214. Small But Mighty - An Internist's Approach to Small Cell Lung Cancer
Nov 12, 2023
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This podcast episode discusses the clinical presentation, classification, investigations, treatment, and prognosis of small cell lung cancer. It explores the aggressive nature, poor prognosis, and causes of SCLC, as well as the various treatment options including chemotherapy and radiotherapy. The controversial topic of prophylactic cranial radiation is also explored, along with the importance of routine MRI imaging and involvement of other specialists in patient care.
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Quick takeaways
Small cell lung cancer is an aggressive subtype characterized by high cell proliferation and metastatic potential.
Patients with small cell lung cancer commonly present with symptoms related to invasion, metastases, and paraneoplastic syndromes.
Deep dives
Understanding Small Cell Lung Cancer
Small cell lung cancer is an aggressive subtype of lung cancer with a poor prognosis. It is characterized by high cell proliferation and metastatic potential. Standard treatments have not significantly changed in decades, prompting intense research into the cellular mechanisms driving progression and resistance. Small cell lung cancer is classified based on neuroendocrine tumor features and is often diagnosed at an advanced stage, leading to low survival rates. The primary cause of small cell lung cancer is smoking, though other mutations may also contribute.
Clinical Presentation and Diagnosis
Patients with small cell lung cancer commonly present with symptoms related to local regional invasion, metastases, and paraneoplastic syndromes. General symptoms include cough, breathlessness, pain, and constitutional symptoms such as fatigue and weight loss. Diagnosis involves imaging tests like chest X-ray or CT scan to identify masses or pleural effusions, followed by biopsies for confirmation. Staging is important to determine appropriate treatment options, with CT and MRI scans used to assess the extent of the disease.
Treatment Approaches
In localized small cell lung cancer, surgery may be considered, but most cases involve chemotherapy and radiotherapy. Response rates to these treatments are high, but relapse is common, leading to the development of resistance. For extensive stage disease, a palliative approach is taken, focusing on platinum-based chemotherapy. Prophylactic cranial radiation may be considered to reduce the incidence of brain metastases. Supportive care is crucial for managing side effects and addressing complications. Recent studies have shown promising results with immune checkpoint inhibitors and chemotherapy combinations, improving survival rates.
In this episode, we review the clinical presentation, classification, investigations, treatment and prognosis of patients with small cell lung cancer. Our medicine minute discusses the CASPIAN trial.
Written by: Dr. Craig Rodrigues (Internal Medicine Resident) Reviewed by: Dr. Susanna Cheng (Medical Oncologist) and Dr. Ignazio La Delfa (Internist)