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]
Overview
Small cell lung cancer comprises 15% to 25% of bronchogenic carcinomas and it is the cancer most commnoly associated with a plethora of paraneoplastic syndromes.[1] It usually develops in the upper airways and involves the hilum and mediastinum. Most of the times, evidence of regional or distant metastases is found at the time patients present with small cell lung carcinoma. [2]
History and Symptoms
Symptoms Related to Tumor Growth in the Thorax
Constitutional Symptoms
Symptoms Related to Paraneoplastic Syndrome
- SCLC is the most frequent cause of paraneoplastic syndromes, being the superior vena cava syndrome and the syndrome of inappropriate antidiuresis the most common.[3][5][6]
| Superior vena cava syndrome | Edema of upper body, visible dilated veins over the upper torso, shoulders and arms, headache, dizziness, drowsiness, blurring of vision, cough, dysphagia | Frequency: 50% |
| Syndrome of inappropriate antidiuresis | Weakness, dysgeusia, and clinical euvolemia: osmolality <275 mOsmol/kg water, urinary osmolality >100 mOsmol/kg water during hypotonicity, urinary sodium >40 mmol/L with normal dietary salt intake. | Frequency: 15-40% |
| Hypercalcemia | Nausea, vomiting, abdominal pain, constipation, polyuria, thirst, dehydration, confusion, irritability | Frequency: 8-12%† |
| Cushing's syndrome | Hypercorticism | Frequency: 2-5% |
| Lambert-Eaton syndrome | Proximal muscles of lower extremities weakness and fatiguability, abnormal gait, hyporeflexia, increased deep-tendon reflexes after facilitation, autonomic dysfunction, and paresthesia | Frequency: 3% |
| Limbic encephalitis and encephalomyelitis | Altered mental status, seizures, memory loss, space and time disorientation, with or without dementia. | Frequency: <1% |
| Paraneoplastic cerebellar degeneration | Ataxia, dysarthria, ocular findings and severe vertigo | Frequency: <1% |
† Hypercalcemia is characteristically uncommon in SCLC patients.
Symptoms Related to the Distant Spread of the Tumor
- Hoarseness (involvement of the recurrent laryngeal nerve)[2]
- Dyspnea (one of the causes is the involvement of the phrenic nerve and subsequent elevation of the hemi-diaphragm)[2]
- Pain, muscle wasting, or change in the skin temperature in areas corresponding to C8, T2 to T4 (involvement of the brachial plexus)[2]
- Chest pain (one of the causes is the involvement of the chest wall)[2]
- Pleuritic chest pain[2]
- Horner syndrome manifested by unilateral miosis, ptosis and anhydrosis (involvement of the sympathetic trunk)[2]
- Arrhythmia (involvement of the pericardium)[2]
- Cardiac tamponade manifested by chest pain, altered mental status, cold extremities, peripheral cyanosis (involvement of the pericardium)[2]
- Dysphagia (compression of the esophagus)[2]
- Superior vena cava syndrome manifested by dyspnea, headache, and swelling of the face, neck, trunk, and arms[2]
- 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 (suggestive of lymphadenopathy)
Uncommon Symptoms
- Abdominal discomfort due to bilateral adrenal mass[7]
- Facial nerve palsy due to metastasis to the facial nerve[8]
References
- ↑ Sher T, Dy GK, Adjei AA (2008). "Small cell lung cancer". Mayo Clin Proc. 83 (3): 355–67. doi:10.4065/83.3.355. PMID 18316005.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 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.
- ↑ Ellison DH, Berl T (2007). "Clinical practice. The syndrome of inappropriate antidiuresis". N Engl J Med. 356 (20): 2064–72. doi:10.1056/NEJMcp066837. PMID 17507705.
- ↑ Boscaro M, Arnaldi G (2009). "Approach to the patient with possible Cushing's syndrome". J Clin Endocrinol Metab. 94 (9): 3121–31. doi:10.1210/jc.2009-0612. PMID 19734443.
- ↑ 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.