Small cell carcinoma of the lung natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [3]
Overview
The natural history of untreated small cell lung cancer (SCLC) is extremely poor, with median survival of only 2 months for stage IV SCLC and less than 3 to 4 months for tumors confined to the thorax. With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months while that of patients with extensive-stage disease ranges from 6 to 12 months. SCLC can be complicated by paraneoplastic syndromes. Limited stage disease, absence of brain metastasis, young age, and female sex are considered good prognostic factors.
Natural History, Complications, and Prognosis
Natutral History
- Approximately 30% of the patients with SCLC have limited stage disease which is characterized by a tumor confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes.
- Patients with extensive-stage disease have tumors that have spread beyond the supraclavicular areas.[1][2][3][4]
Complications
Complications of the Disease Itself
- SIADH[5]
- Cushing syndrome (due to production of ACTH)[5]
- Hypertension (due to production of renin)[5]
- Amenorrhea (due to production of prolactin or growth hormone)[5]
- Galactorrhea (due to production of prolactin or growth hormone)[5]
- Increased production of amylase[5]
- Excessive parathormone (PTH) secretion[6]
- Lambert-Eaton myasthenic syndrome (LEMS)[7]
- Subacute sensory neuropathy[7]
- Paraneoplastic limbic encephalopathy[8]
- Encephalomyelitis[8]
- Paraneoplastic cerebellar degeneration[8]
- Retinopathy[8]
- Myoclonus[8]
- Tripe palms[9]
Complications of the Treatment
Post operative complications following surgery include:[10]
- Atelectasis
- Pneumonia
- Arrhythmia
- Wound infection
- Colitis
- Liver dysfuntion
- Gastric ulcer
Prognosis
Good Prognostic Factors
- Limited stage disease[1]
- Absence of brain metastasis[3]
- Young age[2]
- Female sex[2]
- Asian ethnicity[11]
- Normal white blood cell count[3]
- Surgical resection, radiation, and chemotherapy[12][2]
Bad Prognostic Factors
- Extensive stage disease[1]
- TNM stage III[3]
- Advanced age[2]
- Male sex[2]
- Lower socioeconomic status[11]
- Hispanic and African American ethnicity[11]
- Poor performance status[2]
- Smoking
- Reduced hemoglobin and raised serum lactate dehydrogenase[2]
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.[13]
- When stratified by age, the 5-year relative survival of patients with SCLC was 8.4% and 4.7% for patients<65 and ≥ 65 years of age respectively.[13]
- The survival of patients with SCLC varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of SCLC:[13]
| Stage | 5-year Relative Survival (%)
(2004 - 2010) |
| All stages | 6.3% |
|---|---|
| Localized | 24.2% |
| Regional | 14.3% |
| Distant | 2.8% |
| Unstaged | 7.8% |
References
- ↑ 1.0 1.1 1.2 General Information About Small Cell Lung Cancer. National cancer institute. Accessed on June 17.[1]
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Osterlind K, Andersen PK (1986). "Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation". Cancer Res. 46 (8): 4189–94. PMID 3015384.
- ↑ 3.0 3.1 3.2 3.3 Brueckl WM, Herbst L, Lechler A, Fuchs F, Schoeberl A, Zirlik S; et al. (2006). "Predictive and prognostic factors in small cell lung carcinoma (SCLC)--analysis from routine clinical practice". Anticancer Res. 26 (6C): 4825–32. PMID 17214347.
- ↑ Green, Robert A.; Humphrey, Edward; Close, Henry; Patno, Mary Ellen (1969). "Alkylating agents in bronchogenic carcinoma". The American Journal of Medicine. 46 (4): 516–525. doi:10.1016/0002-9343(69)90071-0. ISSN 0002-9343.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
- ↑ Radulescu D, Pripon S, Bunea D, Ciuleanu TE, Radulescu LI (2007). "Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports". J BUON. 12 (3): 411–4. PMID 17918299.
- ↑ 7.0 7.1 Elrington GM, Murray NM, Spiro SG, Newsom-Davis J (1991). "Neurological paraneoplastic syndromes in patients with small cell lung cancer. A prospective survey of 150 patients". J Neurol Neurosurg Psychiatry. 54 (9): 764–7. PMC 1014512. PMID 1659614.
- ↑ 8.0 8.1 8.2 8.3 8.4 Amir J, Galbraith RC (1992). "Paraneoplastic limbic encephalopathy as a nonmetastatic complication of small cell lung cancer". South Med J. 85 (10): 1013–4. PMID 1329233.
- ↑ Mullans EA, Cohen PR (1996). "Tripe palms: a cutaneous paraneoplastic syndrome". South Med J. 89 (6): 626–7. PMID 8638207.
- ↑ Uramoto H, Nakanishi R, Fujino Y, Imoto H, Takenoyama M, Yoshimatsu T; et al. (2001). "Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer". Thorax. 56 (1): 59–61. PMC 1745907. PMID 11120906.
- ↑ 11.0 11.1 11.2 Ou SH, Ziogas A, Zell JA (2009). "Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity". J Thorac Oncol. 4 (1): 37–43. doi:10.1097/JTO.0b013e31819140fb. PMID 19096304.
- ↑ Gaspar LE, McNamara EJ, Gay EG, Putnam JB, Crawford J, Herbst RS; et al. (2012). "Small-cell lung cancer: prognostic factors and changing treatment over 15 years". Clin Lung Cancer. 13 (2): 115–22. doi:10.1016/j.cllc.2011.05.008. PMID 22000695.
- ↑ 13.0 13.1 13.2 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.