A 58-year-old man presents with weight loss and haemoptysis. He has smoked most of his life.
On examination he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 3.2 mM (2.2-2.6 mmol/L). A bone scan is normal.
From which of the following histological types of lung cancer is he most likely to suffer?
Adenocarcinoma
Large cell carcinoma
Mesothelioma
Small cell carcinoma
Squamous cell carcinoma
Explanation:
Hypercalcaemia in absence of bony metastases occurs in about 15% of squamous cell lung carcinoma from parathyroid hormone related protein (PTHrP) production. This is a feature of non-metastatic manifestation of malignancy.
Inappropriate antidiuretic hormone (ADH) secretion (hyponatraemia) and ectopic adrenocorticotropic hormone (ACTH) production (Cushing’s syndrome) occur with small cell lung cancer.
Clubbing is predominantly associated with squamous cell cancers and occasionally adenocarcinoma.