Pancoast tumors, often caused by smoking, can block the opening between the appendix and the intestine, leading to symptoms like fever, nausea, vomiting, and abdominal pain. Early warning signs may not include coughing, wheezing, shortness of breath, or other respiratory symptoms commonly associated with lung cancer. Pancoast tumors can also cause severe shoulder pain, nausea, vomiting, restlessness, and confusion. Without treatment, severe symptoms may occur.
Horner’s syndrome is a collection of symptoms including drooping or weakness of one eyelid and a small pupil in the same eyelid. Pancoast tumors are relatively uncommon primary lung cancer forming in the lung apex and invading surrounding soft tissues. Symptoms may include muscle pain, nausea, vomiting, increased thirst, an irregular heart rate, and confusion. If not recognized and promptly, some people experience subtle symptoms of lung cancer during the early stages of the disease.
Pancreatic cancer symptoms include pain, weight loss, jaundice, loss of appetite, nausea, change in stool, pancreatitis, and recent-onset diabetes. Symptoms of a Pancoast tumor include facial flushing, a droopy eyelid (ptosis), displaced eyeball (enophthalmos), and lack of sweat (anhidrosis).
| Article | Description | Site |
|---|---|---|
| Symptoms of lung cancer | Additionally, Pancoast tumors may manifest as a constellation of symptoms collectively known as Horner’s syndrome. These include ptosis or ptotic weakness of the eyelid, as well as a small pupil in the same eye. | www.cancerresearchuk.org |
| Patient education: Non-small cell lung cancer treatment | The fever is associated with a reduction in the number of white blood cells in the body. Nausea and vomiting may also occur. The patient may also experience alterations in bowel function, which may manifest as constipation or diarrhea. It is also important to note that there are other potential side effects. | www.uptodate.com |
| Pancoast Tumor | A Pancoast tumor is a relatively uncommon primary lung cancer that develops in the lung apex and subsequently infiltrates the surrounding soft tissues. | www.physio-pedia.com |
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Does lung cancer cause high fever?
Cancers that don’t often cause fever. The most common types of cancer, such as breast cancer, lung cancer and bowel cancer, do not generally cause fever. But they may do if:
- The cancer has spread to the liver
- the cancer is causing an obstruction or blockage somewhere in your body
Treating fever. There are a number of treatments available to help you with a fever.
Can lung cancer cause flu like symptoms?
This information was reviewed and approved by Jeffrey Kern, MD, Bronwyn Long, DNP, MBA, ACHPN, AOCNS, ACNS-BC, Laurie L. Carr, MD (10/1/2019).
Signs and symptoms of lung cancer are few, but may include those similar to a chest cold or a mild flu.
Early during the development of a lung cancer, there may be no symptoms, as the cancer is small and does not interfere with lung function. As the lung cancer advances more symptoms may be present.
If symptoms of lung cancer are present, they may include:
What are the red flags for Pancoast tumors?
Pancoast tumor symptoms may include: Severe shoulder pain, which may include pain in your shoulder blade. Pain that radiates down your arm and stops at your wrist, just above your pinky finger. Arm and hand weakness.
How are Pancoast tumors diagnosed?. In the early stages, Pancoast tumors don’t show up easily on two-dimensional chest X-rays. For this reason, they can be difficult to diagnose.
If your healthcare provider suspects a Pancoast tumor based on your symptoms, they may recommend other diagnostic tests, which may include:
- Additional imaging tests.
- Needle biopsy.
- Video-assisted thoracoscopy surgery (VATS).
- Thoracotomy.
What stage of cancer causes fever?
Fever is the body’s response to an infection or illness. People who have cancer will often have a fever as a symptom. It’s usually a sign that the cancer has spread or that it’s in an advanced stage.
Fever is rarely an early symptom of cancer, but it may be if a person has a blood cancer, such as leukemia or lymphoma.
Some cancers may also cause unusual bleeding. For instance, colon or rectal cancer might cause bloody stools, while blood in the urine may be a symptom of prostate or bladder cancer. It’s important to report such symptoms or any unusual discharge to your doctor for analysis.
Blood loss may be more discreet in stomach cancer, as it may be internal bleeding only and harder to detect.
How aggressive is a Pancoast tumor?
Pancoast tumors are a rare and aggressive form of lung cancer, with cardiac metastasis being very uncommon. First described by Dr. Pancoast in 1924, Pancoast tumors constitute less than 5 of all lung cancers and have survival rates as high as 55 for patients undergoing complete surgical resection. A 54-year-old woman presented with dyspnea, shoulder pain, and weight loss. A contrast-enhanced chest computed tomographic scan revealed an apical mass, metastatic thoracic nodes, and filling defects within both ventricles. Further cardiac magnetic resonance imaging revealed two left ventricular masses infiltrating into the myocardium, suggesting metastatic disease, and a multilobulated mass within the right ventricle, suggesting intracardiac thrombus. The patient was initiated on anticoagulation for intracardiac thrombosis. Surgical pathology of biopsied tissue samples was consistent with advanced metastatic lung adenocarcinoma, making her a poor candidate for surgical intervention. Ultimately, she was transitioned to comfort care.
How fast do Pancoast tumors grow?
Most often, Pancoast tumor grows slowly. In some cases, it can grow and spread quickly and cause rapid death. The cancer may spread to other parts of the body, including the bone, liver, small intestine, and brain.
Pancoast tumors are cancers that start in the top part of the lung (the apex). These cancers were named after an American doctor called Professor Henry Pancoast in 1932. They are also called superior pulmonary sulcus tumours and can trigger several uncomfortable and painful symptoms when it invades the chest wall or spine. These symptoms rarely involve the coughing and shortness of breath that are common with other respiratory malignancies, even though a Pancoast tumor is a type of non-small cell lung cancer. Instead, many patients experience sharp shoulder pain, arm pain and muscle weakness as a result of a tumor placing pressure on a nearby nerve. Patients may also experience other neurological symptoms like tingling sensations, impaired hand function and sensation loss.
Is shoulder pain a sign of lung cancer? Sharp shoulder or scapula (shoulder blade) pain are some of the most common symptoms of a Pancoast tumor, particularly in its early stages. The pain typically develops as the tumor impacts one or more of the nearby structures, such as the:
- Ribs
- Neck
- Ulnar nerve, which runs from the side of the arm to the wrist
- Branchial plexus, the nerve fibers that run downward from the spine and into the shoulder and arm
- Parietal pleura, the highly sensitive outer layer of the membrane that lines the chest cavity.
- Endothoracic fascia, the fibrous tissue that separates the chest wall from the diaphragm and the pleura
What cancer causes nausea and diarrhea?
In Pancreatic Cancer: Digestive difficulties including indigestion, nausea, weight loss, a poor appetite, and diarrhea, can arise as a result of pressure from a pancreatic cyst or tumor on the stomach or the small intestine that causes a block in the digestive tract.
Overview | Causes | Symptoms | Genetics | Diagnosis | Staging | Treatment | Prognosis | Coping.
Pancreatic cancer is known as a “silent disease” because identifiable symptoms are not usually present in the early stages of the disease. Many symptoms of pancreatic cancer are mild at first, so patients may often be unaware of the potential seriousness of them. Due in large part to the position of the pancreas deep in the abdomen, a pancreatic tumor can grow for years before causing pressure, pain, or other signs of illness. This can make it difficult for a patient or doctor to recognize a problem.
There are several symptoms commonly associated with pancreatic cancer. However, other medical conditions can cause these, or similar symptoms. Having one or any combination of these symptoms does not always mean you have pancreatic cancer. If you are experiencing any of these symptoms, you should consult your doctor to discuss possible diagnoses.
Has anyone survived a Pancoast tumor?
Danny Roger, a 55-year-old man from Lafayette, Louisiana, was diagnosed with a large Pancoast Lung Tumor in his upper right lobe. The tumor was inoperable and required chemotherapy, 45 days of radiation, and a year to live. The doctors in Houston were not compassionate and showed no compassion, even though they had good insurance. Danny was very active and did not want to go through chemo and radiation.
The doctors in Houston were also not accommodating to Danny’s schedule, calling him at the last minute and refusing to treat him if he couldn’t make it. They lost Danny’s biopsy, so he needed another one. The couple decided to find another hospital and look for other treatment options.
In the meantime, they researched CyberKnife Radiation Therapy on the internet, which was recommended by patients and could be done with only 3-to-5 treatment sessions. However, the Houston hospitals didn’t have CyberKnife, and other medical centers that did, including one in Lafayette, LA, wouldn’t treat Danny because the tumor was too big. The couple called all over the country trying to find a doctor that would treat him with CyberKnife.
One afternoon, when returning home from Houston, they received a call back from the CyberKnife Center of Miami. Gail Suarez, a radiation therapist and Vice President of Operations, said they could treat Danny’s tumor without any side effects. This was an answer to their prayers and a sense of peace. They went to CyberKnife Miami, where Danny didn’t feel anything during treatment and had no side effects afterwards.
Dr. Mark Pomper, Board Certified Radiation Oncologist and Medical Director at CyberKnife Miami, says that many medical or cancer centers with CyberKnife technology don’t have as much experience using it, so they get scared when they see a big tumor and think it is not worth treating or are worried about complications. Dr. Pomper emphasizes that while it is unlikely that they can cure Danny, they can give him a quality of life while extending his life. He is doing so well and can live longer, and it is a different philosophy that is emerging that seems to work. It is unknown how many new cancer treatments may come around as they help him live longer.
Danny, a cancer patient, underwent the first Cyberknife treatment at CyberKnife Miami. After six rounds of chemotherapy, he had no sign of cancer and the pain disappeared within two weeks. The oncologist in Lafayette recommended more chemo, but Danny chose CyberKnife to treat his lymph nodes. Dr. Pomper treated the two lymph nodes and less than 60 days later, a pet scan showed they were cancer-free. He had one remaining cancerous spot on his adrenal gland, which is currently being treated at CyberKnife Miami.
The family and their daughter are now believers in CyberKnife, as they have heard from other patients who have been treated there. They have recommended CyberKnife to others and have seen it successful in treating others. The team at CyberKnife Miami is wonderful, conscientious, and always on time. Dr. Pomper takes his time with patients, spending more time examining them than all the doctors in Houston combined.
Danny and his wife have faith in the world in CyberKnife Miami, and even doctors in Louisiana knew Dr. Pomper’s excellent reputation in the world of oncology. They have recommended CyberKnife to others and have received successful results. According to doctors in Houston, Danny should have died in March, a year ago. Danny is a true believer and will not go anywhere else but CyberKnife Miami.
The game plan for Danny and his family is to take one day at a time and enjoy their family life. They have five children and four grandchildren, and they are simple country people living a quiet, grateful, blessed, and happy life. They tell Gail and Dr. Pomper all the time, “God sent you to us, this is the answer to our prayers”. They want as much time as possible with Danny, and CyberKnife Miami is giving them that precious gift.
Can prostate cancer cause fever?
Abstract. Metastatic prostate cancer can have an initial presentation with fever and systemic inflammatory response syndrome. Accurate diagnosis allows to differentiate this type of cancer from infectious conditions and to start early treatment.
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Does lung cancer cause nausea and diarrhea?
Stomach issues Nausea and constipation are often the result of dietary issues or gastrointestinal disorders. But they may be an early sign of lung cancer. That’s because lung cancer may affect the stomach by causing hypercalcemia, characterized by too much calcium in the blood.
Coughing. Wheezing. Shortness of breath. These are the symptoms that may come to mind when you think about signs of lung cancer. But while these are some of the common symptoms of lung cancer, the disease may also cause other less well-known signs.
Hoarseness, persistent shoulder pain and even nausea may be indicators of lung cancer. These lesser-known symptoms may be mistaken for other conditions—particularly for nonsmokers, who may not be looking for signs of lung cancer.
Lung cancer is the deadliest form of the disease in the United States, accounting for nearly 132, 000 deaths (22 percent) in 2021, according to the American Cancer Society. Eight in 10 lung cancer deaths are linked to tobacco use, but the disease is being diagnosed in a growing number of nonsmokers. One U. K. study found the percentage of lung cancer patients who never smoked more than doubled from 2008 to 2014—from 13 percent to 28 percent—due to radon, air pollution and other factors.
Which of the following is the most common early symptom of Pancoast tumor?
Unlike other lung tumors–which typically cause coughing and other lung-related symptoms–the most common sign of a Pancoast tumor is severe shoulder pain that extends down the arm.
A Pancoast tumor is a relatively uncommon malignancy that occurs when non-small cell lung cancer develops in the rounded top portion of a lung (apex) and invades nearby chest wall structures, such as lymph nodes, muscles, connective tissues, nerves, the upper ribs or the upper vertebrae. Unlike other lung tumors—which typically cause coughing and other lung-related symptoms—the most common sign of a Pancoast tumor is severe shoulder pain that extends down the arm.
Determining the progression of a Pancoast tumor. Like all types of cancer, Pancoast tumor treatment can vary depending on its extent and spread (stage). After confirming a diagnosis, a physician will perform a process known as staging to make that determination. In the case of a Pancoast tumor, the staging process is usually based on the National Cancer Institute TNM classification system, which involves an assessment of:
- The location and size of the primary tumor (T)
- Any lymph node involvement (N)
- The presence or absence of distant cancer metastasis (M)
📹 High Yield Internal Medicine Review for Step 2 CK & Shelf Exam
This is meant to be a last minute review of high yield topics for your shelf exam or step 2 ck. Its more helpful if you have already …
love this but there’s an error at 17:44, he says restrictive cardiomyopathy causes decreased EF but it causes preserved EF!! Diastolic dysfunction due to deposits like amyloidosis, sarcoidosis and hemochromatosis cause a filling problem which leads to less blood filling in the ventricles but there is no issue squeezing that blood back out so EF stays the same. sorry to nitpick just wanted to clarify for anyone perusal!!
Just a minor correction that a lot of med students understand incorrectly- “pain out of proportion to exam” doesn’t mean the patient winces upon palpation. Rather it means patient is in extreme pain at baseline, but when you palpate them you do not invoke any additional tenderness even if you press very hard. You’d expect to really hurt them even on light palpation, but they tolerate deep palpation.
1:01:20 –> Small Correction: Now, according to UWorld, you should image patients even if they have all the classical signs of appendicitis (Alvarado score ≥4) b/c it decreases the # of false positives getting appendectomies. You should use CT for everyone, except pregnant women and children, when you should use U/S. MRI is an ok choice too, but only choose it if the others aren’t available. 1:25:35 –> you should also give Potassium with the IVF and insulin, bc total body stores are decreased. (from UW#2185) *Also, thank you so much for these articles. It’s a huge relief to have something to go over for that last high yield review.
THANK YOU!! I have step 2 CK in a little over a week so this was so helpful. If I had watched this before my last practice test I would have gotten at least 5 questions right that I originally got wrong. I know this probably took a lot of effort on your part, so thank you! Wishing you luck with where ever you are on your medical journey!
I just want to say, I want over all of your high yield articles two times over the week before step 2 and received a 241, which I thought would never have been possible this time last year. I can definitely say these articles help me organize the content much better and were a reason for my score, so thank you for taking the time out to do them, they’re a gift!
Hey Dr High Yield. It would be great if when you have time, during or after residency, to go through and update your articles with current guidelines now that some are changing. Asthma for instance. Overall your articles are AMAZINGLY helpful for a quick refresher before these exams!!! I’ve definitely benefited like thousands of other students!
I just completed step2 I can’t thank you enough!!I only watched your articles in the last week. For most of the questions I can hear your voice emphasizing the next steps in my head I never realized they could be so helpful I thought they are pretty basic while listening but listening to them made a difference in saving time both during the revision and during the exam. Huge thanks
Very good source for Shelf study! There are some inaccuracies, but they’re mainly because of recent/relatively recent changes in Medicine. For example, diagnosing appendicitis has changed to include CT abdomen confirmation (according to the new Alvarado scoring system), though a lot of doctors still diagnose clinically (UWorld says get the CT lol). Another discrepancy are the screening parameters, but these regularly change with new research. Otherwise, this article is mainly solid!
Thanks from the bottom of my heart Dr. High Yield !!!! Your articles are gold. Loved the mnemonic of RTAs. I got this from UptoDate, hope it helps: Although Valve diameter < 1.0 cm is indicative of severe AS, it is not a mandatory criteria to diagnose it. Most important criteria are transvalvular pressure gradient > 40 mmhg or peak aortic jet velocity >0.4 m/s. Others: For gastrinoma, secretin test is the best next step only if gastrin levels are between 110 and less than 1,000. For appendicitis, best next step is CT with IV contrast as long as it is avaliable within 3 hours. Just as a comment: For BBs intoxication IV fluids and stabilization are first before giving glucagon.
For the Gi segment: 57:58 Gallstone ileus will typically present pneumobilia on radiograph or CT (not “gas in the gallbladder wall”) 58:10 “…proximal to the ileus (sic)” isn’t necessarily true; the stone can get lodged anywhere in the GI tract 1:06:00 Colonoscopy screening guidelines are after 45 now (although still controversial). They’ll prob say the patient is over 50 to avoid this.
First off, I love you. Thank you for the article series. Secondly, at 2:13:45 time on the article Hereditary hemochromatosis Type 1 is autosomal RECESSIVE. This is the classic version with HFE gene mutation. Type 2 is an autosomal recessive mutation of hepcidin gene. Type 3 is another autosomal recessive mutation of the transferrin receptor 2 gene. Type 4 involves a mutation of the ferroportin gene and this form is autosomal dominant.
FYI since this article was published the 3:11:00 reference to the herpes zoster vaccine being at 60 years old was in reference to the live attenuated shingles vaccine. In 2020 the FDA removed this from the market and US physicians can only prescribe the recombinant herpes zoster vaccine (trade name shingrex) starting at age 50. The benefit is this new vaccine no longer has any contraindications like the old live attenuated vaccine with regards to PMH for Shingles/Chickenpox (I forget what it was).
This is really great! I have gone through ALL your articles and they are just perfect for rapid review and revision for the Step 2CK exam. I was wondering if it would be possible for you to share the notes you have made for all these articles too just for a quick reference. Thank you so much once again 🙂
Excellent article. I believe prerequisites for really getting the most out of this is – having given Step 1 and gruelling through medical school. Luckily I’ve done both so I can catch up quite easily with what you’re saying. Also excellent source of passive review when one is feeling lazy. Thanks and cheers mate
Hey man, just wanted to say thanks for all the time and effort. I’m a 2nd year PA student and your reviews are extremely helpful as quick review tools before our End of Rotation exams as well. I know that probably wasn’t the intention but you should know the range your articles truly have! It’ll help to have some smart APPs by your side some day!
Hi doc, I really wish you setup a paypal or some sort and put it in the description for all of your articles. Plenty of people do this through patreon or some other platform. I know these vids must have taken you quite a long time to make, but unfortunately med school related websites are quite niche and I’m afraid you aren’t getting the credit you deserve!
@Doctor High Yield, MD Hi Dr. Vuu, I found your articles amazing! I have my Step 2 CK exam coming up in a few days and there is no time for me to purchase and receive the paperback version of the “Dr. High Yield’s Step 2 CK Notes”, is there a way for me to purchase the pdf version? I’m in desperate need of it!! Sincere appreciation!