Extrapulmonary Small Cell Carcinoma Workup

  • Author: Irfan Maghfoor, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Feb 28, 2012
 

Laboratory Studies

No laboratory investigations aid in the diagnosis of extrapulmonary small cell carcinoma. Most of the laboratory studies done in the workup are to assess end organ function prior to instituting therapy, especially chemotherapy, or to diagnose a suspected paraneoplastic syndrome.

  • Complete blood count with differential is obtained to assess bone marrow reserve, but it may give clues to bone marrow infiltration by the tumor. Bone marrow infiltration is suspected based on a leukoerythroblastic (presence of red and white blood cell precursors in peripheral blood) picture of peripheral blood.
  • Blood urea nitrogen and serum creatinine and electrolytes are obtained to asses renal function prior to instituting potentially nephrotoxic drugs as well as estimate renal clearance of chemotherapeutic agents. In addition, low sodium and abnormalities in other electrolytes such as potassium may point towards presence of a paraneoplastic syndrome.
  • Serum bilirubin and transaminases are obtained to assess liver function and for appropriate dosing of hepatically cleared chemotherapeutic agents.
  • Serum calcium is assessed for suspected hypercalcemia and bone metastases.
Next

Imaging Studies

The diagnosis of extrapulmonary small cell carcinoma by definition requires a chest radiograph, computed tomographic scan, or both without findings of chest involvement.

  • Chest radiograph is obtained to exclude pulmonary involvement.
  • CT scan of chest, abdomen, and pelvis is obtained to exclude pulmonary involvement and stage the extent of disease.
Previous
Next

Procedures

  • Bone marrow aspiration and biopsy are performed to confirm or rule out bone marrow involvement in case of peripheral blood abnormalities. Some authors recommend that bone marrow biopsy should be done in every patient to confirm limited disease.
  • Sputum cytology, bronchoscopy, or both are performed to exclude pulmonary origin of small cell carcinoma.
  • Special tests may be performed depending on primary site of origin:
    • Upper endoscopy: Esophagus
    • Direct laryngoscopy, bronchoscopy, and upper endoscopy: Origin in head and neck region
    • Cystoscopy: Urinary bladder
    • Lower endoscopy: Rectum and large bowel
    • Pelvic examination: Cervix and uterus
Previous
Next

Histologic Findings

Extrapulmonary small cell carcinoma histologically consists of sheets of uniform small round cells with scant cytoplasm, dense nuclei, and indistinct nucleoli.

Immunohistochemical stains with silver impregnated stains usually have positive results.

Previous
Next

Staging

There is no American Joint Committee on Cancer (AJCC) staging classification for extrapulmonary small cell carcinoma. In the reported literature, extrapulmonary small cell carcinoma is universally staged similarly to small cell carcinoma of lung, that is limited stage and extensive stage.

  • Limited stage: Tumor is confined to organ of origin with or without regional lymph node involvement. Alternatively, limited stage has also been defined as that encompassed within one radiation port.
  • Extensive stage: Disease has spread to distant organs or beyond regional lymph nodes.
Previous
Proceed to Treatment & Management
 
 
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.

Specialty Editor Board

Robert C Shepard, MD, FACP  Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American College of Physician Executives, American College of Physicians, American Federation for Clinical Research, American Federation for Medical Research, American Medical Association, American Medical Informatics Association, American Society of Hematology, Association of Clinical Research Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts Medical Society, and Society for Biological Therapy

Disclosure: Nothing to disclose.

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

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, 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, 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

  1. Verset L, Arvanitakis M, Loi P, Closset J, Delhaye M, Remmelink M, et al. TTF-1 positive small cell cancers: Don't think they're always primary pulmonary!. World J Gastrointest Oncol. Oct 15 2011;3(10):144-7. [Medline]. [Full Text].

  2. Frazier SR, Kaplan PA, Loy TS. The pathology of extrapulmonary small cell carcinoma. Semin Oncol. Feb 2007;34(1):30-8. [Medline].

  3. Hueser CN, Nguyen NC, Osman M, Havlioglu N, Patel AJ. Extrapulmonary small cell sarcinoma: involvement of the brain without evidence of extracranial malignancy by serial PET/CT scans. World J Surg Oncol. Sep 25 2008;6:102. [Medline].

  4. O'Kane AM, O'Donnell ME, Shah R, Carey DP, Lee J. Small cell carcinoma of the appendix. World J Surg Oncol. Jan 15 2008;6:4. [Medline].

  5. Pryor JG, Simon RA, Bourne PA, Spaulding BO, Scott GA, Xu H. Merkel cell carcinoma expresses K homology domain-containing protein overexpressed in cancer similar to other high-grade neuroendocrine carcinomas. Hum Pathol. Oct 3 2008;[Medline].

  6. Grossman RA, Pedroso FE, Byrne MM, Koniaris LG, Misra S. Does surgery or radiation therapy impact survival for patients with extrapulmonary small cell cancers?. J Surg Oncol. Nov 1 2011;104(6):604-12. [Medline].

  7. Kim JH, Lee SH, Park J, et al. Extrapulmonary small-cell carcinoma: a single-institution experience. Jpn J Clin Oncol. May 2004;34(5):250-4. [Medline].

  8. Grossman RA, Pedroso FE, Byrne MM, Koniaris LG, Misra S. Does surgery or radiation therapy impact survival for patients with extrapulmonary small cell cancers?. J Surg Oncol. Nov 1 2011;104(6):604-12. [Medline].

  9. Sengoz M, Abacioglu U, Salepci T, et al. Extrapulmonary small cell carcinoma: multimodality treatment results. Tumori. May-Jun 2003;89(3):274-7. [Medline].

  10. Briggs JC, Ibrahim NB. Oat cell carcinomas of the oesophagus: a clinico-pathological study of 23 cases. Histopathology. Mar 1983;7(2):261-77. [Medline].

  11. Casas F, Ferrer F, Farrus B, et al. Primary small cell carcinoma of the esophagus: a review of the literature with emphasis on therapy and prognosis. Cancer. Oct 15 1997;80(8):1366-72. [Medline].

  12. Galanis E, Frytak S, Lloyd RV. Extrapulmonary small cell carcinoma. Cancer. May 1 1997;79(9):1729-36. [Medline].

  13. Ibrahim NB, Briggs JC, Corbishley CM. Extrapulmonary oat cell carcinoma. Cancer. Oct 15 1984;54(8):1645-61. [Medline].

  14. Koss LG, Spiro RH, Hajdu S. Small cell (oat cell) carcinoma of minor salivary gland origin. Cancer. Sep 1972;30(3):737-41. [Medline].

  15. Levenson RM Jr, Ihde DC, Matthews MJ, et al. Small cell carcinoma presenting as an extrapulmonary neoplasm: sites of origin and response to chemotherapy. J Natl Cancer Inst. Sep 1981;67(3):607-12. [Medline].

  16. Lo Re G, Canzonieri V, Veronesi A, et al. Extrapulmonary small cell carcinoma: a single-institution experience and review of the literature. Ann Oncol. Dec 1994;5(10):909-13. [Medline].

  17. Lobins R, Floyd J. Small cell carcinoma of unknown primary. Semin Oncol. Feb 2007;34(1):39-42. [Medline].

  18. Paraf F, Serre I, Sarfati E, et al. [Neuroendocrine carcinoma of the esophagus]. Ann Chir. 1990;44(3):249-51. [Medline].

  19. Pearse AG. Common cytochemical and ultrastructural characteristics of cells producing polypeptide hormones (the APUD series) and their relevance to thyroid and ultimobranchial C cells and calcitonin. Proc R Soc Lond B Biol Sci. May 14 1968;170(18):71-80. [Medline].

  20. Remick SC, Ruckdeschel JC. Extrapulmonary and pulmonary small-cell carcinoma: tumor biology, therapy, and outcome. Med Pediatr Oncol. 1992;20(2):89-99. [Medline].

  21. Richardson RL, Weiland LH. Undifferentiated small cell carcinomas in extrapulmonary sites. Semin Oncol. Dec 1982;9(4):484-96. [Medline].

  22. Tanabe G, Kajisa T, Shimazu H, et al. Effective chemotherapy for small cell carcinoma of the esophagus. Cancer. Dec 1 1987;60(11):2613-6. [Medline].

  23. Van Der Gaast A, Verwey J, et al. Chemotherapy as treatment of choice in extrapulmonary undifferentiated small cell carcinomas. Cancer. Feb 1 1990;65(3):422-4. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.