Since he has gross left pleural effusion, can simply drain the pleural effusion and do a cytoblock testing..if positive then can avoid biopsy and further testing can be done on the block..this with other blood tumour markers can help in diagnosis..looks like advanced carcinoma of lung but needs confirmation and proper evaluation for further planning.

Seems like you have an advanced lung cancer.. Needs biopsy from lung mass to confirm .. Needs IHC and EGFR ALK gene testing on biopsy if proven Nonsmall cell lung cancer to decide on treatment.. If painful bone sites needs palliative radiation and chemotherapy or targeted therapy

First ,he has to undergo biopsy from the lung mass or the swelling from the neck (if large enough for biopsy) ,then only treatment can be planned.