• Originates in the bronchi lining

• Characterized by fast-growing small-sized cells

• Highly aggressive and quickly spreads

• Constitutes about 15% of lung cancers, primarily found in smokers and typically located centrally in the lungs

• Often spreads to the mediastinum with early extrathoracic metastases and paraneoplastic syndromes being common

• Diagnosis usually occurs at an advanced stage, making surgery rare

• Tobacco smoking: Especially heavy and prolonged smoking.

• Second-hand smoke

• Asbestos exposure

• Radon exposure

• Primary risk factor: Cigarette smoking

• Other risks:

– Second-hand smoke exposure

– Occupational exposure to carcinogens (e.g. asbestos, radon)

– Family history of lung cancer

• SCLC arises from abnormal cell growth in the bronchi

• Characterized by:

– A high propensity for rapid growth

– Early metastasis to distant organs

– Invasion of nearby tissues and organs

• Non-Small Cell Lung Cancer (NSCLC): Includes adenocarcinoma and squamous cell carcinoma

• Pneumonia

• Tuberculosis

• SCLC accounts for around 15% of lung cancer cases in the UK.

• SCLC is more prevalent in older individuals, particularly those aged 65 and above.

• SCLC commonly affects those above 40, primarily due to smoking.

• About 47,000 new cases of lung cancer are reported annually in the UK, with SCLC being a significant portion.

• Paraneoplastic syndromes occur in about 10% of SCLC patients, leading to systemic symptoms unrelated to the tumor.

• Persistent cough (lasting over six weeks)

• Shortness of breath

• Chest pain

• Hemoptysis (coughing up blood)

• Fatigue

• Unintended weight loss

• Recurrent respiratory infections

• Early signs may be subtle, but 40% present with intrathoracic symptoms such as:

– Cough

– Dysphagia

– Hemoptysis

– Dyspnea

– Weight loss

– Chest pain

– Fatigue

– Night sweats

– Fever

– Hoarseness

– Finger clubbing

• Fatigue

• Weight loss

• Bone tenderness

• Confusion

• Hepatomegaly

• Lymphadenopathy

• Headache

• Nausea and vomiting

• Paraneoplastic syndromes are present in about 10% of patients, causing systemic symptoms unrelated to the tumor, such as hormone imbalances or neurological symptoms.

General Investigations:

– Elevated lactic acid dehydrogenase (LDH) levels and hyponatremia.

– Liver function tests (LFT).

Imaging Studies:

– Chest X-ray (CXR).

– Contrast-enhanced chest CT scan.

– Positron-emission tomography CT (PET-CT).

Biopsy Procedures:

– Bronchoscopy.

– Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

– Surgical biopsy if less invasive methods fail.

Staging Procedures:

– PET scans or bone scans may be performed.

– Neck ultrasound.

Metastasis Evaluation:

– Contrast-enhanced CT or MRI scans of the brain.

– Bone scanning.

– Liver ultrasound and biopsy.

• Elevated lactic acid dehydrogenase (LDH) levels

• Hyponatremia

• Liver function tests (LFT).

• Chest X-ray (CXR)

• Contrast-enhanced chest CT scan

• Positron-emission tomography CT (PET-CT)

• Bone scan and neck ultrasound for staging.

• Bronchoscopy

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

• Surgical biopsy if less invasive methods fail.

• Contrast-enhanced CT or MRI scans of the brain

• Bone scanning

• Liver ultrasound and biopsy.

• Limited to one hemithorax

• Involves ipsilateral hilar, mediastinal, and supraclavicular lymph nodes

• May include ipsilateral pleural effusion.

• Contralateral lung metastases

• Distant metastatic involvement.

• American Joint Committee on Cancer (AJCC) TNM staging system: Rarely applied for SCLC.

• Based on T (tumor size and extent), N (spread to regional lymph nodes), and M (metastasis)

• Stage groupings range from IA (T1N0M0) to IV (any metastases).

• Treatment Options:

– Chemotherapy, radiation, and surgery depending on the stage

– Targeted therapy and immunotherapy for specific cases

• Prescribing Management:

– Limited-Stage Disease:

– Chemotherapy, concurrent thoracic irradiation, prophylactic cranial irradiation

– Extensive Disease:

– Platinum-based chemotherapy, consider thoracic irradiation

– Relapse:

– Second-line chemotherapy (cyclophosphamide, doxorubicin, vincristine, topotecan)

– Pain management with opiates like morphine

• Non-Prescribing Management:

– Advice on smoking cessation for all patients

– Surgery rare for early stages

– Supportive measures based on stage and metastases location

– Radiotherapy for specific symptoms

– Stent insertion for superior vena cava obstruction

• Chemotherapy, radiation, and surgery depending on the stage

• Targeted therapy and immunotherapy for specific cases

• Chemotherapy

• Concurrent thoracic irradiation

• Prophylactic cranial irradiation

• Platinum-based chemotherapy

• Consider thoracic irradiation

• Second-line chemotherapy with agents like cyclophosphamide, doxorubicin, vincristine, topotecan

• Opiates like morphine

• Smoking cessation advice for all patients

• Surgery: Rare, typically for early stages

• Supportive measures: Based on stage and metastases location

• Radiotherapy: For specific symptoms

• Stent insertion: For superior vena cava obstruction

• Generally poor due to late diagnosis

• Initial treatment may lead to remission, but the 5-year survival rate is lower than in other lung cancer types

• One year or more: 40.6%

• Five years or more: 16.2%

• Predicted ten years or more: 9.5%

• Females have higher survival rates at 1, 5, and 10 years

• Better survival for those under 40

• Early-stage diagnosis significantly increases survival (1 year: 88%, 5 years: 57%)

• Tobacco use contributes to over 80% of lung cancer deaths

• Primary prevention can reduce cancer burden

• Other risk factors: Radiation, workplace exposures, air pollution

• No UK screening program; US uses LDCT screening (20% reduced mortality)

• US Preventive Services Task Force recommends LDCT screening for certain age and smoking history

• Chronic respiratory infections

• Recurrent sinusitis

• Bronchiectasis (irreversible bronchi dilation)

• Hearing loss

• Infertility

• Respiratory failure in severe cases