Small cell lung cancer Flashcards
what is the definition pf SCLC?
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.
Presents more aggressive than NSCLC, high grade
Neuroendocrine tumour
what is the epidemiology of SCLC?
More common in men
Around 15% of lung cancers
Linked to smoking
what is the aetiology of SCLC?
Smoking
Radon gas
what are the risk factors for SCLC?
Smoking
Passive smoking
Radon gas exposure
what is the pathophysiology of SCLC?
These tumours tend to arise in the central lung with mediastinal involvement. SCLC is an aggressive malignancy. Approximately two-thirds of patients have evidence of distant metastasis at presentation (extensive stage), while one third present with limited-stage disease (confined to the ipsilateral hemithorax).
what are the key presentations of SCLC?
Local: Dyspnoea Chest pain Shoulder pain Persistent cough (>6 weeks) Hemoptysis Recurrent chest infections Systemic: Weight loss Fatigue SADH ACTH, PTH secretion HPOA Eaton-lambert Thrombophlebitis Non-infective endocarditis DIC
what are the first line and gold standard investigations for SCLC?
History: Duration of cough Duration of horde vice Weight loss intentional or unintentional Fatigue Worrying the patient? CXR CT cest, liver, adrenal glands Sputum cytology Biopsy - obtained via bronchoscopy, fine needle aspiration (CT guided) Histology on biopsy sample - H&E and immunohistochemistry Molecular testing on biopsy sample
what are the differential diagnoses for SCLC?
NSCLC
Pneumonia
Carcinoid tumour
how is SCLC managed?
Chemotherapy - primary treatment
Not usually treated with surgery
how is SCLC monitored?
After potentially curative treatment for lung cancer, patients should be followed regularly to assess for disease recurrence and treatment-related toxicity.
what are the complications of SCLC?
Post obstructive pneumonia
Chemotherapy induced haematological toxicity
SVCS
what is the prognosis of SCLC?
5-year survival rates are approximately 12% to 24% for the limited stage and 1% to 5% for the extensive stage.
what is a carcinoid tumour?
another type of neuroendocrine tumour, benign with malignant potential, treat with surgery
what are the paraneoplastic features for SCLC?
ADH
ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome
