Small cell carcinoma of the lung natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
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. | The [[Natural history of disease|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 syndrome]]s. Limited stage disease, absence of [[brain]] [[metastasis]], young age, and female sex are considered good [[prognostic]] factors. | ||
==Natural History | ==Natural History, Complications, and Prognosis== | ||
=== | === Natutral History === | ||
==Complications== | * Approximately 30% of the [[Patient|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]]. | ||
===Complications of the Disease Itself=== | * [[Patients]] with extensive-stage disease have [[tumors]] that have spread beyond the [[supraclavicular]] areas.<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref><ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref><ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }} </ref><ref name="GreenHumphrey1969">{{cite journal|last1=Green|first1=Robert A.|last2=Humphrey|first2=Edward|last3=Close|first3=Henry|last4=Patno|first4=Mary Ellen|title=Alkylating agents in bronchogenic carcinoma|journal=The American Journal of Medicine|volume=46|issue=4|year=1969|pages=516–525|issn=00029343|doi=10.1016/0002-9343(69)90071-0}}</ref> | ||
* [[SIADH]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | |||
* [[Cushing syndrome]] (due to production of [[ACTH]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | ===Complications=== | ||
* Hypertension (due to production of [[renin]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | =====Complications of the Disease Itself===== | ||
* [[Amenorrhea]] (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | |||
* [[Galactorrhea]] (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | *[[SIADH]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | ||
* Increased production of amylase<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | *[[Cushing syndrome]] (due to production of [[ACTH]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | ||
* Excessive [[parathormone]] (PTH) secretion<ref name="pmid17918299">{{cite journal| author=Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI| title=Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports. | journal=J BUON | year= 2007 | volume= 12 | issue= 3 | pages= 411-4 | pmid=17918299 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17918299 }} </ref> | *[[Hypertension]] (due to production of [[renin]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | ||
* [[Lambert-Eaton myasthenic syndrome]] (LEMS)<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614 }} </ref> | *[[Amenorrhea]] (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | ||
*[[Galactorrhea]] (due to production of [[prolactin]] or [[growth hormone]])<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | |||
* Increased production of [[amylase]]<ref name="pmid16813730">{{cite journal| author=Gandhi L, Johnson BE| title=Paraneoplastic syndromes associated with small cell lung cancer. | journal=J Natl Compr Canc Netw | year= 2006 | volume= 4 | issue= 6 | pages= 631-8 | pmid=16813730 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16813730 }} </ref> | |||
* Excessive [[parathormone]] ([[Parathyroid hormone|PTH]]) secretion<ref name="pmid17918299">{{cite journal| author=Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI| title=Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports. | journal=J BUON | year= 2007 | volume= 12 | issue= 3 | pages= 411-4 | pmid=17918299 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17918299 }} </ref> | |||
*[[Lambert-Eaton myasthenic syndrome]] (LEMS)<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614 }} </ref> | |||
* Subacute [[sensory neuropathy]]<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614 }} </ref> | * Subacute [[sensory neuropathy]]<ref name="pmid1659614">{{cite journal| author=Elrington GM, Murray NM, Spiro SG, Newsom-Davis J| title=Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients. | journal=J Neurol Neurosurg Psychiatry | year= 1991 | volume= 54 | issue= 9 | pages= 764-7 | pmid=1659614 | doi= | pmc=PMC1014512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1659614 }} </ref> | ||
* Paraneoplastic limbic encephalopathy<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | *[[Paraneoplastic syndrome|Paraneoplastic]] [[Limbic encephalitis|limbic]] [[encephalopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | ||
* Encephalomyelitis<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | *[[Encephalomyelitis]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | ||
* [[Paraneoplastic cerebellar degeneration]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | *[[Paraneoplastic cerebellar degeneration]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | ||
* [[Retinopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | *[[Retinopathy]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | ||
* [[Myoclonus]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | *[[Myoclonus]]<ref name="pmid1329233">{{cite journal| author=Amir J, Galbraith RC| title=Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer. | journal=South Med J | year= 1992 | volume= 85 | issue= 10 | pages= 1013-4 | pmid=1329233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1329233 }} </ref> | ||
*[[Tripe palms]]<ref name="pmid8638207">{{cite journal| author=Mullans EA, Cohen PR| title=Tripe palms: a cutaneous paraneoplastic syndrome. | journal=South Med J | year= 1996 | volume= 89 | issue= 6 | pages= 626-7 | pmid=8638207 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8638207 }} </ref> | |||
===Complications of the Treatment=== | =====Complications of the Treatment===== | ||
Post operative complications following surgery include:<ref name="pmid11120906">{{cite journal| author=Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T et al.| title=Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. | journal=Thorax | year= 2001 | volume= 56 | issue= 1 | pages= 59-61 | pmid=11120906 | doi= | pmc=PMC1745907 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11120906 }} </ref> | Post operative complications following surgery include:<ref name="pmid11120906">{{cite journal| author=Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T et al.| title=Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer. | journal=Thorax | year= 2001 | volume= 56 | issue= 1 | pages= 59-61 | pmid=11120906 | doi= | pmc=PMC1745907 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11120906 }} </ref> | ||
* [[Atelectasis]] | * [[Atelectasis]] | ||
* [[Pneumonia]] | * [[Pneumonia]] | ||
* [[Arrhythmia]] | * [[Arrhythmia]] | ||
* Wound infection | * [[Wound]] infection | ||
* [[Colitis]] | * [[Colitis]] | ||
* Liver dysfuntion | * [[Liver]] dysfuntion | ||
* [[Gastric ulcer]] | * [[Gastric ulcer]] | ||
==Prognosis== | ===Prognosis=== | ||
===Prognostic factors=== | ====Good Prognostic Factors==== | ||
*[[Small cell carcinoma of the lung staging|Limited stage disease]]<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref> | |||
* Absence of brain [[metastasis]]<ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }} </ref> | |||
* Young age<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> | |||
* Female sex<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> | |||
* Asian ethnicity<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304 }} </ref> | |||
* Normal [[white blood cell count]]<ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }} </ref> | |||
* Surgical resection, [[radiotherapy|radiation]], and [[chemotherapy]]<ref name="pmid22000695">{{cite journal| author=Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS et al.| title=Small-cell lung cancer: prognostic factors and changing treatment over 15 years. | journal=Clin Lung Cancer | year= 2012 | volume= 13 | issue= 2 | pages= 115-22 | pmid=22000695 | doi=10.1016/j.cllc.2011.05.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22000695 }} </ref><ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }} </ref> | |||
====Bad Prognostic Factors==== | |||
*[[Small cell carcinoma of the lung staging|Extensive stage disease]]<ref name="NCI">General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page1]</ref> | |||
*[[Lung cancer staging|TNM stage III]]<ref name="pmid17214347">{{cite journal| author=Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S et al.| title=Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice. | journal=Anticancer Res | year= 2006 | volume= 26 | issue= 6C | pages= 4825-32 | pmid=17214347 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17214347 }}</ref> | |||
* Advanced age<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }}</ref> | |||
* Male sex<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }}</ref> | |||
* Lower socioeconomic status<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304 }}</ref> | |||
* Hispanic and African American ethnicity<ref name="pmid19096304">{{cite journal| author=Ou SH, Ziogas A, Zell JA| title=Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. | journal=J Thorac Oncol | year= 2009 | volume= 4 | issue= 1 | pages= 37-43 | pmid=19096304 | doi=10.1097/JTO.0b013e31819140fb | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19096304 }}</ref> | |||
* Poor [[performance status]]<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }}</ref> | |||
*[[Smoking]] | |||
* Reduced [[hemoglobin]] and raised serum [[lactate dehydrogenase]]<ref name="pmid3015384">{{cite journal| author=Osterlind K, Andersen PK| title=Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. | journal=Cancer Res | year= 1986 | volume= 46 | issue= 8 | pages= 4189-94 | pmid=3015384 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3015384 }}</ref> | |||
===5-Year Survival=== | |||
* Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> | |||
* 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.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> | |||
* 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:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 600px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''5-year Relative Survival (%)''' | |||
'''(2004 - 2010)''' | |||
|- | |||
! style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''All stages''' | |||
| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |6.3% | |||
|- | |||
! style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''Localized''' | |||
| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |24.2% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |14.3% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |2.8% | |||
|- | |||
| style="font-size: 100; padding: 0 5px; background: #DCDCDC" align="center" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align="center" |7.8% | |||
|} | |||
==References== | ==References== | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Lung cancer]] | [[Category:Lung cancer]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} |
Latest revision as of 22:19, 3 September 2019
Small Cell Carcinoma of the Lung Microchapters |
Differentiating Small Cell Carcinoma of the Lung from other Diseases |
---|
Diagnosis |
Treatment |
Case Studies |
Small cell carcinoma of the lung natural history, complications and prognosis On the Web |
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FDA on Small cell carcinoma of the lung natural history, complications and prognosis |
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Directions to Hospitals Treating Small cell carcinoma of the lung |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [3]
Overview
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.
Natural History, Complications, and Prognosis
Natutral History
- Approximately 30% of the 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.[1][2][3][4]
Complications
Complications of the Disease Itself
- SIADH[5]
- Cushing syndrome (due to production of ACTH)[5]
- Hypertension (due to production of renin)[5]
- Amenorrhea (due to production of prolactin or growth hormone)[5]
- Galactorrhea (due to production of prolactin or growth hormone)[5]
- Increased production of amylase[5]
- Excessive parathormone (PTH) secretion[6]
- Lambert-Eaton myasthenic syndrome (LEMS)[7]
- Subacute sensory neuropathy[7]
- Paraneoplastic limbic encephalopathy[8]
- Encephalomyelitis[8]
- Paraneoplastic cerebellar degeneration[8]
- Retinopathy[8]
- Myoclonus[8]
- Tripe palms[9]
Complications of the Treatment
Post operative complications following surgery include:[10]
- Atelectasis
- Pneumonia
- Arrhythmia
- Wound infection
- Colitis
- Liver dysfuntion
- Gastric ulcer
Prognosis
Good Prognostic Factors
- Limited stage disease[1]
- Absence of brain metastasis[3]
- Young age[2]
- Female sex[2]
- Asian ethnicity[11]
- Normal white blood cell count[3]
- Surgical resection, radiation, and chemotherapy[12][2]
Bad Prognostic Factors
- Extensive stage disease[1]
- TNM stage III[3]
- Advanced age[2]
- Male sex[2]
- Lower socioeconomic status[11]
- Hispanic and African American ethnicity[11]
- Poor performance status[2]
- Smoking
- Reduced hemoglobin and raised serum lactate dehydrogenase[2]
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.[13]
- 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.[13]
- 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:[13]
Stage | 5-year Relative Survival (%)
(2004 - 2010) |
All stages | 6.3% |
---|---|
Localized | 24.2% |
Regional | 14.3% |
Distant | 2.8% |
Unstaged | 7.8% |
References
- ↑ 1.0 1.1 1.2 General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[1]
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Osterlind K, Andersen PK (1986). "Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation". Cancer Res. 46 (8): 4189–94. PMID 3015384.
- ↑ 3.0 3.1 3.2 3.3 Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S; et al. (2006). "Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice". Anticancer Res. 26 (6C): 4825–32. PMID 17214347.
- ↑ Green, Robert A.; Humphrey, Edward; Close, Henry; Patno, Mary Ellen (1969). "Alkylating agents in bronchogenic carcinoma". The American Journal of Medicine. 46 (4): 516–525. doi:10.1016/0002-9343(69)90071-0. ISSN 0002-9343.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
- ↑ Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI (2007). "Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports". J BUON. 12 (3): 411–4. PMID 17918299.
- ↑ 7.0 7.1 Elrington GM, Murray NM, Spiro SG, Newsom-Davis J (1991). "Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients". J Neurol Neurosurg Psychiatry. 54 (9): 764–7. PMC 1014512. PMID 1659614.
- ↑ 8.0 8.1 8.2 8.3 8.4 Amir J, Galbraith RC (1992). "Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer". South Med J. 85 (10): 1013–4. PMID 1329233.
- ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.
- ↑ Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T; et al. (2001). "Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer". Thorax. 56 (1): 59–61. PMC 1745907. PMID 11120906.
- ↑ 11.0 11.1 11.2 Ou SH, Ziogas A, Zell JA (2009). "Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity". J Thorac Oncol. 4 (1): 37–43. doi:10.1097/JTO.0b013e31819140fb. PMID 19096304.
- ↑ Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS; et al. (2012). "Small-cell lung cancer: prognostic factors and changing treatment over 15 years". Clin Lung Cancer. 13 (2): 115–22. doi:10.1016/j.cllc.2011.05.008. PMID 22000695.
- ↑ 13.0 13.1 13.2 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.