This week the Heme-Onc team reviewed the case of a patient who presented with progressive shortness of breath and left arm pain, found to have small cell lung cancer. In this post, we’ll review some of the high yield clinical features, complications, and treatments you should know for patients with small cell lung cancer.
Small cell lung cancer (SCLC) makes up about 13% of newly diagnosed lung cancer cases worldwide. SCLC is seen almost exclusively in patients with a significant smoking history and most often in the elderly (> 60 yo). Due to the cancer’s rapid double time, patients frequently present in an advanced stages with metastatic disease and with acute symptoms. Common symptoms are consistent with the presentation of all lung cancers – SOB, wheezing, dyspnea, hemoptysis. Metastatic disease can result in superior vena cava syndrome (occurs in 50% of cases!), bone pain, or radiculopathies such as arm pain with brachial plexus involvement as described in our noon report case. SCLC is the most frequent cause of paraneoplastic syndromes with SIADH in 15-40% of cases and Cushing syndrome in 2-5% of cases. Prognosis of SCLC is very poor. Median survival for limited-stage disease and extensive-stage disease if 15-20 months and 8-13 months respectively. If a diagnosis of SCLC is made, staging should be completed with contrast-enhanced CT of the chest and upper abdomen. All patients should undergo an MRI head to assess for brain metastasis. It’s important to remember a few things about treatment. Treatment largely depends on staging however if chemotherapy is given, platinum-based chemo is the first choice for SCLC. A unique treatment factor for SCLC is prophylactic whole-brain radiation. SCLC patients with significant response to induction chemotherapy or in confirmed remission, prophylactic cranial irradiation is recommended as studies have shown improved survival and reduced incidence of brain metastases.
You can read a more in-depth review here.
To review, here are some key points:
- SCLC is often seen in the elderly with significant smoking history
- SCLC grows quick and so patients often present with acute symptoms and with metastatic disease
- Staging should be done in all newly diagnosed patients and included an MRI of the head
- SCLC prognosis is poor, even with treatment
- Prophylactic whole-brain radiation should be given to SCLC who have significant response to chemotherapy or who are in remission
- van Meerbeek, J et al. "Small-cell lung cancer." The Lancet. 2011; 378: 1741-55.
- <Lung Cancer diagnosis by Gan Khoon Lay from the Noun Project>
Authored by: GREGORY WIGGER, MD