Pathobiology and staging of small cell carcinoma of the lung
- Bonnie S Glisson, MD, FACP
Bonnie S Glisson, MD, FACP
- Professor and Associate Chair
- Department of Thoracic/Head and Neck Medical Oncology
- University of Texas MD Anderson Cancer Center
- Lauren A Byers, MD
Lauren A Byers, MD
- Assistant Professor
- University of Texas MD Anderson Cancer Center
- Section Editors
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Andrew Nicholson, MD
Andrew Nicholson, MD
- Section Editor — Pulmonary Pathology
- Professor of Respiratory Pathology
- Imperial College School of Medicine, London
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
Small cell lung cancer (SCLC) is distinguished from non-small cell lung cancer (NSCLC) by its rapid doubling time, high growth fraction, and the early development of widespread metastases. Although the cancer is initially highly responsive to chemotherapy and radiotherapy, the majority of patients will relapse with broadly resistant disease within a few months to a year from initial therapy.
The epidemiology, pathology, clinical presentation, staging, and prognostic factors of SCLC will be reviewed here. The treatment of SCLC is discussed separately. (See "Extensive stage small cell lung cancer: Initial management" and "Limited stage small cell lung cancer: Initial management" and "Prophylactic cranial irradiation for patients with small cell lung cancer".)
Small cell lung cancer (SCLC) occurs almost exclusively in smokers and appears to be most common in heavy smokers . Historically SCLC has been rare in never smokers, representing just 2.9 percent of the lung cancer cases in women, and none in men, from a case control series .
The proportion of lung cancer in the United States that is classified as SCLC has steadily decreased. This was illustrated by an analysis of the Surveillance, Epidemiology, and End Results (SEER) database, in which the proportion of SCLC declined from 17 percent in 1986 to 13 percent in 2002 . This overall decrease in incidence was accompanied by an increase in the percentage of cases of SCLC arising in women (28 percent in 1973 versus 50 percent in 2002).
These epidemiologic changes may be due to differences in smoking patterns (eg, decreased in men) . In addition, changes in the pathologic criteria for SCLC may have led to some cases being classified as having large cell neuroendocrine carcinoma . (See 'Classification of SCLC' below.)
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- Classification of SCLC
- Tumor markers
- Genetic abnormalities
- Immune biomarkers
- INITIAL EVALUATION
- CLINICAL PRESENTATION
- Limited versus extensive stage disease
- TNM staging system
- Staging workup
- - Utility of PET scanning
- PROGNOSTIC FACTORS
- INFORMATION FOR PATIENTS