Highlights & Basics
- 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.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: small cell lung cancer [internet publication].[Full Text]
Dingemans AC, Früh M, Ardizzoni A, et al. Small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jul;32(7):839-53.[Abstract][Full Text]
Simone CB 2nd, Bogart JA, Cabrera AR, et al. Radiation therapy for small cell lung cancer: an ASTRO clinical practice guideline. Pract Radiat Oncol. 2020 May - Jun;10(3):158-73.[Abstract][Full Text]
National Institute for Health and Care Excellence. Lung cancer: diagnosis and management. Mar 2023 [internet publication].[Full Text]
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