The Oncological and Surgical Management of Small Cell Lung Cancer
Pp. 466-489 (24)
Despite the fact that, approximately, one-seventh of all lung cancers are
small cell lung carcinoma (SCLC), it is the fifth leading cause of cancer mortality.
Histologically it represents small (<20 microns) cells with scanty cytoplasm with
neuroendocrine properties. It is usually hilar tumour with early and multiple metastasis.
The major symptoms are chest pain, dyspnea, wheezing and dysphonia. Paraneoplastic
syndromes such as Cushing syndrome, secretion of Inappropriate ADH syndrome and
some dramatic signs of tumours such as vena cava superior syndrome are not
uncommon. Malignant pleural effusion develops in up to 35% of patients.The latest
(seventh) TNM staging systems is defined to be applicable to SCLC, but they have been
used very frequently in clinical practice because patients with SCLC seldom present at a
stage for which surgery is appropriate and oncologists anonymously refused to stratify
the patients according to these comprehensive staging systems. Nevertheless
stratification by stages I–III should be used in all patients for early-stage SCLC whether
treatment is surgical or not and full details of TNM staging should be reported.
Although, very small fraction of patients with T1N0 disease could be amenable to
surgical resection, major treatment modalities for SCLC are chemotherapy and
radiotherapy with elective cranial irradiation. Studies showed significantly superior
survival for thoracic irradiation and adjuvant chemotherapy when compared with
Patients with early-stage SCLC (T1–2 N0) may benefit from a combined modality
approach that includes surgery. Neoadjuvant chemo/radiotherapy could possibly
provide better survival in these patients.
As conclusion, SCLC is a very aggressive histologic type of lung cancer which
develops metastasis rapidly and leads to very dismal prognosis. Challenging treatment
approach is usually needed including chemotherapy, radiotherapy, surgery and new
treatment modalities. Strategies for prohibition of smoking has been reduced and will
reduce the incidence of SCLC.
Small cell lung cancer, SCLC, chemotherapy, radiotherapy, elective
cranial irradiation, paraneoplastic syndromes.
Istanbul University Cerrahpasa Medical Faculty, Department of Thoracic Surgery, Kocamustafapasa, Fatih Istanbul, 34303 Turkey.