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Initial Evaluation of the Patient With Lung Cancer: Symptoms, Signs, Laboratory Tests, and Paraneoplastic Syndromes^*

ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition)

^* From the Department of Respiratory Medicine (Dr. Spiro), University College Hospital, London, UK; Veterans Affairs Palo Alto Health Care System (Dr. Gould), Stanford, CA; and Pulmonary, Critical Care, and Respiratory Services (Dr. Colice), Washington Hospital Center, Washington, DC.

Correspondence to: Stephen G. Spiro, MD, Department of Respiratory Medicine, University College Hospital, Grafton Way, London WC1E 6AU, UK; e-mail: stephen.spiro{at}uclh.nhs.uk

Background: This chapter of the guidelines is intended to provide an evidence-based assessment of the initial evaluation of patients recognized as having lung cancer and the recognition of paraneoplastic syndromes.

Methods: The current medical literature that is applicable to this issue was identified by a computerized search and was evaluated using standardized methods. Recommendations were framed using the approach described by the Health and Science Policy Committee of the American College of Chest Physicians.

Results: Patients with lung cancer usually present with multiple symptoms, both respiratory related and constitutional. There is usually a time delay between symptom recognition by the patient and the ultimate diagnosis of lung cancer by the physician. Whether this time delay impacts prognosis is unclear, but delivering timely and efficient care is an important component in its own right. Lung cancer may be accompanied by a variety of paraneoplastic syndromes. These syndromes may not necessarily preclude treatment with a curative intent.

Conclusions: The initial evaluation of the patient with known or suspected lung cancer should include an assessment of symptoms, signs, and laboratory test results in a standardized manner as a screen for identifying those patients with paraneoplastic syndromes and a higher likelihood of metastatic disease.

Key Words: evaluation • laboratory tests • paraneoplastic syndrome • signs • symptoms