Oncology
Small Cell Lung Cancer
소세포폐암
Highly aggressive neuroendocrine lung cancer
- How common
- 15% of lung cancers (almost all smokers)
- Typical age
- Ages 60–70
What is it?
Tobacco-induced concurrent loss of TP53 and RB1 in neuroendocrine cells drives rapid proliferation.
Commonly affected: Central lung, mediastinum, brain, liver, bone, adrenals
How it develops
- Tobacco carcinogensPAH, NNK form DNA adducts
- TP53 + RB1 lossBoth tumor suppressors inactivated (>90%)
- Neuroendocrine phenotypeHormone/peptide secretion (ACTH, ADH)
- Early widespread metastasisBrain/liver/bone/marrow mets in 70% at diagnosis
Symptoms
- Rapid weight loss10kg in weeks not uncommon
- SVC syndromeFace/arm swelling, headache, distended veins
- SIADH/hyponatremiaNausea, confusion, seizures
- Ectopic ACTH/CushingMuscle weakness, edema, hyperpigmentation
- Lambert-Eaton syndromeProximal weakness improving with use
How it is examined
- SVC assessmentPemberton sign (facial congestion with arm raise)
- Neurologic examParaneoplastic and brain mets evaluation
- Performance statusECOG; often PS 2–3 at diagnosis
Imaging
CXR: mediastinal widening, large hilar mass.
- Mediastinal widening
- Bulky hilar mass
CT, PET-CT, brain MRI, marrow workup for LD vs ED stage.
- Central lung mass
- Extensive nodes
- Brain/liver mets
Non-surgical care
- Stage: LD vs EDLimited (one hemithorax) vs Extensive disease
- Chemotherapy (platinum-etoposide)Cisplatin or carboplatin + etoposide x 4–6 cycles
- Immunotherapy (1st-line ED)Atezolizumab or durvalumab added to chemo (CASPIAN)
- Prophylactic cranial irradiationPCI in responders prevents CNS relapse
- 2nd-line lurbinectedin/topotecanSecond-line agents at relapse
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
T1-2N0 very early stage (<5% of SCLC)
Procedures that may be discussed
- Lobectomy + LN dissection + adjuvant chemoRT
- Most patients: concurrent chemoRT without surgery
Outlook
LD median 16–24 months, 5-yr 25%. ED median 10–12 months, 5-yr <5%.