Chapter 28

The Oncological and Surgical Management of Small Cell Lung Cancer

Akif Turna

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. </p><p> 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 radiotherapy alone. </p><p> 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. </p><p> 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.

Total Pages: 466-489 (24)

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