Small cell carcinoma of the lung (SCLC) comprises approximately 15% of all lung cancer patients and is recognized as a very aggressive form of malignancy [1] [2]. The clinical presentation of patients with lung cancer is centered around respiratory symptoms, but depending on the stage, various systemic signs are observed [1] [3] [4]. Although the diagnosis might be made incidentally, the vast majority of patients experience some symptoms when the disease is recognized [1] [3]. Studies have established a different frequency of symptoms depending on the location of tumor growth [3] [4]. Cough is the most common symptom when the tumor is localized in the bronchi, as are hemoptysis and dyspnea [3] [4]. Stridor and wheezing are less frequent in the initial stages [3] [4]. When intrathoracic spread has occurred, chest pain develops in up to 49% of patients and is often accompanied by pleural/pericardial effusions, dysphagia, Horner's syndrome (ptosis, miosis, anhidrosis), and hoarseness [3] [4]. In the most advanced stages where metastatic spread is evident, systemic findings of weight loss, fever, night sweats, and fatigue are reported, together with headaches, paraplegia, and bone pain [3] [4]. Several paraneoplastic syndromes are well-known to occur in small cell carcinoma of the lung and other types of lung cancer, including Lambert-Eaton myasthenic syndrome (LEMS), syndrome of inappropriate antidiuretic hormone secretion (SIADH), etc [3] [4]. Small cell lung carcinoma is strongly linked with cigarette smoking [1].

• Weight Loss

  A 67-year-old female presenting with a history of weight loss and abdominal distension was noted on examination to have ascites. [ncbi.nlm.nih.gov]

  The clinical presentation encompasses cough, hemoptysis, chest pain, and systemic signs of weight loss and fatigue in patients who reached the later stages of the disease. [symptoma.com]

  Generally a patient with small-cell lung cancer notices fatigue, weakness, and weight loss. These lung cancers are notorious for causing paraneoplastic syndromes. [lung-cancer.com]

  loss Anxiety Pain iStock Smoking greatly increases a person's risk The earlier you begin smoking and the longer you smoke, the greater your risk of developing lung cancer. [healthcentral.com]

  loss, shortness of breath, and chest pains.[1] The vast majority (85%) of cases of lung cancer are due to long-term tobacco smoking.[4] About 10–15% of cases occur in people who have never smoked.[13] These cases are often caused by a combination of [play.google.com]

• Fatigue

  The clinical presentation encompasses cough, hemoptysis, chest pain, and systemic signs of weight loss and fatigue in patients who reached the later stages of the disease. [symptoma.com]

  Like many other types of cancer, lung cancer may also cause systemic symptoms, like loss of appetite or general fatigue. [cancercenter.com]

  Generally a patient with small-cell lung cancer notices fatigue, weakness, and weight loss. These lung cancers are notorious for causing paraneoplastic syndromes. [lung-cancer.com]

  […] coughing up blood or rust-colored sputum. iStock Quality-of-life issues In general, some of the more common problems encountered by cancer patients either as a result of the disease itself or as a side-effect of cancer treatments include: Sleep disorders Fatigue [healthcentral.com]

  These include: diarrhea fatigue nausea vomiting major hair loss loss of appetite dry mouth mouth sores pain from nerve damage You should weigh these side effects against other options when deciding whether chemotherapy is right for you. [healthline.com]

• Fever

  Case of a 33-year-old female with AIDS who presented with fevers, chills, lower back pain and a large right hilar mass. Biopsy of the right paratracheal nodes revealed poorly differentiated non-small cell carcinoma with extensive necrosis. [ncbi.nlm.nih.gov]

  In the most advanced stages where metastatic spread is evident, systemic findings of weight loss, fever, night sweats, and fatigue are reported, together with headaches, paraplegia, and bone pain. [symptoma.com]

  Clinical presentation can significantly vary and can present in the following ways: constitutional fever weight loss malaise primary tumor cough hemoptysis dyspnea local invasion dysphagia ( esophageal compression ) hoarseness ( recurrent laryngeal nerve [radiopaedia.org]

• Malaise

  Clinical presentation can significantly vary and can present in the following ways: constitutional fever weight loss malaise primary tumor cough hemoptysis dyspnea local invasion dysphagia ( esophageal compression ) hoarseness ( recurrent laryngeal nerve [radiopaedia.org]

  Charbit A, Malaise EP, Tubiana M (1971) Relation between the pathological nature and the growth rate of human tumors. Eur J Cancer 7: 307 Google Scholar 8. [link.springer.com]

  Lung cancer at an early stage may not cause any symptoms but when the tumor has grown, it may manifest itself by the following signs and symptoms: cough chest pain coughing out of blood chest infection malaise poor appetite and weight loss shortness of [lcp.gov.ph]

• Cough

  The clinical presentation encompasses cough, hemoptysis, chest pain, and systemic signs of weight loss and fatigue in patients who reached the later stages of the disease. [symptoma.com]

  When lung cancer does cause signs in its early stages, they may vary from person to person but commonly include: A new cough that is persistent or worsens, or a change in an existing chronic cough Cough that produces blood Pain in the chest, back or shoulders [cancercenter.com]

  Source: Medifocus Guidebook iStock The three most common symptoms There are numerous symptoms of lung cancer, but the most common ones are persistent or worsening cough, shortness of breath (dyspnea), and coughing up blood or rust-colored sputum. iStock [healthcentral.com]

  The most common symptoms were dyspnea and cough. Histopathologically tumor positive margins were found in 84.8% (A), 10.6% (B), 4.5% (C), and 0% (D). [ncbi.nlm.nih.gov]

  Cough that exceeds in 1 month. 2. Gasp and having a hard time to breath 3. Having a frequent phlegm. 4. There's a wheezing if breathe. 5. Cough with blood 6. Chest pain if breathe. Watch the Video: [youtube.com]

• Hoarseness

  When intrathoracic spread has occurred, chest pain develops in up to 49% of patients and is often accompanied by pleural/pericardial effusions, dysphagia, Horner's syndrome (ptosis, miosis, anhidrosis), and hoarseness. [symptoma.com]

  […] laughing or deep breathing Shortness of breath that comes on suddenly and occurs during everyday activities Unexplained weight loss Feeling that you are tired or weak Loss of appetite Lung infections such as bronchitis or pneumonia that won't go away Hoarseness [cancercenter.com]

  Clinical presentation can significantly vary and can present in the following ways: constitutional fever weight loss malaise primary tumor cough hemoptysis dyspnea local invasion dysphagia ( esophageal compression ) hoarseness ( recurrent laryngeal nerve [radiopaedia.org]

  Symptoms of Small Cell• Because of the large lymph node swelling inthe chest the patient may have shortness ofbreath, trouble swallowing, hoarseness, facialswelling (superior vena cava syndrome)• Many present with symptoms of spread ormetastases: headaches [slideshare.net]

• Pleural Effusion

  Thoracic washings may provide evidence of cancer beyond the pleura in patients without pleural effusion which may be indicative of advanced disease. [ncbi.nlm.nih.gov]

  The effusion may be all in one area, or there may be several areas of effusion (septated pleural effusions). Symptoms The symptoms of a malignant pleural effusion can be very uncomfortable. Shortness of breath is by far the most common symptom. [verywellhealth.com]

  His chest Xray shows a large hilar mass in the left thorax but is negative for pleural effusion. PET scan shows metastasis to 4 lymph nodes in the left thorax but no metastasis to other organs. [pathologyoutlines.com]

  […] emergencies chapter Pleural effusion Chest pain Dyspnea Benign pleural effusion may be due to lymphatic obstruction, post-obstructive pneumonitis, or atelectasis Malignant pleural effusion occurs when malignant cells are present in pleural fluid Dysphagia [pathophys.org]

• Hemoptysis

  The clinical presentation encompasses cough, hemoptysis, chest pain, and systemic signs of weight loss and fatigue in patients who reached the later stages of the disease. [symptoma.com]

  The diagnosis of small cell carcinoma was based on repeated hemoptysis and cytologic finding of a rapidly growing mass over the forehead. [ncbi.nlm.nih.gov]

  Precursor lesion - uncommonly seen: Pulmonary neuroendocrine cell hyperplasia. [1] Clinical: +/-Hemoptysis. Gross Central location (close to large airways) - typical. Necrosis. Images Small cell carcinoma of the lung - centre of image. [librepathology.org]

  Symptoms can include cough, chest discomfort or pain, weight loss, and, less commonly, hemoptysis; however, many patients present with metastatic disease without any clinical symptoms. [merckmanuals.com]

  Clinical presentation can significantly vary and can present in the following ways: constitutional fever weight loss malaise primary tumor cough hemoptysis dyspnea local invasion dysphagia ( esophageal compression ) hoarseness ( recurrent laryngeal nerve [radiopaedia.org]

• Chronic Cough

  When lung cancer does cause signs in its early stages, they may vary from person to person but commonly include: A new cough that is persistent or worsens, or a change in an existing chronic cough Cough that produces blood Pain in the chest, back or shoulders [cancercenter.com]

  Most patients with SCLC present with unspecific symptoms, such as new cough, a change in the pattern of their chronic cough or weight loss. This delays the time to diagnosis substantially. [breathe.ersjournals.com]

• Dysphagia

  When intrathoracic spread has occurred, chest pain develops in up to 49% of patients and is often accompanied by pleural/pericardial effusions, dysphagia, Horner's syndrome (ptosis, miosis, anhidrosis), and hoarseness. [symptoma.com]

  Clinical presentation can significantly vary and can present in the following ways: constitutional fever weight loss malaise primary tumor cough hemoptysis dyspnea local invasion dysphagia ( esophageal compression ) hoarseness ( recurrent laryngeal nerve [radiopaedia.org]

  CASE REPORT A 64-year-old male individual came to our service complaining of dysphagia and odynophagia evolving for six months and a lesion in his left oropharynx. [scielo.br]

  Oncologic emergencies chapter Pleural effusion Chest pain Dyspnea Benign pleural effusion may be due to lymphatic obstruction, post-obstructive pneumonitis, or atelectasis Malignant pleural effusion occurs when malignant cells are present in pleural fluid Dysphagia [pathophys.org]

Even if the diagnosis of small cell carcinoma of the lung is made early on, it carries a very poor prognosis [1] [5]. Nevertheless, an early diagnosis will undoubtedly prolong the patient's life and provide an opportunity for more efficient treatment. The first step in the diagnostic workup is a thorough patient history that will cover the onset of symptoms and their progression, followed by auscultation of the lungs and a detailed physical examination. If evident suspicion is raised, imaging studies must be used. Although plain radiography might be useful as a first-line study, computed tomography is recommended [3]. In addition to the lungs, the head, the abdomen, and the extremities should be assessed in order to determine the stage of the tumor [1] [3]. To confirm the diagnosis of a small cell carcinoma of the lung, a sample is needed for histopathological examination [1] [3] [4] [6]. Bronchoscopy and transthoracic needle aspiration (TTNA, which may be guided by ultrasound or CT if necessary) are the two procedures that can obtain a viable sample for testing and subsequent determination of the exact tumor type [3] [4] [6]. TTNA, however, is more prone to inducing pneumothorax compared to standard bronchoscopy [6].

• Atelectasis

  Central tumours generally produce symptoms of cough, dyspnea, atelectasis, postobstructive pneumonia, wheezing, and hemoptysis; whereas, peripheral tumours, in addition to causing cough and dyspnea, can lead to pleural effusion and severe pain as a result [pathophys.org]

  TNM classification TX Positive cytology only T1 ≤3 cm T1a ≤2 cm T1b >2–3 cm T2 Main bronchus ≥2 cm from carina, invades visceral pleura, partial atelectasis T2a >3–5 cm T2b >5–7 cm T3 >7 cm; chest wall, diaphragm, pericardium, mediastinal pleura, main [annonc.oxfordjournals.org]

• Pulmonary Infiltrate

  The patient described herein presented with constitutional symptoms and nodular pulmonary infiltrates associated with noncaseating granulomas without evident neoplasm in both transbronchial and open lung biopsy specimens. [ncbi.nlm.nih.gov]

• Hyponatremia

  On further evaluation, they were found to have hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone. [ncbi.nlm.nih.gov]

  […] in Nephrology for details Ectopic secretion of ADH → retain free water in collecting ducts Euvolemic hyponatremia and concentrated urine Mild symptoms include headache and weakness, severe symptoms include altered mental status, seizures, respiratory [pathophys.org]

  Hyponatremia as prognostic factor in small cell lung cancer--a retrospective single institution analysis. Respir Med. 2012 Jun. 106(6):900-4. [Medline]. Campling BG, Sarda IR, Baer KA, Pang SC, Baker HM, Lofters WS, et al. [emedicine.medscape.com]

• Pleural Effusion

  Thoracic washings may provide evidence of cancer beyond the pleura in patients without pleural effusion which may be indicative of advanced disease. [ncbi.nlm.nih.gov]

  The effusion may be all in one area, or there may be several areas of effusion (septated pleural effusions). Symptoms The symptoms of a malignant pleural effusion can be very uncomfortable. Shortness of breath is by far the most common symptom. [verywellhealth.com]

  His chest Xray shows a large hilar mass in the left thorax but is negative for pleural effusion. PET scan shows metastasis to 4 lymph nodes in the left thorax but no metastasis to other organs. [pathologyoutlines.com]

  […] emergencies chapter Pleural effusion Chest pain Dyspnea Benign pleural effusion may be due to lymphatic obstruction, post-obstructive pneumonitis, or atelectasis Malignant pleural effusion occurs when malignant cells are present in pleural fluid Dysphagia [pathophys.org]

RESULTS: In 31 patients (66%), resection was complete; 3 patients (6%) received induction treatment and 30 (64%) adjuvant treatment. Five years later, 26% (95% CI 12-40%) of the patients that received surgical treatment were still alive. [ncbi.nlm.nih.gov]

Small Cell Lung Cancer Chemotherapy and Radiation Therapy For people with small cell lung cancer, regardless of stage, chemotherapy is an essential part of treatment. Radiation treatment may be used as well depending on the stage of cancer. [lungcancer.org]

Generally, the prognosis of these patients is poor. When brain metastases develop, the prognosis is even poorer. Most of these cases present parenchymal metastases; however, intraventricular dissemination may also occur although it is very uncommon. [ncbi.nlm.nih.gov]

Treatment and prognosis Most cases will present in advanced stages, not operable, and with a dismal prognosis. Only about 5% of patients present at an early stage (Ia, Ib, or IIa), with a potentially curable disease. [radiopaedia.org]

The causes of hemorrhagic pericarditis are considered, emphasizing the necessity to know if the effusion has a malignant etiology. [ncbi.nlm.nih.gov]

Etiology The predominant cause of small cell lung cancer (SCLC) (and non-SCLC) is tobacco smoking. [emedicine.medscape.com]

METHODS: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients from 1988 to 2007 with SCLC. Survival was determined by Kaplan-Meier analysis and compared using the log-rank test. [ncbi.nlm.nih.gov]

Journal of Clinical Epidemiology. 1997;50:21-29.) demonstrated that doctors are very good at predicting which patients would or would not be cured, but we are not very accurate when it comes to predicting how long individual patients with incurable disease [oncolink.org]

Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol. 2006 Oct 1. 24(28):4539-44. [Medline]. American Cancer Society. [emedicine.medscape.com]

Govindan R, Page N, Morgensztern D, Read W, Tierney R, et al. (2006) Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. [journals.plos.org]

Symptoms Mechanism and pathophysiology Primary lung lesion symptoms Cough (50-70%) Presence of a mass irritates the cough receptors in the airway More common in squamous cell carcinoma andSCLC (more commonly found in the central airways) Obstruction from [pathophys.org]

[…] coding ICD-10: C34.90 - malignant neoplasm of unspecified part of unspecified bronchus or lung Sites Lung: central / bronchial / hilar; rarely a peripheral nodule Submucosal growth Metastasis to liver, adrenals, bone, bone marrow, brain; often widespread Pathophysiology [pathologyoutlines.com]

Pathophysiology Small cell lung carcinoma (SCLC) arises in peribronchial locations and infiltrates the bronchial submucosa. [emedicine.medscape.com]

The aim of this study is to determine the involved margins and safe distances of the resection sites from tumor for prevention of local recurrences. [ncbi.nlm.nih.gov]

Causes, Risk Factors, and Prevention Learn about the risk factors for small cell lung cancer and what you might be able to do to help lower your risk. Early Detection, Diagnosis, and Staging Know the signs and symptoms of small cell lung cancer. [cancer.org]

Preventive Radiation Therapy to the Brain In more than half of the people with small cell lung cancer, the cancer also spreads to the brain. [lungcancer.org]

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