Small cell carcinoma of the lung natural history, complications and prognosis
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The natural history of untreated small cell lung cancer (SCLC) is extremely poor, with median survival of only 2 months for stage IV SCLC and less than 3 to 4 months for tumors confined to the thorax. With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months while that of patients with extensive-stage disease ranges from 6 to 12 months. SCLC can be complicated by paraneoplastic syndromes. Limited stage disease, absence of brain metastasis, young age, and female sex are considered good prognostic factors.
Approximately 30% of patients with SCLC have limited stage disease which is characterized by a tumor confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. Patients with extensive-stage disease have tumors that have spread beyond the supraclavicular areas.
Complications of the Disease Itself
- Cushing syndrome (due to production of ACTH)
- Hypertension (due to production of renin)
- Amenorrhea (due to production of prolactin or growth hormone)
- Galactorrhea (due to production of prolactin or growth hormone)
- Increased production of amylase
- Excessive parathormone (PTH) secretion
- Lambert-Eaton myasthenic syndrome (LEMS)
- Subacute sensory neuropathy
- Paraneoplastic limbic encephalopathy
- Paraneoplastic cerebellar degeneration
- Tripe palms
Complications of the Treatment
Post operative complications following surgery include:
Good Prognostic Factors
- Limited stage disease
- Absence of brain metastasis
- Young age
- Female sex
- Asian ethnicity
- Normal white blood cell count
- Surgical resection, radiation, and chemotherapy
Bad Prognostic Factors
- Extensive stage disease
- TNM stage III
- Advanced age
- Male sex
- Lower socioeconomic status
- Hispanic and African American ethnicity
- Poor performance status
- Reduced hemoglobin and raised serum lactate dehydrogenase
- Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.
- When stratified by age, the 5-year relative survival of patients with SCLC was 8.4% and 4.7% for patients<65 and ≥ 65 years of age respectively.
- The survival of patients with SCLC varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of SCLC:
|Stage||5-year relative survival (%), (2004-2010)|
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