Lung Cancer: Small Cell Flashcards
Definition
Primary bronchial carcinoma
Derived from neuroendocrine Kulchitsky cells (APUD cells)
- Amine = high
- Precursor Uptake: high uptake of precursors e.g. 5-HTP
- Decarboxylate: high content of the enzyme decarboxylase
Rapid growth and patients usually present in ASD advanced stages
Location + metastases
Central lesion
Mets:
- lymph nodes
- brain
- liver
- adrenal glands
- bone
- bone marrow
Paraneoplastic syndromes associated with SCLC
SIADH = Hyponatraemia
Ectopic ACTH = Cushing’s Syndrome
- Hyperglycaemia, hypertension, hypokalaemic alkalosis and muscle weakness
- May result in bilateral adrenal hyperplasia
Lambert-Eaton = myaesthenic syndrome
Epidemiology and Risk factors
Increasing age
Smoking
Other environmental exposure: radon, asbestos, arsenic, chromium, and radiation
Family history
Signs
Reduced breath sounds and a fixed monophonic wheeze may be present
Stony dull percussion: malignant peripheral effusion
Supraclavicular or persistent cervical lymphadenopathy
Symptoms
Persistent cough +/- haemoptysis
Dyspnoea
Pleuritic chest pain
Constitutional symptoms:
- Fever
- Weight loss and anorexia
- Night sweats
- Lethargy
Extra-pulmonary symptoms
Clubbing: strongly associated with squamous cell carcinoma
Facial plethora and swelling: due to SVCO
Hoarseness: due to recurrent laryngeal nerve palsy (Pancoast tumour)
Investigations
First line = CXR
- hilar enlargement
- consolidation
- pleural effusion
- circular opacity
GOLD STANDARD = CT with contrast
Biopsy = central lesions via bronchoscopy and endo bronchial ultrasound
Management
Smoking cessation
Majority of patients with SCLC are not suitable for surgery
Surgery is only appropriate for a very small subset of patients with early disease (T1-2a, N0, M0)
Extensive disease:
- chemo radiotherapy = CISPLATIN (platinum based agents) or palliative chemotherapy
Complications
Addison’s disease
Hepatomegaly
Hypercalcaemia
Focal neurological deficit
