Examination can be remarkably normal despite a sizeable tumour. The patient will frequently show signs of weight loss and have the habitus of a patient suffering from chronic obstructive airways disease, with a ruddied face, cyanosis and pursed lip breathing. The fingers will frequently be tobacco stained and clubbing may be evident.

Examination of the chest frequently reveals the hyper-inflated chest of the chronic bronchitic. It may however be remarkably normal. A central tumour may invoke stridor on auscultation or signs of distal lung atelectasis with sympathetic effusion. A more peripheral tumour may show signs of pleural irritation. An apical tumour which has begun to invade the brachial plexus will cause a Pancoast syndrome. This initially involves painful paraesthesia of the inner aspects of the upper arm and of the ulnar aspect of the hands. Thrombo-embolic phenomena may develop as the subclavian artery is encased in tumour. A tumour invading the sympathetic chain and stellate ganglion in the apex will cause a Horner’s syndrome with sweating on the affected side, ptosis of the eyelid and constriction of the pupil. Other clinical signs would be those of a para-neoplastic or metastatic lesion.