Answer:
All would be possible etiologies for his dyspnea and all need to be considered.
Although often a consequence of cancer progression, dyspnea (and any symptom) in the patient with advanced cancer may be due to a new manifestation of the cancer, toxicity from treatment, or an unrelated condition. For example, Mr. Martino may now have a new malignant pericardial effusion causing cardiac tamponade, a pulmonary embolus, radiation pnuemonitis or chemotherapy cardiotoxicity causing CHF. It is critical to keep an open diagnostic mind to avoid missed treatment opportunities.