Small cell lung cancer

Background

• A form of lung cancer that is almost exclusively in smokers, particularly in heavy smokers

Risk Factors

• Tobacco smoking
• Second-hand smoke
• Asbestos exposure
• Radon exposure

Clinical Presentation

• May be detected in asymptomatic patients as an incidental finding
• Potential symptoms include cough, dyspnea, weight loss, and functional decline
• On imaging, there is most commonly a central, hilar mass with bulky mediastinal lymphadenopathy
• About 70% have metastatic disease at presentation, including liver, adrenal glands, bone, bone marrow, and brain

Staging

TMN

• Stage 1: a single lesion ≤3 cm with no lymphadenopathy
• Stage 2: ipsilateral lymph nodes and mediastinum
• Stage 3: contralateral lymph nodes and metastases
• Stage 4: distant metastases

VALSG

• Limited stage: disease confined to ipsilateral lung, lymph nodes, and mediastinum, which can be contained within one radiotherapy window
• Extensive stage: metastasis to contralateral lung, contralateral lymph nodes, or distant sites

Management

Stage 1

• Potentially curative
• Surgical resection
  • If lymph nodes negative, adjuvant chemotherapy
  • If lymph nodes positive, adjuvant chemoradiotherapy
• The adjuvant chemotherapy is platinum-based

Stage 2/Limited Stage

• Not curative
• Early chemoradiotherapy

Stage 3 or 4/Extensive Stage

• Not curative
• Chemotherapy extends median survival from 3 months to 8 to 13 months
• Prophylactic cranial irradiation