Small cell lung cancer

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 utilised 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.[1]Brambilla E, Travis WD, Colby TV, et al. The new World Health Organization classification of lung tumours. Eur Respir J. 2001 Dec;18(6):1059-68. https://erj.ersjournals.com/content/18/6/1059.long http://www.ncbi.nlm.nih.gov/pubmed/11829087?tool=bestpractice.com