moans, Psychic overtones Stones – renal stones [epomedicine.com]

• Pleural Effusion

  The patient also had axillary lymphnode metastasis on the same side as the chest swelling with a contralateral pleural effusion. [ncbi.nlm.nih.gov]

  Annals of Laboratory Medicine. 2013; 33(3): 225-228 [Pubmed] 5 Myelomatous pleural effusion-A case report J. Miller,P.A. [dx.doi.org]

  We also assessed the frequency of additional findings including pleural effusion (38%), pericardial thickening (38%), displacement or narrowing of either the tracheobronchial tree (68%) or major vessels (68%), and hepatic masses (24%). [ajronline.org]

  Breathlessness: (due to large pleural effusion or tumour occludes a large bronchus). Stridor: (Tumour compress the main bronchi). [m.theindependentbd.com]

For stages I and II, surgical removal of the tumor is indicated, whereas adjuvant chemotherapy or radiation therapy may be administered with a goal of maximizing the effects of surgery [5]. Etoposide, carboplatin, cislatin or irinotecan are recommended chemotherapeutic agents. In more advanced stages of the disease (III and IV), chemotherapy and possibly palliative radiation is used [6], but because the prognosis is very poor, palliative and symptomatic care is equally important to provide the patient with an adequate level of support.

Unfortunately, about 80% of patients who are diagnosed with lung cancer are already in advanced stages of the disease and the prognosis is very poor, even with all available therapy [3]. The TNM staging is used for classification of patients, ranging from I (localized disease) to IV (presence of distant metastases) [5]. With treatment, 5-year survival ranges from 67% in stage I to < 1 % in stage IV [6]. Moreover, SCLC recognized in early stages has a 5-year survival between 20-25%, whereas almost no patients survives five years when the tumor is diagnosed late [8].

The exact cause remains unknown, but various carcinogenic events have been documented after use of tobacco and exposure to other carcinogens such as asbestos and radon [6]. There are two main types of lung cancer: small-cell (SCLC, constituting 15% of cases) and more commonly non-small cell (NSCLC), which is further divided into adenocarcinoma, squamous cell carcinoma and large cell carcinoma [8].

In the United States, more than 220,000 new cases and almost 160,000 deaths occurred in 2015, making lung cancer the most common cause of cancer death [1]. A slight predilection toward male gender was observed [1], whereas the single most important risk factor is cigarette smoking [7]. Alcohol consumption, exposure to radon, asbestos and other occupational or environmental pollutants that are known lung carcinogens, but also genetic factors have shown to be additional risk factors [5]. Elderly patients are most frequently diagnosed, as a marked increase in incidence rates are seen after 60 years of life [7].

The exact pathogenesis model remains to be elucidated, but several key mutations that presumably occur after exposure to tobacco and other carcinogenic substances have been discovered so far. Abnormal expression of epidermal growth factor receptor (EFGR), inactivity of p53, one of the main tumor suppressor genes, as well as K-RAS mutations are some of the most important [4].

Avoidance and cessation of smoking is by far the most important preventive strategy against lung cancer [5]. Although implementation of mass screening is still not suggested, the use of imaging studies such as CT in regular screening of at-risk patients has been recommended [8].

Bronchogenic carcinoma, one of the most common malignant diseases worldwide, is the leading cause of death from cancers in the United States and the rest of the world [1]. The pathogenesis model almost invariably include mutations of various genes involved in cell cycle as a result of exposure to tobacco and other carcinogenic substances (asbestos, radon, alcohol, etc) [2]. Lung cancer is classified into small-cell (SCLC) and non-small cell (NSCLC) carcinoma, both having a very poor prognosis. The clinical presentation may be nonspecific, with respiratory complaints such as cough, hemoptysis, chest pain and breathing difficulties, but the onset is often insidious and the diagnosis is made in advanced stages of the disease in 80% of patients [3]. Imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) and subsequent bronchoscopy with histopathological examination to determine the exact subtype is necessary to confirm the location and the type of bronchogenic carcinoma [3]. Treatment principles include surgery, chemotherapy and radiation, but overall 5-year survival rates are around 15% [4]. For this reason, cessation of tobacco smoking and avoiding exposure to other substances that are known to be involved in the pathogenesis is vital in reducing the burden of this fatal malignant disease [5].

Bronchogenic carcinoma (lung cancer) is the leading cause of death from a malignant disease worldwide, with more than 160,000 deaths in the United States in 2015. Its development is still incompletely understood, but various mutations as a result of tobacco exposure have been documented, suggesting the direct role of tobacco in this tumor. Additional substances that are brought into connection with lung cancer are radon and asbestos, whereas genetic factors have also been proposed. Signs and symptoms include breathing difficulties, cough that may be accompanied by blood expectoration (termed hemoptysis) and chest pain, but in up to a quarter of patients, an asymptomatic course is observed. Imaging studies such as plain radiography, computed tomography (CT scan) or magnetic resonance imaging (MRI) can be used to determine the location and size of the tumor, but to identify the exact subtype, a biopsy is necessary. Treatment depends on the stage of the tumor and includes surgery, chemotherapy and radiation, but despite available therapy, the prognosis is very poor, with overall 5-year survival rates of only 15%. For this reason, cessation of tobacco smoking and avoiding exposure is mandatory in reducing the risk of this highly fatal malignancy.

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7.
2. Dela Cruz CS, Tanoue LT, Matthay RA. Lung Cancer: Epidemiology, Etiology, and Prevention. Clin Chest Med. 2011;32(4):10.1016/j.ccm.2011.09.001.
3. Al Jahdali H. Evaluation of the patient with lung cancer. Ann Thorac Med. 2008;3(6):74-78.
4. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013.
5. Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA. Non–Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship. Mayo Clin Proc. 2008;83(5):584-594.
6. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
7. Wender R, Fontham ET, Barrera E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63(2):107-117.
8. Jett JR, Schild SE, Kesler KA, Kalemkerian GP. Treatment of small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5):e400S-419S.