Small cell lung cancer (SCLC) is an aggressive malignancy. Approximately two-thirds of patients have evidence of distant metastasis at presentation. It primarily develops in older adult smokers.
Most common presenting symptoms are cough, chest pain, haemoptysis, dyspnoea, and weight loss.
A suspicious lung mass should be biopsied during bronchoscopy or computed tomography (CT)-guided transthoracic needle aspiration.
Staging studies should include chest/abdomen CT and brain magnetic resonance imaging (preferred) or head CT, with mediastinoscopy and/or bone marrow aspirate and biopsy in selected cases. If disease appears to be confined to the chest, positron emission tomography (PET)-CT can be done to assess for distant metastases. Bone scan can be done if PET-CT is not available. Accurate staging is very important for treatment selection.
Localised disease (defined as disease that can be contained within a radiation portal) should be treated with concurrent chemotherapy and radiotherapy. Radiotherapy should be started as early as possible. Surgery should be offered to patients with clinical T1N0 or T2N0 disease after mediastinoscopy. Extensive-stage disease should be treated with chemotherapy and immunotherapy. Palliative radiotherapy may be utilized if necessary. Prophylactic cranial irradiation should be considered for all patients with limited-stage disease.
Small cell lung cancer (SCLC), previously referred to as oat cell carcinoma, is a malignant epithelial tumour arising from cells lining the lower respiratory tract. The tumour cells are small and densely packed, with scant cytoplasm, finely granular nuclear chromatin, and absence of nucleoli.
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- weight loss
Other diagnostic factors
- age 65 to 70 years
- male sex
- pulmonary examination abnormalities
- personality changes
- nausea and vomiting
- bone pain and/or fractures
- cervical or supraclavicular adenopathy
- facial swelling
- dilated neck or chest/abdominal wall veins
- finger clubbing
- hypertrophic osteoarthropathy
- cigarette smoking
- environmental tobacco exposure
- radon gas exposure
- asbestos exposure
1st investigations to order
- chest x-ray
- CT chest, liver, and adrenal glands
Investigations to consider
- MRI or CT of brain
- bone scan
- positron emission tomography (PET)
- bone marrow aspirate and biopsy
- serum sodium
- renal function
- lung function tests
at initial presentation: limited disease
at initial presentation: extensive disease
relapse within 6 months
relapse after 6 months
Rebecca Suk Heist, MD, MPH
Associate Professor of Medicine
Harvard Medical School
Massachusetts General Hospital
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
CBM declares that she has no competing interests.
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.
LG, ARC, CRK, and LBM declare that they have no competing interests.
Alan Neville, MD
AN declares that he has no competing interests.
- Non-small cell lung cancer
- Carcinoid tumour
- Guidelines and advice: lung cancer
- Small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
Lung cancer: questions to ask your doctor
BronchoscopyMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer