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

  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]

  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]

  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]

  As the cancer progresses, common symptoms may include: • Persistent or worsening cough; • Frequent lung infections; • Unintentional weight loss. [secure.ssa.gov]

  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]

• 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]

  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]

  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]

  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]

  Palliative care Lung symptoms commonly reported by patients with incurable lung cancer include shortness of breath from pleural effusion, coughing, or haemoptysis (coughing up blood). [myvmc.com]

  Continued When to Seek Medical Care Consult a doctor if any of the following symptoms are present: Shortness of breath Coughing up blood Unexplained weight loss Voice change New cough or change in the consistency of a cough Unexplained persistent fatigue [webmd.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]

  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]

  The most common signs and symptoms that may occur with NSCLC and SCLC include cough, shortness of breath, wheezing, fatigue, chest pain, weight loss and loss of appetite, recurring lung infections, hoarseness, coughing up blood, and swelling of the face [medicinenet.com]

  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]

  Diagnosis It is important to make an accurate diagnosis of a malignant pleural effusion since the prognosis and treatment are much different than for non-malignant (benign) pleural effusions. [verywellhealth.com]

  Palliative care Lung symptoms commonly reported by patients with incurable lung cancer include shortness of breath from pleural effusion, coughing, or haemoptysis (coughing up blood). [myvmc.com]

  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 Enlargement of the subcarinal [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]

  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

  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]

  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]

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

  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 bronchus [annonc.oxfordjournals.org]

  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]

• 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]

  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]

  […] 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 depression [pathophys.org]

• 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]

  Diagnosis It is important to make an accurate diagnosis of a malignant pleural effusion since the prognosis and treatment are much different than for non-malignant (benign) pleural effusions. [verywellhealth.com]

  Palliative care Lung symptoms commonly reported by patients with incurable lung cancer include shortness of breath from pleural effusion, coughing, or haemoptysis (coughing up blood). [myvmc.com]

  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 Enlargement of the subcarinal [pathophys.org]

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5. Jett JR, Schild SE, Kesler KA, Kalemkerian GP. Treatment of small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e400S-e419S.
6. Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e142S-e165S.