| **** | Small Cell Lung Cancer (SCLC) from the small, immature neuro endocrine cells → ‣ | Non-small Cell Lung Cancer (NSCLC) from other cells · Adenocarcinoma · Squamous cell carcinoma (SCC) → ‣ · Carcinoid · Large cell | | --- | --- | --- | | ****Extrapulmonary Presentation | Symptoms are usually rapid-onset and begin 8 to 12 weeks before presentation. Superior vena cava (SVC) syndrome Can cause Paraneoplastic syndromes: · SIADH (syndrome of inappropriate antidiuresis) ADH - weakness, dysgeusia (w/ clinical euvolemia) · Ectopic Cushing syndrome ACTH – elevated free cortisol, edema, proximal myopathy, and hypokalemic alkalosis. · Lambert-Eaton Myasthenic syndrome Antibody against neurons - weakness of proximal arms and legs, relieved temporarily after exercise. Can involve ANS | Constitutional symptoms: fever, night sweat, weightless Intrathoracic effects: cough, hemoptysis, chest pain, dyspnea, or hoarseness, Extra thoracic effects: (SCC): grows at apex, compresses blood vessels and nerves. · Pancoast syndrome (pain in shoulder, forearm, scapula, finger) · Horner syndrome (ipsilateral SNS loss) Bony metastasis in 20% of initial presentation. | | Staging | Veterans Administration Lung Cancer Study Group staging system: · Limited Disease (LD) · Extensive Disease (ED) Depends on whether a reasonable radiation plan can safely encompass disease extent. Surgical patients staged by TNM system. | TNM staging – clinical staging (I – IV) · stage I, II, or III NSCLC are treated with the intent to cure. · stage IV – non-curable. Stage I, II are given pathologic stage after surgical resection for surveillance/ adjuvant chemotherapy. | | Prognosis | Close to 70% of patients with SCLC have disseminated disease at the time of presentation. At this stage, the cancer is not curable, and the prognosis is poor. Even with chemotherapy, the majority of patients are dead within 24 months, and less than 2% are alive at five years. For individuals with localized lung disease, treatment with chemotherapy and radiation does offer a better survival of 80% at two years, but less than 15% are alive at five years. | Prognosis is generally better than SCLC. The prognosis of NSCLC is dependent on the TNM staging, and the performance status/comorbidities of the patient. Poor prognostic factors: · poor performance · Poor appetite · weight loss · Lymphatic vessel invasion, occult lymph node metastasis. · Metabolic activity on PET scan. Recurrence after complete resection has been cited at 41 percent, with the median time to recurrence at 11.5 months and median survival of 8.1 months. |
Chest CT (low dose) → Imaging, screening