Features

• usually central
• arise from APUD* cells
  • Amine - high amine content
  • Precursor Uptake - high uptake of amine precursors
  • Decarboxylase - high content of the enzyme decarboxylase
• associated with ectopic ADH, ACTH secretion
• ADH → hyponatraemia
• ACTH → Cushing's syndrome
• ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
• Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

Management

• usually metastatic disease by time of diagnosis
• patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery. NICE support this approach in their 2011 guidelines
• however, most patients with limited disease receive a combination of chemotherapy and radiotherapy
• patients with more extensive disease are offered palliative chemotherapy

© Image used on license from Radiopaedia

CT scan showing small cell lung cancer with multiple pulmonary nodules and extensive mediastinal nodal metastases.

Management

Surgery plays little role in the management of small cell lung cancer, with chemotherapy being the mainstay of treatment. Adjuvant radiotherapy is also now given in patients with limited disease.

Having said that recent studies have supported a role for surgery in patients with very early stage disease (e.g. T1, N0, M0). Please see the NICE guidelines for more details.