Small cell lung cancer

Last reviewed: 25 Apr 2022
Last updated: 21 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • dyspnoea
  • haemoptysis
  • chest pain
  • weight loss
More key diagnostic factors

Other diagnostic factors

  • age 65 to 70 years
  • male sex
  • fatigue
  • pulmonary examination abnormalities
  • hoarseness
  • confusion
  • personality changes
  • nausea and vomiting
  • headache
  • dysphagia
  • bone pain and/or fractures
  • seizures
  • cervical or supraclavicular adenopathy
  • facial swelling
  • dilated neck or chest/abdominal wall veins
  • finger clubbing
  • hypertrophic osteoarthropathy
Other diagnostic factors

Risk factors

  • cigarette smoking
  • environmental tobacco exposure
  • radon gas exposure
  • asbestos exposure
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • CT chest, liver, and adrenal glands
More 1st investigations to order

Investigations to consider

  • bronchoscopy
  • biopsy
  • thoracentesis
  • thoracoscopy
  • MRI or CT of brain
  • bone scan
  • mediastinoscopy
  • positron emission tomography (PET)
  • bone marrow aspirate and biopsy
  • FBC
  • LFTs
  • serum sodium
  • renal function
  • lung function tests
More investigations to consider

Treatment algorithm

ACUTE

at initial presentation: limited disease

at initial presentation: extensive disease

ONGOING

relapse within 6 months

relapse after 6 months

Contributors

Authors

Rebecca Suk Heist, MD, MPH
Rebecca Suk Heist

Associate Professor of Medicine

Harvard Medical School

Thoracic Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

RSH has received honoraria for consulting from Novartis, Abbvie, Daichii Sankyo, and EMD Serono. RSH's institution (not RSH) has received research funding from Agios, Abbvie, Exelixis, Daichii Sankyo, Novartis, Lilly, Mirati, Corvus, Incyte, and Genentech Roche.

Catherine B. Meador, MD, PhD

Clinical Fellow in Thoracic Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

CBM declares that she has no competing interests.

Acknowledgements

Dr Rebecca Suk Heist and Dr Catherine B. Meador would like to gratefully acknowledge Dr Leena Gandhi, Dr Alvin R. Cabrera, Dr Christopher R. Kelsey, and Dr Lawrence B. Marks, previous contributors to this topic.

Disclosures

LG, ARC, CRK, and LBM declare that they have no competing interests.

Peer reviewers

Alan Neville, MD

Professor

Assistant Dean

Undergraduate Program

McMaster University

Hamilton

Ontario

Canada

Disclosures

AN declares that he has no competing interests.

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