Small cell carcinoma of the lung history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Guillermo Rodriguez Nava, M.D. [2]
Overview
Small cell lung cancer comprises 15% to 25% of bronchogenic carcinomas and it is the cancer most commnoly associated with a plethora of paraneoplastic syndromes.[1] It usually develops in the upper airways and involves the hilum and mediastinum. Most of the times, evidence of regional or distant metastases is found at the time patients present with small cell lung carcinoma. [2]
History and Symptoms
- Patients are typically men older than 40 years, heavy current or ex-smokers and have a lot of pulmonary, cardiovascular, and metabolic comorbidities.[3]
- Early small cell carcinoma of the lung does not have any symptoms. Initial presenting symptoms may be airway related, but are often constitutional and attributable to metastases:[4][5]
- Cough 75%
- Weight loss 68%
- Dyspnea 60%
- Chest pain 49%
- Hemoptysis 35%
- Bone pain 25%
- Clubbing 20%
- Fever 20%
- hoarseness 18%
- Weakness 10%
- Superior vena cava syndrome 4%
- Dysphagia 2%
- New onset of wheezing and stridor 2%
- Cough, dyspnea, chest pain, and hemoptysis most commonly are related to the primary tumor.[2]
- The intrathoracic spread of lung cancer produces a variety of symptoms such as hoarseness due to recurrent laryngeal nerve palsy; pain, cutaneous temperature change, and muscle wasting along the C8, T1 and T2 nerve roots (Pancoast's syndrome); Horner syndrome: miosis, ipsilateral ptosis and lack of facial sweating; dysphagia due to enlargement of the subcarinal lymph nodes and compression of the middle third of the esophagus.[2]
- The [[]]pericardium is the most common site of cardiac involvement, which can cause pericardial effusion or supraventricular arrhythmias.[6]
- Common sites of metastasis include bone, liver, lymph node, the central nervous system, adrenal glands, subcutaneous tissue and pleura.[2]
- Bone: most commonly axial skeleton and proximal long bones, which causes pain.
- Liver: can cause jaundice, weakness and weight loss.
- Adrenal glands: very common with SCLC, although evidence of adrenal insufficiency is uncommon.
- Central nervous system: may produce headache, nausea and vomiting, focal neurologic symptoms, seizures, confusion, and personality changes.
- Lymph nodes: being the supraclavicular fossa the most common site of palpable lymphadenopathy
- SCLC is the most frequent cause of paraneoplastic syndromes, being the superior vena cava syndrome, the syndrome of inappropriate antidiuresis and hypercalcemia the most common.[3][7][8]
| Superior vena cava syndrome | Edema of upper body, visible dilated veins over the upper torso, shoulders and arms, headache, dizziness, drowsiness, blurring of vision, cough, dysphagia | Frequency: 50% |
| Syndrome of inappropriate antidiuresis | Weakness, dysgeusia, and clinical euvolemia: osmolality <275 mOsmol/kg water, urinary osmolality >100 mOsmol/kg water during hypotonicity, urinary sodium >40 mmol/L with normal dietary salt intake. | Frequency: 15-40% |
| Hypercalcemia | Nausea, vomiting, abdominal pain, constipation, polyuria, thirst, dehydration, confusion, irritability | Frequency: 8-12% |
| Cushing's syndrome | Hypercorticism | Frequency: 2-5% |
| Lambert-Eaton syndrome | Proximal muscles of lower extremities weakness and fatiguability, abnormal gait, hyporeflexia, increased deep-tendon reflexes after facilitation, autonomic dysfunction, and paresthesia | Frequency: 3% |
| Limbic encephalitis and encephalomyelitis | Altered mental status, seizures, memory loss, space and time disorientation, with or without dementia. | Frequency: <1% |
| Paraneoplastic cerebellar degeneration | Ataxia, dysarthria, ocular findings and severe vertigo | Frequency: <1% |
References
- ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.
- ↑ 2.0 2.1 2.2 2.3 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
- ↑ 3.0 3.1 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
- ↑ Grippi MA (1990). "Clinical aspects of lung cancer". Semin Roentgenol. 25 (1): 12–24. PMID 2181676.
- ↑ Hyde L, Hyde CI (1974). "Clinical manifestations of lung cancer". Chest. 65 (3): 299–306. PMID 4813837.
- ↑ Onuigbo WI (1974). "The spread of lung cancer to the heart, pericardium and great vessels". Jpn Heart J. 15 (3): 234–8. PMID 4546955.
- ↑ Ellison DH, Berl T (2007). "Clinical practice. The syndrome of inappropriate antidiuresis". N Engl J Med. 356 (20): 2064–72. doi:10.1056/NEJMcp066837. PMID 17507705.
- ↑ Boscaro M, Arnaldi G (2009). "Approach to the patient with possible Cushing's syndrome". J Clin Endocrinol Metab. 94 (9): 3121–31. doi:10.1210/jc.2009-0612. PMID 19734443.