A 66-year-old White man presents to his doctor with complaints of fatigue, nonspecific flu-like symptoms, chest pain on deep inspiration, and dyspnea. He also reports loss of appetite and a 15-lb unintentional weight loss over the past 4 months with a seemingly constant headache.

The patient has been married for 40 years and has three adult children and four young grandchildren. He retired 1 year ago after working at an oil refinery for 45 years. He has a history of smoking one pack of cigarettes per day for 30 years but quit 10 years ago. He also has hypertension and hyperlipidemia, both of which are pharmacologically well controlled.

Physical exam reveals diminished breath sounds, dullness to percussion of the chest,and asymmetrical chest expansion, which is diminished on the right. Lymphadenopathy is present in both the cervical and mediastinal lymph nodes. Laboratory testing is performed: complete blood count with differential, which reveals white blood count 20,000 cells/µL; and a comprehensive metabolic panel in which aspartate aminotransferase = 50 U/L, alanine transaminase = 60 U/L, alkaline phosphatase = 200 U/L, and calcium = 15 mg/dL. Chest radiography shows a mass in the right upper lobe. His Performance Status score =1.