 Mild Symptoms:

Headache
Weakness
Predisposing Precipitating Factors:
 Severe Symptoms:
Factors:  Second hand smoking
Altered mental status
 Genetics SMALL CELL  Exposure to radiation,
seizures
 Advanced asbestos, nickel, tar, talc
CARCINOMA  Air pollution
Respiratory depression
Age Death
 Smoking

Hyponatremia

Widespread/Rapid Multiple Neuroendocrine

Carcinogenesis Increased water
Metastases Cells Increase ADH SIADH reabsorption

Undergo mutation
and secretes
 BRAIN biological substances
 LIVER
 ADRENAL
GLANDS
 BONE
Increased ACTH Increased Cortisol
Paraneoplastic
production
Syndrome

Cushing’s Syndrome

Central Tumor

 Muscle Weakness
 Hyperglycemia
 hypokalemia
 Hypertension
Cancer induced Mediastinal  Weight gain
Airway Involvement
Obstruction of invasion lipolysis and
airway proteolysis

Increased effort Angiogenesis Enlargement of

Irritates Tumour infiltrate Obstruction of
to ventilate the Loss of Subcranial lymph
cough the pericardium SVC
lungs adipose and nodes
receptor skeletal
Blood vessel is muscle
Post
leaky and Pericardial
Obstructive
tortuous effusion Compressed SVC
Cough Reflex Pneumonia
Dyspnea middle third of Syndrome
And Distal Weight loss
esophagus
Atelectasis

Rupture

Dysphagia
Pleural
effusion Hemoptysis

Chest pain
and dyspnea

Laboratory and diagnostic Pharmacologic treatment Medical Management

findings

Laboratory And Diagnostic Findings 2. Sputum cytology

Antineoplastics,
1. Biopsy 
Alkylating
Is a non invasive test and, if positive,
 can provide an accurate
Surgical
 Biopsy  Skeletal Resection
 the removal
Sputum Cytology of a small amount of tissue for examination
Radionuclide  Topoisomerase
under a diagnosis of central lung cancers. Although

SCLC usually presents as
Radiation
 CBC Imaging Inhibitors
Therapy
microscope.
Serum A pathologist
 then analyzes the sample(s). If cancer
Bronchoscopy  cells a large, central tumor, tumor cells frequently
Antineoplastics, involve the submucosal
 Chemotherapy
Chemistries and fine needle Anthracycline
areRadiography
found, the pathologist will determine if it is SCLC or NSCLC,
PD-1/PD-L1
layer of the bronchus with little or noImmunotherapy
exophytic endobronchial
 aspiration
based on what it looks
CT scan  like when seen through a microscope. Inhibitors extension.
Thoracentesis
 MRI
3. Complete blood cell count 10. Magnetic resonance imaging (MRI) scan. 
Bone marrow examination is not routinely performed in SCLC An MRI also produces images that allow doctors to see the
unless abnormalities are identified in the CBC or peripheral smear location of a lung tumor and/or lung cancer metastases and measure
examination, raising the possibility of bone marrow spread. These the tumor’s size. An MRI uses magnetic fields, not x-rays, to produce
abnormalities may include cytopenia or the presence of immature detailed images of the body. A special dye called a contrast medium is
white and red blood cell. given before the scan to create a clearer picture. 

4. Serum Chemistries
Presence of elevated serum calcium and ALP level raises the
suspicion of bone metastasis. Serum electrolytes should be obtained
to look for paraneoplastic syndromes, such as SIADH. The presence
of hyponatremia is considered and adverse prognostic indicator.
Elevated serum LDH indicates an increased tumor mass and high cell
turnover.

5. Radiography
Good posteroanterior and lateral radiographs are useful in
identifying the primary tumor, as well as concurrent parenchymal
abnormalities. Mediastinal widening may indicate mediastinal lymph
node involvement.

6. CT Scan
Scanning of all common sites of metastasis should be performed
Pharmacological Treatment
to stage the disease adequately. Evaluation via CT scanning of the 1. Antineoplastics, Alkylating
thorax and commonly involved abdominal viscera is the minimum  Carboplatin (Paraplatin)
requirement in standard staging workup of SCLC. Platinum alkylating agent that interferes with the function of DNA
by producing interstand DNA cross-links. It can be used for the

7. Skeletal Radionuclide Imaging treatment of SCLC.

 Cisplatin
Bone is common site of metastasis for small lung cancer. A
Platinum-containing compoundthat exerts an antineoplastic effect
radionuclide bone scan should therefore be obtained to identify bone
by covalently binding to DNA, with preferential bidning to the N-7
metastastis. Bone scans should be obtained in all patients with SCLC
position of guanine and adenosine. It can react with 2 different sites
at diagnosis or during follow-up if new bone-related symptoms
on DNA to produce cross-links.
develop or if the serum calcium or alkaline phosphatase level is
 Ifosfamide (Ifex)
elevated.
A nitrogen mustard alkylating agent that inhibits DNA and protein
synthesis. ALthough not FDA approved, ifosfamide is often used as a
8. Bronchoscopy and Fine Needle Aspiration
treatment for relapsed SCLC.
SCLC is usually centrally located and can be approached easily
 Lurbinectedin (Zepzelca)
with a bronchoschope. The advantage of endoscopy is direct
It binds guanine residues in the minor groove of DNA, forming
visualization of the tumor, allowing for direct biopsy as well as
adducts and resulting in a bending of DNA helix towards the major
cytologic examination of bronchial washings.
groove. The addict formation triggers a cascade of events that can
affect the subsequent activity of DNA-binding proteins, including some
9. Thoracentesis transcription factors, and DNA repair pathways. FDA granted
In SCLC, the presence of malignant pleural effusion upstages the accelerated approval for adults with metastatic SCLC with disease
disease to extensive-stage SCLC. For adequate staging, pleural progression on or after platinum-based chemotherapy.
effusions should be aspirated and examined for malignant cells if no
other sites of distant spread are identified. 2. Topoisomerase Inhibitors
 Irinotecan (Camptosar)
 Binds reversibly to the topisomerase I-DNA complex and prevents
the ligation of the cleaved DNA strand. Used off label treatment of
extensive-stage small cell lung cancer.

3. Antineoplastics, Anthracycline
 Doxorubicin (Adriamycin, Caelyx, Rubex)
Causes DNA strand breakage through its effects on
topoisomerase II and through direct intercalation into DNA, which
causes DNA polymerase inhibition. It has a labeled indication for the
Medical Management
treatment of smal cell lung cancer.
1. Chemo therapy
4. PD-1/PD-L1 Inhibitors The use of drugs to destroy cancer cells, usually by keeping the

 Atezolizumab (Tecentriq) cancer cells from growing, dividing, and making more cells. A

Indicated in combination with carboplatin and etoposide as first- chemotherapy regimen, or schedule, usually consists of a specific

line treatment of adults with extensive stage SCLC. number of cycles given over a set period of time. A patient may

 Pembrolizumab (keytruda) receive 1 drug at a time or combinations of different drugs given at the

Indicated for patients with metastatic small cell lung cancer with same time.

metastatic SCLC with disease progression on or after platinum based Chemotherapy is the primary treatment for SCLC because it

chemotherapy and at least 1 other prior line of therapy. spreads quickly. The most commonly used chemotherapy regimen is

 Nivolumab (Opdivo) etoposide (available as a generic drug) or irinotecan (Camptosar) plus

Indicated for patients with metastatic SCLC who have progressed a platinum-based drug such as cisplatin (available as a generic drug)

after platinum-based chemotherapy and at least 1 other line of or carboplatin (available as a generic drug).

therapy. Provides an option for patients who have progressed after The side effects of chemotherapy depend on the individual and

platinum-based chemotherapy as first-line treatment, and for those the dose used, but they can include fatigue, risk of infection, nausea

with progression after second-line chemotherapy. and vomiting, loss of appetite, diarrhea, and hair loss.

2. Immunotherapy
Also called biologic therapy, is designed to boost the body's
natural defenses to fight the cancer. It uses materials made either by
the body or in a laboratory to improve, target, or restore immune
system function. For example, the PD-1 pathway may be very
important in the immune system’s ability to control cancer growth.
Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or
slowed the growth of SCLC for some patients. Common side effects
include skin reactions, flu-like symptoms, diarrhea, and weight
changes

3. Radation Therapy
Radiation therapy is the use of high energy x-rays or other
particles to destroy cancer cells. A radiation oncologist is a doctor who
specializes in giving radiation therapy to treat cancer. The most
common type of radiation treatment is called external-beam radiation
therapy, which is radiation given from a machine outside the body. A
radiation therapy regimen, or schedule, usually consists of a specific
number of treatments given over a set period of time. This can vary
from just a few days of treatment to several weeks.
People with SCLC who receive radiation therapy often experience
fatigue and loss of appetite. If radiation therapy is given to the neck or
center of the chest, patients may also develop a sore throat and have
difficulty swallowing. Patients may also notice skin irritation, similar to
sunburn, where the radiation was directed. Most side effects go away
soon after treatment is finished.
4. Resection Surgery
Surgery is the removal of the tumor and some surrounding healthy
tissue during an operation. A surgical oncologist is a doctor who
specializes in treating cancer using surgery. For lung cancer, a
thoracic surgeon is specially trained to perform lung cancer surgery.
Surgery is rarely used for patients with SCLC and is only
considered for people with very early-stage disease, such as cancer in
a small lung nodule. In those situations, chemotherapy, with or without
radiation therapy, is given after surgery.