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, hemoptysis, dyspnea, 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.
Localized disease (defined as disease that can be contained within a radiation portal) should be treated with concurrent chemotherapy and radiation therapy. Radiation therapy 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 radiation therapy 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 tumor arising from cells lining the lower respiratory tract. The tumor cells are small and densely packed, with scant cytoplasm, finely granular nuclear chromatin, and absence of nucleoli.
History and exam
Key diagnostic factors
- chest pain
- weight loss
Other diagnostic factors
- age 65 to 70 years
- male sex
- pulmonary exam 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
- Non-small cell lung cancer
- Carcinoid tumor
- 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
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