Small cell carcinoma of the lung natural history, complications and prognosis
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The natural history of untreated small cell lung cancer (SCLC) is extremely poor, with median survival of only 2 months for stage IV SCLC and less than 3 to 4 months for tumors confined to the thorax. With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months while that of patients with extensive-stage disease ranges from 6 to 12 months. SCLC can be complicated by paraneoplastic syndromes.
Approximately 30% of patients with SCLC have limited stage disease which is characterized by a tumor confined to the hemithorax of origin, the mediastinum, or the supraclavicular lymph nodes. Patients with extensive-stage disease have tumors that have spread beyond the supraclavicular areas.
Complications of the Disease Itself
- Cushing syndrome (due to production of ACTH)
- Hypertension (due to production of renin)
- Amenorrhea (due to production of prolactin or growth hormone)
- Galactorrhea (due to production of prolactin or growth hormone)
- Increased production of amylase
- Excessive parathormone (PTH) secretion
- Lambert-Eaton myasthenic syndrome (LEMS)
- Subacute sensory neuropathy
- Paraneoplastic limbic encephalopathy
- Paraneoplastic cerebellar degeneration
Complications of the Treatment
Post operative complications following surgery include:
Although for most patients with small cell carcinoma of lung the current treatment regimens do not provide cure, the potential prognostic factors that are considered to influence the prognosis of the disease, i.e. the chance of recovery and treatment options include the following.
Good Prognostic Factors
- Extent of the disease: Limited stage disease is considered to be a good prognostic factor. With the current treatment modalities, the median survival of patients with limited stage disease ranges from 16 to 24 months. Some patients with limited-stage disease who might be eligible for surgery with or without adjuvant chemotherapy have an even a better prognosis.
- Cancer staging: TNM stage III (T1a: Tumor size 2 cm or less; N2: Metastasis in ipsilateral peribronchial and/or hilar lymph nodes and intrapulmonary nodes including involvement by direct extension; M0: No distant metastasis) and above has a bad prognosis on the progression of the disease. But absence of metastasIs in the brain at the time of diagnosis and limited stage disease may be positive prognostic indicators.
- Age: Advanced age and young age at the time of diagnosis are considered as negative and favorable prognostic factors of the disease respectively.
- Sex: While diseased males are associated with a worse survival, diseased females live significantly longer than diseased males.
- Socioeconomic status: Most of the patients are from the lower socioeconomic status and are unmarried. They have a poor prognosis when it comes to disease progression.
- Ethnicity: Hispanics and African Americas are significantly affected and they carry a poor prognosis. But Asian ethnicity carry a favorable prognosis.
- Performance status: Poor performance status is significantly associated with a reduced duration of survival.
- Smoking: A positive smoking history is a well known and established independent poor prognostic factor for small cell carcinoma of the lung.
- Laboratory values: Albumin is another independent factor that can affect the prognosis of disease. Reduced hemoglobin concentration, and raised serum lactate dehydrogenase values have been demonstrated as factors that are associated with a significant reduction in the duration of survival following the disease. A normal white blood cell count is the most powerful positive prognostic indicator among laboratory values.
- Treatment: All treatment modalities like surgical resection, radiation, and chemotherapy serve as favorable prognostic factors, contributing to the survival.
Bad Prognostic Factors
- Extent of the disease: Patients with extensive-stage disease have a worse prognosis than patients with limited-stage disease. With the current treatment modalities, the median survival for patients with extensive-stage disease ranges from 6 to 12 months and their long-term disease-free survival is rare.
- Between 2004 and 2010, the 5-year relative survival of patients with SCLC was 6.6%.
- When stratified by age, the 5-year relative survival of patients with SCLC was 8.4% and 4.7% for patients <65 and ≥ 65 years of age respectively.
- The survival of patients with SCLC varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of SCLC:
|Stage||5-year relative survival (%), (2004-2010)|
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