Workup/Staging Flashcards
How do pts with SCLC usually present?
Large hilar mass with bulky mediastinal LAD that causes cough, shortness of breath, weight loss, postobstructive pneumonia, and debility. Other common presentations include paraneoplastic syndromes such as Lambert–Eaton, SIADH, or ectopic ACTH production.
Classically, does SCLC present centrally or peripherally in the lung?
Classically, SCLC presents centrally in the lung.
What histology is most commonly associated with superior vena cava obstruction (SVCO) syndrome?
SCLC is most commonly associated with SVCO syndrome.
Do SCLC pts present with solitary peripheral nodules without mediastinal LAD? What % have true stage I dz (T1–2, N0) after mediastinal staging?
This presentation is very uncommon; <5% of pts have true stage I dz.
How should pts be managed whose FNA results cannot clearly differentiate b/w small cell and atypical carcinoid histology?
Surgical staging, with mediastinoscopy → surgical resection if the MNs are negative (NCCN 2018)
Once SCLC has been diagnosed in a pt who presents with a large hilar mass, what further workup is necessary besides the basic H&P and labs?
LDH levels, CT C/A/P +/– PET, MRI brain, bone scan if PET is not done, BM Bx (for pts with elevated LDH), thoracentesis with cytopathologic exam for pts with pleural effusion, and smoking cessation counseling
What % of pts with SCLC at the time of Dx present with brain mets, BM involvement, and bone mets?
Brain mets: 10%–15% (30% are asymptomatic)
BM involvement: 5%–10%
Bone mets: 30%
What is the latest AJCC system for staging SCLC?
The same as for non-SCLC, but this system is not commonly used.
How SCLC is most commonly staged?
SCLC is commonly staged using the International Association of Lung Cancer system, which is a modification of the VALCSG system. There are 2 stages: limited and extensive. Tumors are staged according to whether the Dz can be encompassed within an RT port. Limited stage Dz is typically confined to the ipsi hemithorax, without malignant pleural effusion, contralat Dz, or mets; other presentations are usually extensive stage.
What % of pts present with limited-stage SCLC (LS-SCLC)?
∼33% of pts present with LS-SCLC.
What are the most important adverse prognostic factors in SCLC? What additional factors are assoc. w/ poor prognosis in extensive- and limited-stage dz
Poor PS; extensive-stage; weight loss (>5% in prior 6 mos); ↑ LDH; male gender; endocrine paraneoplastic syndromes (controversial), variant, or of mixed cell type; metastatic Dz. For extensive-stage: older age, poor PS, abnl Cr/LDH, >1 metastatic site. For limited-stage: male, age >70, abnl LDH, >stage I.
What is the MS of untreated limited- and extensive-stage SCLC?
∼12 wks for limited stage and ∼6 wks for extensive stage, based on a VALCSG trial comparing cyclophosphamide to placebo
What is the MS for pts with limited- vs. extensive-stage SCLC?
Limited stage: 20–30 mos
Extensive stage: 8–13 mos
What is the long-term survival rate in limited-stage SCLC treated with a combined modality?
26% long-term survival (5 yrs) (Turrisi A et al., NEJM 1999)
What additional workup should be considered for pts with carcinoid tumors of the lung?
Consider octreotide scan.
