Bronchial carcinoma - small cell

Question 1

What does SCLC stand for?

Answer 1

Small cell lung cancer.

Question 2

Define SCLC.

Answer 2

Small-cell carcinoma is a type of highly malignant cancer that most commonly arises within the lung, although it can occasionally arise in other body sites, e.g. GI tract, cervix and prostate.

Question 3

Which cells does the tumour typically arise from?

Answer 3

Epithelial tumour arising from Kulchitsky cells lining the lower respiratory tract.

Question 4

The number of deaths from lung cancer exceeds those of which other cancers?

Answer 4

Colorectal, breast and prostate cancers.

Question 5

Who is most affected?

Answer 5

· Men aged 65-70.

· Black and non-Hispanic white people.

Question 6

What is the pathophysiology of SCLC?

Answer 6

· Highly associated with smoking.

· Arise in the central lung with mediastinal involvement.

Question 7

What is the aetiology of SCLC?

Answer 7

· Cigarette smoking - 90% of cases:

• Multiple carcinogens.
• Hydrocarbons.
• Nitrosamines.

· Radon gas.

Question 8

List the common risk factors associated with SCLC.

Answer 8

· Cigarette smoking.

· Environmental tobacco exposure.

Question 9

List the common signs and symptoms associated with SCLC.

Answer 9

· Cough.
· Dyspnoea. 
· Haemoptysis. 
· Chest pain. 
· Weight loss. 
· Fatigue. 
· Wheeze, rales, decreased breath sounds and dullness to percussion.

Question 10

What investigations would you request if you suspected a patient had SCLC?

Answer 10

· CXR.
· CT chest, liver and adrenal glands.
· Sputum cytology. 
· Bronchoscopy. 
· Thoracentesis. 
· PET scan. 
· Bloods. 
· Lung function tests. 
· Histology - sputum examined.

Question 11

What would you look for on a CXR?

Answer 11

· Central mass.
· Hilar lymphadenopathy.
· Pleural effusion.

Question 12

Differentials?

Answer 12

· Non-small cell lung cancer.
· Pneumonia/Bronchitis. 
· Carcinoid tumour. 
· Metastatic cancer from a non-thoracic primary site. 
· Infectious granuloma. 
· Sarcoidosis. 
· Rheumatoid arthritis. 
· Wegener's granulomatosis.
· TB. 
· Lymphoma.

Question 13

What are the treatment options for limited disease?

Answer 13

· Chemotherapy.
· Radiotherapy.
· Prophylactic cranial irradiation.
· Surgery.

Question 14

What are the treatment options for extensive disease?

Answer 14

· Chemotherapy.
· Prophylactic cranial irradiation.
· Radiotherapy.

Question 15

Complications?

Answer 15

· Post-obstructive pneumonia/hypoxia. 
· Chemo-induced haematological toxicity. 
· SVC syndrome.
· Paraneoplastic syndrome.
· Radiation-induced oesophageal injury. 
· Radiation-induced lung injury. 
· Acute/massive haemoptysis.