The Oncological and Surgical Management of Small Cell Lung Cancer

Abstract

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.