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Syndrome of inappropriate ADH ( SIADH) can be caused by ectopic ADH secreted by a small-cell lung cancer. It can be caused by a Pancoast tumour (tumour in the pulmonary apex) pressing on the sympathetic ganglion. Horner’s syndrome is a triad of partial ptosis, anhidrosis and miosis. Pemberton’s sign is where raising the hands over the head causes facial congestion and cyanosis. It presents with facial swelling, difficulty breathing, and distended neck and upper chest veins. It is caused by direct tumour compression on the superior vena cava. Superior vena cava obstruction is a complication of lung cancer. Phrenic nerve palsy, due to nerve compression, causes diaphragm weakness and presents with shortness of breath. It is caused by a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum. Recurrent laryngeal nerve palsy presents with a hoarse voice. Sometimes they can be the first evidence of lung cancer in an otherwise asymptomatic patient. Exam questions commonly ask you to suggest the underlying cause of a paraneoplastic syndrome. These are linked to different types and distributions of lung cancer. Lung cancer is associated with a lot of extrapulmonary manifestations and paraneoplastic syndromes.

Lymphadenopathy – often supraclavicular nodes are the first to be found on examination.

Presenting features of lung cancer include: Chemotherapy can improve survival, but it is essentially palliative. There is a substantial latent period between exposure to asbestos and the development of mesothelioma of up to 45 years. It is strongly linked to asbestos inhalation. Mesothelioma is a lung malignancy affecting the mesothelial cells of the pleura. SCLC may be responsible for various paraneoplastic syndromes. Small-cell lung cancer cells contain neurosecretory granules that release neuroendocrine hormones.

Other types (around 10% of total lung cancers).

Large-cell carcinoma (around 10% of total lung cancers).

Squamous cell carcinoma (around 20% of total lung cancers).

Adenocarcinoma (around 40% of total lung cancers).

Non-small-cell lung cancer can be further divided into:

Non-small-cell lung cancer (around 80%).

Small-cell lung cancer ( SCLC) (around 20%).The histological types of lung cancer can be broadly divided into: Around 80% of lung cancers are thought to be preventable.

Lung cancer is the third most common cancer in the UK, behind breast and prostate cancer.