Small cell lung cancer

Last reviewed: 26 Aug 2023
Last updated: 13 Jun 2023



History and exam

Key diagnostic factors

  • cough
  • dyspnea
  • hemoptysis
  • chest pain
  • weight loss
More key diagnostic factors

Other diagnostic factors

  • age 65 to 74 years
  • male sex
  • fatigue
  • pulmonary exam 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
  • CBC
  • LFTs
  • serum sodium
  • renal function
  • lung function tests
More investigations to consider

Treatment algorithm


at initial presentation: limited disease

at initial presentation: extensive disease


relapse within 6 months

relapse after 6 months



Catherine B. Meador, MD, PhD

Attending Physician

Center for Thoracic Cancers

Instructor in Medicine

Harvard Medical School

Massachusetts General Hospital




CBM declares that she has no competing interests.


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


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

Peer reviewers

Alan Neville, MD


Assistant Dean

Undergraduate Program

McMaster University





AN declares that he has no competing interests.

  • Differentials

    • Non-small cell lung cancer
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  • Guidelines

    • NCCN clinical practice guidelines in oncology: small cell lung cancer
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  • Patient leaflets

    Lung cancer: questions to ask your doctor


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