From Chest Pain to Spinal Cord Compression: A Rare Presentation of Stage IV Thoracic Squamous Cell Carcinoma, a case report

Abstract

Delayed diagnosis of cancer, often secondary to vague or non-specific symptoms, remains one of the most critical factors contributing to poor survival rates in the United Kingdom¹. We discuss a 50-year-old, otherwise fit and healthy man presenting to the Emergency Department with vague symptoms, including atypical chest pain, left-sided shoulder pain, and hoarseness of voice. He had a history of multiple presentations to the ED and GP surgery with similar nonspecific symptoms, and was repeatedly managed as anxiety or costochondritis. On one of the presentations, the patient had anisocoria and mild left-sided ptosis, indicating possible Horner’s syndrome². Subsequent CT imaging confirmed a partly necrotic anterior mediastinal mass encasing major vessels with necrotic supraclavicular nodes, later confirmed as metastatic squamous cell carcinoma. This case highlights the importance of thorough clinical examination, especially in patients with recurrent nonspecific presentations, as subtle findings can provide critical diagnostic clues, uncover severe underlying pathology, and enable timely intervention.