Small cell carcinoma of the lung history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Guillermo Rodriguez Nava, M.D. [2]; Rim Halaby, M.D. [3]
Overview
Small cell lung cancer (SCLC) is characterized by a relatively rapid onset of symptoms. Patients usually present within 8 to 12 weeks of the onset of symptoms, which can be related either to the tumor growth in the thorax or to the distant spread of the tumor. In addition, SCLC is associated with the occurrence of paraneoplastic syndromes such as the syndrome of inappropriate antidiuresis (SIADH).
History and Symptoms
History
- SCLC is characterized by a relatively rapid onset of symptoms.
- Patients with SCLC usually present within 8 to 12 weeks of the onset of symptoms.
- A typical SCLC patient is a 70 year old male who is either a smoker or an ex-smoker.[1]
- A full medical history should be obtained.
- Information should be obtained regarding:
- Tobacco smoking status
- Family history of lung cancer
Symptoms Related to Tumor Growth in the Thorax
Constitutional Symptoms
Symptoms Related to Paraneoplastic Syndromes
- Syndrome of inappropriate antidiuresis (SIADH) (frequency: 15 - 40%):[1]
- Hypercalcemia (frequency: 8 - 12%):[1]
- Cushing's syndrome (frequency: 2 - 5%):[1]
- Rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity)
- A round face often referred to as a "moon face"
- Excessive sweating
- Insomnia
- Reduced libido
- Amenorrhoea
- Lambert-Eaton syndrome (frequency: 3%):[1]
- Weakness of the proximal muscles of lower extremities
- Abnormal gait
- Autonomic dysfunction
- Paresthesia
- Limbic encephalitis and encephalomyelitis (frequency < 1%):[1]
- Altered mental status
- Seizures
- Memory loss
- Space and time disorientation with or without dementia
- Paraneoplastic cerebellar degeneration (frequency < 1%):[1]
- Ataxia
- Dysarthria
- Severe vertigo
- Amenorrhea (due to production of prolactin or growth hormone)[3]
- Galactorrhea (due to production of prolactin or growth hormone)[3]
Symptoms Related to the Distant Spread of the Tumor
- Hoarseness (involvement of the recurrent laryngeal nerve)[4]
- Dyspnea (one of the causes is the involvement of the phrenic nerve and subsequent elevation of the hemi-diaphragm)[4]
- Pain, muscle wasting, or change in the skin temperature in areas corresponding to cervical spinal nerve C8 or thoracic nerve T2 to T4 (involvement of the brachial plexus)[4]
- Chest pain (one of the causes is the involvement of the chest wall)[4]
- Pleuritic chest pain[4]
- Horner syndrome manifested by unilateral miosis, ptosis and anhydrosis (involvement of the sympathetic trunk)[4]
- Arrhythmia (involvement of the pericardium)[4]
- Cardiac tamponade manifested by chest pain, altered mental status, cold extremities, peripheral cyanosis (involvement of the pericardium)[4]
- Dysphagia (compression of the esophagus)[4]
- Superior vena cava syndrome manifested by dyspnea, headache, and swelling of the face, neck, trunk, and arms[4]
- Localized bone pain most commonly on the axial skeleton and proximal long bones (suggestive of bone metastasis)
- Jaundice (suggestive of liver metastasis)
- Headache, nausea and vomiting, focal neurologic symptoms, seizures, confusion, and personality changes (suggestive of brain metastasis)
- Palpable masses, particularly in the supraclavicular area (suggestive of lymphadenopathy)
Uncommon Symptoms
- Abdominal discomfort due to bilateral adrenal mass[5]
- Facial nerve palsy due to metastasis to the facial nerve[6]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
- ↑ Beckles MA, Spiro SG, Colice GL, Rudd RM (2003). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes". Chest. 123 (1 Suppl): 97S–104S. PMID 12527569.
- ↑ 3.0 3.1 Gandhi L, Johnson BE (2006). "Paraneoplastic syndromes associated with small cell lung cancer". J Natl Compr Canc Netw. 4 (6): 631–8. PMID 16813730.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
- ↑ Singh N, Madan K, Aggarwal AN, Das A (2013). "Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature". J Thorac Dis. 5 (3): E83–6. doi:10.3978/j.issn.2072-1439.2011.09.05. PMC 3698258. PMID 23825789.
- ↑ Yildiz O, Buyuktas D, Ekiz E, Selcukbiricik F, Papila I, Papila C (2011). "Facial nerve palsy: an unusual presenting feature of small cell lung cancer". Case Rep Oncol. 4 (1): 35–8. doi:10.1159/000324182. PMC 3082487. PMID 21526004.