Small cell carcinoma of the lung laboratory tests
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The initial evaluation of patients with small cell lung cancer (SCLC) confirmed by histopathological findings include a complete blood count with differential, electrolytes, liver function test, calcium level, LDH, BUN, and creatinine. These laboratory tests should also be performed to assess the response to the initial therapy.
Laboratory Findings
Biopsy
The confirmation of the diagnosis of SCLC relies on the histopathological findings of the tumor biopsy.[1]
In SCLC, the tumor cells are small and round, but they can sometimes be ovoid or spindle shaped. They have a scant cytoplasm with a high mitotic count and a hyperchromatic nuclei. Nearly all SCLC are immunoreactive for keratin, thyroid transcription factor 1, and epithelial membrane antigen. Neuroendocrine and neural differentiation result in the expression of molecules like dopa decarboxylase, calcitonin, neuron-specific enolase, chromogranin A, CD56 (also known as nucleosomal histone kinase 1 or neural-cell adhesion molecule), gastrin-releasing peptide, and insulin-like growth factor 1. One or more markers of neuroendocrine differentiation can be found in approximately 75% of SCLC.[2]
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Histopathologic image of small cell carcinoma of the lung. CT-guided core needle biopsy. H & E stain.
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Micrograph of a small-cell carcinoma of the lung showing cells with nuclear molding, minimal amount of cytoplasm and stippled chromatin. FNA specimen. Field stain.
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Anaplastic (microcellular, oat cell) carcinoma from the lung.
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Histopathologic image of small-cell carcinoma of the lung. CT-guided core needle biopsy.
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Small cell carcinoma, pleural FNA.
Laboratory Tests
The following laboratory tests must be ordered in all patients with SCLC during the initial evaluation as well as during the assessment of response to treatment following the initial therapy:[1]
- Complete blood count with differential
- Low hemoglobin, thrombocytopenia, or leukopenia can be found if the metastatic cells infiltrated the bone marrow.
- Electrolytes
- Hyponatremia can be present if syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurred as a complication of SCLC.
- Liver function test
- Liver function test should be done as a baseline and will be monitored during treatment. Liver enzymes can be elevated in metastasis.
- LDH
- Calcium level
- Hypercalcemia can be present in case of excessive production of parathyroid hormone as a paraneoplastic syndrome.
- BUN
- Creatinine
References
- ↑ 1.0 1.1 NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
- ↑ National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.