Small Cell Lung Cancer Differential Diagnoses

  • Author: Winston W Tan, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Mar 1, 2012
 
 

Diagnostic Considerations

Because of rapid tumor growth and early dissemination, any delay in instituting therapy may result in upstaging of the tumor from limited to extensive stage, thus converting a potentially curable illness to incurable disease.

Early recognition of vertebral and paraspinal metastases is crucial, as these conditions potentially lead to permanent loss of neurologic function if the diagnosis is delayed. Both conditions are oncologic emergencies.

Pericardial tamponade is also an emergency; this condition requires early recognition and treatment.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Winston W Tan, MD  Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices

Winston W Tan, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Irfan Maghfoor, MD  Consulting Oncologist, Department of Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia

Irfan Maghfoor, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

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Table 1. 2008-2010 Estimates of New Cases of Lung Cancer and Estimates of Lung Cancer Deaths
Newly Diagnosed Cases of Diagnosed Lung Cancer Lung Cancer Deaths
2008 Estimates
Total (% of all cancers)215,020 (15%)161,840 (29%)
Men114, 69090,810
Women100,33071,030
2009 Estimates
Total (% of all cancers)219,440 (15%)159,390 (28%)
Men116,09088,900
Women103,35070,490
2010 Estimates
Total (% of all cancers)222,520 (15%)157,300 (28%)
Men116,75086,220
Women105,77071,080
Sources: American Cancer Society. Cancer facts & figures 2008,[15] 2009,[19] 2010.[20]
Table 2. Paraneoplastic Syndromes
Organ System Syndrome Mechanism Frequency
EndocrineSIADHAntidiuretic hormone5-10%
Ectopic secretion of ACTHAdrenocorticotropic hormone5%
Atrial natriuretic factor
NeurologicEaton-Lambert reverse myasthenic syndrome5-6%
Subacute cerebellar degeneration
Subacute sensory neuropathy
Limbic encephalopathyAnti-Hu, Anti-Yo antibodies
ACTH = adrenocorticotropic hormone; SIADH = syndrome of inappropriate antidiuretic hormone.
Table 3. Commonly Used Chemotherapy Regimens in Small Cell Lung Cancer
Regimen Dose
“CAV” Regimen
Cyclophosphamide1000 mg/m2 IV day 1
Doxorubicin (Adriamycin)50 mg/m2 IV day 1
Vincristine2 mg IV
“PE” Regimen
Cisplatin25 mg/m2 IV days 1-3
Etoposide100 mg/m2 IV days 1-3
“CAVE” Regimen
Cyclophosphamide1000 mg/m2 IV day 1
Doxorubicin (Adriamycin)50 mg/m2 IV day 1
Vincristine1.4 mg/m2 IV day 1 (maximum 2 mg)
Etoposide100 mg/m2 IV day 1
“PEC” Regimen
Paclitaxel200 mg/m2 IV day 1
Etoposide50 mg/d PO alternating with



100 mg/d PO from days 1-10



CarboplatinAUC 6 IV day 1
Single-Agent Regimens
Topotecan1.5 mg/m2 IV day 1-5
Etoposide50 mg PO bid days 1-14
AUC = area under the concentration curve; bid = twice daily; IV = administered intravenously; PO = administered orally.
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