eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Lung Cancer, Oat Cell (Small Cell): Follow-up

Author: Irfan Maghfoor, MD, Consulting Oncologist, Department of Oncology, King Faisal Specialist Hospital and Research Center, Saudi Arabia
Coauthor(s): Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
Contributor Information and Disclosures

Updated: May 22, 2009

Follow-up

Further Outpatient Care

  • Patients with small cell lung cancer (SCLC) require close monitoring for adverse effects and response to therapy. Blood work, including CBC with differential, is needed prior to each cycle of chemotherapy to ensure marrow recovery before the next dose of chemotherapy is administered. Renal function should be monitored because of nephrotoxicity from cisplatin.
  • CT scans should be obtained after 2 cycles of therapy to assess response before chemotherapy is continued.
  • Serum LDH, if elevated before start of therapy, is a good marker for response and should be monitored.

Deterrence/Prevention

Smoking cessation: Since tobacco smoking is the predominant cause of lung cancer, the only means of decreasing the incidence is decreasing the prevalence of smoking. The evidence is clear that the incidence of lung cancer is decreasing in men in the United States, and this decrease has coincided with a decrease in smoking among males. Concerted efforts are required from government, public health agencies, and health care providers to increase public awareness of the hazards of smoking, devise tougher laws to restrict teen smoking, and restrict smoking in public places.

Complications

  • Tumor lysis syndrome: Tumor lysis can occur rapidly in patients with small cell lung cancer on institution of chemotherapy, especially in extensive-stage disease. The laboratory features of tumor lysis syndrome (TLS) are hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia. Patients should be well hydrated and, preferably, premedicated with allopurinol. The management of established tumor lysis syndrome is urinary alkalinization, correction of electrolyte abnormalities, and dialysis, if necessary.
  • Spinal cord compression: A thorough neurologic examination and radiologic evaluation of the spine is indicated with any suspicion of spinal cord compression. The goal is to prevent development of neurological deficit.
  • Hyponatremia results from inappropriate secretion of ADH, which results in the inability of the kidneys to excrete free water. SIADH is reported in 5-10% of patients with small cell lung cancer. Serum sodium is usually less than 130 mEq/L. Other causes of hyponatremia (ie, volume depletion, abnormal renal function) must be excluded. Fluid restriction and pharmacologic therapy in the form of demeclocycline (a tetracycline antibiotic that decreases the sensitivity of renal tubules to the action of ADH) are usual forms of management.

Patient Education

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education articles Lung Cancer and Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Delay in diagnosis and treatment: 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.
  • Effects of therapy: Small cell lung cancers may respond very quickly to chemotherapy, which carries a risk of rapid tumor lysis, especially in extensive-stage disease, with associated life-threatening electrolyte abnormalities and risk of renal shutdown. Therefore, treating physicians must remember this potential adverse effect, and patients should be hydrated adequately and, preferably, premedicated with allopurinol.
  • Spinal cord compression: New onset of back pain in patients known to have malignant disease should raise the suspicion of cord compression. A thorough neurologic examination and radiologic evaluation of the spine is indicated with any suspicion of spinal cord compression. The goal is to prevent development of neurological deficit. Once present, a neurological deficit can progress within hours to cause complete paraplegia. Any delay in instituting appropriate therapy may result in permanent neurological deficit.
  • Electrolyte abnormalities: Small cell lung cancer is associated with a number of electrolyte abnormalities because of frequent production of peptide hormones. The most common abnormality is hyponatremia, and, if severe, it may cause neurological symptoms and signs, including seizures, coma, and death. Prompt recognition of abnormality and severity is important. Management has been discussed already.
 


More on Lung Cancer, Oat Cell (Small Cell)

Overview: Lung Cancer, Oat Cell (Small Cell)
Differential Diagnoses & Workup: Lung Cancer, Oat Cell (Small Cell)
Treatment & Medication: Lung Cancer, Oat Cell (Small Cell)
Follow-up: Lung Cancer, Oat Cell (Small Cell)
References
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Further Reading

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Keywords

small cell lung cancer, SCLC, non–small-cell lung cancers, NSCLCs, lung cancer treatment, lung cancer diagnosis, lung cancer symptoms, small cell carcinoma, SCC, oat cell carcinoma, paraneoplastic syndromes, tumor suppressor genes

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
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: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Medical Editor

Antoni Ribas, MD, Department of Medicine, Division of Hematology-Oncology, Assistant Professor of Medicine, University of California at Los Angeles Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, 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; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
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