History

Fact Explanation
Asymptomatic Minority of patients can be asymptomatic especially in early stages. [3]
Risk factors for the development of lung carcinoma Smoking, occupational exposure to asbestos, radon, arsenic, chromium, nickel, vinyl chloride, and ionizing radiation are known risk factors. Presence of chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and tuberculosis also play a role in development of bronchial carcinoma. [3,8]
Cough and or hemoptysis Cough is the most common presenting complain and it is due to the irritation and obstruction of the airway due to the growing tumor. [1]
Bone pain and fractures Malignant metastasis in the bone result in bone pain and pathological fractures.
Nonspecific symptoms These include fatigue, anorexia, and weight loss. [3]
Superior vena cava obstruction Due to compression of the superior vena cava. Patients present with shortness of breath, swelling of the face and or arm and distended veins in the upper chest and arms. [7,9]
Recurrent laryngeal nerve paralysis Due to compression by the tumor or displaced structures, direct infiltration of the recurrent laryngeal nerve. Nerve infiltration results in hoarseness of voice. [6]
Symptoms due to phrenic nerve paralysis [5] Tumor invasion of the phrenic nerve causes nerve paralysis. Most patients are asymptomatic at rest, dyspnea on exertion and decreased exercise tolerance can be the presenting complains.
Dysphagia and odynophagia [3] Compression of the esophagus due to the expanding tumor produces dysphagia. Pericardial infiltration and effusion may also contribute to dysphagia.
Stridor Due to bronchial obstruction. [1]
Symptoms of brain secondary Patients present with confusion, seizures, personality change, early morning nausea and vomiting which is relieved by vomiting.
Symptoms of paraneoplastic syndrome [3] Paraneoplastic syndrome occurs in small cell carcinoma. Hypercalcemia [13], syndrome of inappropriate antidiuretic hormone, Cushing's syndrome (ectopic ACTH production), finger clubbing, hypertrophic pulmonary osteoarthropathy, Eaton-Lambert myasthenic syndrome, subacute cerebellar degeneration, subacute sensory neuropathy and limbic encephalitis [11,12] (cognitive dysfunction, memory impairment, seizures and psychiatric symptoms are common presenting complains) can manifest in paraneoplastic syndrome. [3]
Symptoms of lower respiratory tract infection Pneumonia results due to obstruction of the air way due to the tumor. Patients complain of fever, chest pain, cough and shortness of breath. [10]
Breathlessness [2] Airway obstruction and associated pleural effusion may result in breathlessness. [3]
Chest discomfort or pain Chest discomfort is due to direct pressure effects of the tumor. [3] Infiltration of the intercostal nerves and the parietal pleura cause chest pain.
Horner’s syndrome (Pancoast's tumor) [3,4] Compression of the cervical sympathetic trunk produces Horner’s syndrome. Patients present with referred pain over the scapula, weak and atrophic hand muscles.
Palpable lymphadenopathy [14] Due to metastatic deposits. Small cell lung carcinoma is known to grow rapidly and metastasize in to the lymph nodes early in the illness.
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. CONGLETON J, MUERS M.F. The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy. Respir Med. [online] 1995 Apr;89(4):291-6. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7597269
  3. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  4. VELTEN IM, GUSEK-SCHNEIDER GC, TOMANDL B. Diplopia as first symptom of a bronchogenic carcinoma. Klin Monbl Augenheilkd [online] 2000 Jul;217(1):52-4. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10949817
  5. JAMAL AKHTAR, MOHAMMED AZFAR SIDDIQUI,NAFEES AHMAD KHAN,MD ARIF ALAM. Right Phrenic Nerve Palsy: A Rare Presentation of Thoracic Aortic Aneurysm. Malays J Med Sci. [online] Jul 2013; 20(4): 98–101. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773361/
  6. HARO E. M, SEBASTIÁN Q. F.,RUBIO G. M. Vocal Cord Paralysis and Staging Bronchogenic Carcinoma. Arch Bronconeumol. [online] 2004;40 (7):333-4. [viewed 30 April 2014] Available from: DOI: 10.1016/S1579-2129(06)60313-3
  7. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  8. KAN YONEMORI, HIDEO KUNITOH, IKUO SEKINE. Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker. Nature Clinical Practice Oncology. [online] 2006: 3, 399-403. [viewed 30 April 2014] Available from: doi:10.1038/ncponc0534
  9. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  10. AKINOSOGLOU KS, KARKOULIAS K, MARANGOS M. Infectious complications in patients with lung cancer. Eur Rev Med Pharmacol Sci. [online] 2013 Jan;17(1):8-18. [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23329518
  11. KYOICHI KAIRA, TAKASHI OKAMURA, HIROKI TAKAHASHI, NORIO HORIGUCHI, NORIAKI SUNAGA, TAKESHI HISADA, MASANOBU YAMADA. Small-cell lung cancer with voltage-gated calcium channel antibody-positive paraneoplastic limbic encephalitis: a case report. Journal of Medical Case Reports [online] 2014, 8:119. [viewed 4 May 2014] Available from: doi:10.1186/1752-1947-8-119
  12. ALAMOWITCH S, GRAUS F, UCHUYA M, REÑÉ R, BESCANSA E, DELATTRE JY: Limbic encephalitis and small cell lung cancer clinical and immunological features. Brain [online] 1997, 120:923-928. [viewed 4 May 2014] Available from: doi: 10.1093/brain/120.6.923
  13. JESSICA TANA, ALEJANDRO CALVO. Small Cell Lung Cancer (SCLC) Presenting as Acute Pancreatitis: The Role of Hypercalcemia. World Journal of Oncology. [online] February 2012: 3 (1) 42-44. [viewed 4 May 2014] Available from: doi:10.4021/wjon266w
  14. DAVID G. P., DAVID H. J., CHRISTOPHER G. A., WILLIAM S., THOMAS J. S. at al. American Society of Clinical Oncology Treatment of Unresectable Non–Small-Cell Lung Cancer Guideline: Update 2003. JCO January 15, 2004: [online] 22 (2) 330-353. [viewed 7 May 2014] Available from: doi: 10.1200/JCO.2004.09.053

Examination

Fact Explanation
Fever [8] Patients can be febrile due to concurrent infection.
Examination of the respiratory system Wheezing in a localized area is due to bronchial obstruction. [1] Centrally located tumors can cause lung collapse resulting absent breath sounds over the affected side. Peripheral tumors cause segmental collapse. This results in dull percussion note and diminished breath sounds in the affected area. Malignant pleural effusions produce reduced chest expansion, stony dull percussion note, and absent breath sounds over the affected segment. [4]
Palpable lymph nodes Metastatic deposits to the lymph nodes. [6]
Signs of Horner’s syndrome [2,3] Patients will have ptosis, miosis, anhidrosis, and enophthalmos.
Signs of superior vena cava obstruction [5,7] These include distended neck and facial veins and positive Pemberton's sign.
Signs of increased intracranial pressure Examination of the optic fundus will show papilledema. Focal neurological signs can present in some.
Signs of pericardial effusion Malignant pericardial effusion produces muffled heart sounds. Some patients have distended jugular veins. [9]
Cachexia [8] In advanced disease sever loss of appetite results in significant loss of weight.
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. VELTEN IM, GUSEK-SCHNEIDER GC, TOMANDL B. Diplopia as first symptom of a bronchogenic carcinoma. Klin Monbl Augenheilkd [online] 2000 Jul;217(1):52-4. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10949817
  4. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  5. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  6. KAN YONEMORI, HIDEO KUNITOH, IKUO SEKINE. Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker. Nature Clinical Practice Oncology. [online] 2006: 3, 399-403. [viewed 30 April 2014] Available from: doi:10.1038/ncponc0534
  7. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  8. RASSAM J W, ANDERSON G. Incidence of paramalignant disorders in bronchogenic carcinoma. Thorax. [online] Feb 1975; 30(1): 86–90. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC470249/
  9. WILLIAM C. LITTLE, GREGORY L. FREEMAN. Pericardial Disease. Circulation. [online]2006; 113: 1622-1632. [viewed 4 May 2014] Available from: doi: 10.1161/CIRCULATIONAHA.105.561514

Differential Diagnoses

Fact Explanation
Lower respiratory tract infection Aspiration Pneumonia, bacterial or viral pneumonia are differential diagnoses of bronchial carcinoma.
Benign lung tumors PET scan and histological examination will help in differentiating the two. [2]
Non-small cell lung carcinoma Patients with small cell carcinoma have relatively short history when compared to non-small cell carcinoma. There can be evidence of metastasis at presentation in small cell carcinoma. Histology and immunohistochemical studies will confirm the diagnosis. [5]
Bronchitis Causes hemoptysis due to mucosal inflammation, edema and rupture of superficial blood vessels. [1]
Pleural effusion Parapneumonic effusion, tuberculosis, Hydatid disease, connective tissue and autoimmune disease, chylothorax, empyema and mesothelioma are other causes of pleural effusion. Pleural fluid analysis helps in differentiation. [3]
Superior vena cava (SVC) syndrome Other than bronchial carcinoma breast and mediastinal neoplasms can cause SVC syndrome. Thrombosis of the SVC may also result inSVC syndrome. [4]
Tuberculosis Patients present with cough, hemoptysis loss of appetite and loss of weight.
References
  1. JACOB L. B., ROBERT W. P. Hemoptysis: Diagnosis and Management. Am Fam Physician. [online] 2005 Oct 1;72(7):1253-1260. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2005/1001/p1253.html
  2. TIRA BUNYAVIROCH, EDWARD COLEMAN. PET Evaluation of Lung Cancer. J Nucl Med [online] March 2006: 47 (3) 451-469. [viewed 30 April 2014] Available from: http://jnm.snmjournals.org/content/47/3/451.full
  3. NAJIB M. R., STEPHEN J. C., ROBERT J. O. D. Pleural effusion: a structured approach to care. Br Med Bull [online] 2004: 72 (1): 31-47. [viewed 30 April 2014] Available from: doi: 10.1093/bmb/ldh040
  4. RONNY COHEN, DERRICK MENA, ROGER CARBAJAL-MENDOZA, NINON MATOS, NISHU KARKI. Superior vena cava syndrome: A medical emergency? Int J Angiol. [online] 2008 Spring; 17(1): 43–46. [viewed 1 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728369/
  5. VAN MEERBEECK JP, FENNELL DA, DE RUYSSCHER DK. Small-cell lung cancer. Lancet. [online] 2011 Nov 12;378(9804):1741-55. [viewed 4 May 2014] Available from: doi: 10.1016/S0140-6736(11)60165-7.

Investigations - for Diagnosis

Fact Explanation
Chest X-ray Localized emphysema is an early sign. [1] Also shows malignant pleural effusions of more than 500ml. [3,5]
CT scan [3,5] Enable visualizing the primary rumor and distant metastasis.
PET scanning [3] As the CT, PET scan visualizes the tumor and distant metastasis.
Bronchoscopy Visualizes the lesion. Biopsy specimen can be obtained by bronchial washings and brushings for confirmation of the diagnosis. [1,2]
Exploratory thoracotomy Not routinely done. [1]
Pleural fluid full report A blood stained, exudate (pleural fluid protein is more than 30g/l), with pH less than 7.3 (due to increased lactic acid levels) is suggestive of a malignancy. Pleural fluid is rich in lymphocytes and malignant cells. [4] Pleural fluid amylase levels are elevated in adenocarcinoma. [3]
Histology This will provide the definitive diagnosis.
Video-assisted thoracoscopy [2] Aids in visualization of the tumor and biopsy specimens can be obtained.
Sputum cytology Enables detection of malignant cells. [2]
References
  1. ROBERT R. S. Early Detection of Bronchogenic Carcinoma. Chest. [online] 1950;18(3):185-197. [viewed 30 April 2014] Available from: doi:10.1378/chest.18.3.185
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  4. NAJIB M. R., STEPHEN J. C., ROBERT J. O. D. Pleural effusion: a structured approach to care. Br Med Bull [online] 2004: 72 (1): 31-47. [viewed 30 April 2014] Available from: doi: 10.1093/bmb/ldh040
  5. SORENSEN M, FELIP E. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol [online] 2009: 20 (4). [viewed 30 April 2014] Available from: doi: 10.1093/annonc/mdp133

Investigations - Fitness for Management

Fact Explanation
Lung function test [1,3] If the forced expiratory volume in first second (FEV1) or carbon monoxide diffusion in the lung (DLCO) is less than 80% of the predicted, postresection pulmonary reserve should be estimated with ventilation-perfusion scan should be estimated to plan the definitive management. [2]
Complete blood count [2,3] Bone marrow infiltration can cause pancytopenia. Poor appetite may have led to iron deficiency anemia.
Serum electrolytes[2,3] Assesses the renal function.
Serum calcium [2] Paraneoplastic syndrome may cause hypercalcemia.
Liver function test This includes the assessment of hepatic transaminases and alkaline phosphatase levels. Some drugs are metabolized in the liver and liver function may be deranged in the presence of metastasis. [2,3]
References
  1. CONGLETON J, MUERS M.F. The incidence of airflow obstruction in bronchial carcinoma, its relation to breathlessness, and response to bronchodilator therapy. Respir Med. [online] 1995 Apr;89(4):291-6. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/7597269
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. SORENSEN M, FELIP E. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol [online] 2009: 20 (4). [viewed 30 April 2014] Available from: doi: 10.1093/annonc/mdp133

Investigations - Followup

Fact Explanation
Chest X-ray Even after successful treatment bronchial carcinoma may recur. Patients should be followed up for at least for two years. [1]
References
  1. CHRISTOPHE DODDOLI, PASCAL THOMAS, OLIVIER GHEZ, ROGER GIUDICELLI, PIERRE FUENTES. Surgical management of metachronous bronchial carcinoma. Eur J Cardiothorac Surg [online] 2001: 19(6): 899-903. [viewed 30 April 2014] Available from: doi: 10.1016/S1010-7940(01)00690-X

Investigations - Screening/Staging

Fact Explanation
Full blood count Pancytopenia may suggest bone marrow infiltration by the tumor. [8]
Renal function test [7,9] Hyponatremia can occur due to syndrome of inappropriate anti-diuretic hormone secretion. It should be corrected prior to surgery. [7]
Liver function test [9] Liver function is deranged in metastatic disease.
Computerized tomography (CT) Tumor size can be estimated. CT is helpful in detecting local invasion of the tumor and lymph node metastasis. Can detect small pleural effusions that are not detectable from a chest X-ray. [1] Low dose CT is the investigation of choice for screening of lung cancer. Current smokers or people who have quit smoking with in past 15 years who are in the age group of 55 to 74 years should be screened. [4]
PET scanning [3] Findings are similar to CT. imaging studies aid in staging the disease. Small cell lung carcinoma is broadly divided in to either limited (T1-4, N0-3, M0) or extensive disease. In extensive disease tumor metastases involve the ipsilateral lung, distant organs and malignant pleural or pericardial effusion. [6]
Diagnostic thoracentesis [1] Pleural fluid is obtained for the assessment of cell counts, total protein, lactate dehydrogenase, glucose, pH, amylase, and cytology.
Pleural Biopsy Detects pleural deposits. [1]
Pericardial fluid aspiration This enables the confirmation of malignant pleural effusion. [5]
Bone scan [3] Evaluates bone metastasis. Especially useful in small cell carcinoma because it usually presents with metastatic disease.
MRI of the head Visualizes cerebral metastasis. [3]
References
  1. Management of Malignant Pleural Effusions. American Journal of Respiratory and Critical Care Medicine. [online] 2000: 162 (5). 1987-2001. [viewed 30 April 2014] Available from: doi: 10.1164/ajrccm.162.5.ats8-00
  2. HARO E. M, SEBASTIÁN Q. F.,RUBIO G. M. Vocal Cord Paralysis and Staging Bronchogenic Carcinoma. Arch Bronconeumol. [online] 2004;40 (7):333-4. [viewed 30 April 2014] Available from: DOI: 10.1016/S1579-2129(06)60313-3
  3. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  4. Screening for lung cancer. U.S. Preventive Services Task Force Recommendation Statement [online] [viewed 3 May 2014] Available from: http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm
  5. JAUME SAGRISTÀ-SAULEDA, AXEL SARRIAS MERCÉ, JORDI SOLER-SOLER. Diagnosis and management of pericardial effusion. World J Cardiol. [online] May 26, 2011; 3(5): 135–143. [viewed 4 May 2014] Available from: doi: 10.4330/wjc.v3.i5.135
  6. SORENSEN M, FELIP E. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol [online] 2009: 20 (4). [viewed 30 April 2014] Available from: doi: 10.1093/annonc/mdp133
  7. ADEDAYO A. O., EBENEZER K., SUHAIL A. R. Tumor-Related Hyponatremia. Clin Med Res. [online] Dec 2007; 5(4): 228–237. [viewed 7 May 2014] Available from: doi: 10.3121/cmr.2007.762
  8. VENKATA S.S.A,. ULLAS B., LOKNATH D., HEMANT K.D., MADHUMATI M. ANUPAMA G. A Case of Carcinoma Lung Presenting as Pancytopenia. Austral - Asian Journal of Cancer [online] July 2006: 5 (3), [viewed 7 May 2014] Available from: file:///C:/Users/HP/Downloads/A%20Case%20of%20Carcinoma%20Lung%20Presenting%20as%20Pancytopenia.pdf
  9. RAVI T., VANITA N., KUMAR P. Stage IV lung cancer: Is cure possible? Indian J Med Paediatr Oncol. [online] 2013 Apr-Jun; 34(2): 121–125. [viewed 7 May 2014] Available from: doi: 10.4103/0971-5851.116207

Management - General Measures

Fact Explanation
Cessation of smoking Smoking is a main causative factor for the development of lung carcinoma. [3] Counseling and nicotine replacement therapy whenever necessary will be helpful. [2]
Management of malignant pleural effusions Therapeutic thoracentesis and fluid aspiration will provide symptomatic relief. Chemical pleurodesis will prevent the recurrences. [4]
Management of superior vena cava obstruction Stent placement or balloon dilatation can establish the patency of the vein. [1]
Management of malignant pericardial effusion Pericardiocentesis is done if the patient is in hemodynamic compromise. [5]
Treatment of respiratory tract infection Lower respiratory tract infection is a common complication either due to tracheal obstruction and aspiration due to the tumor or secondary to immune suppression due to treatment. [6]
Management of hypercalcemia Intravenous fluids, loop diuretics and bisphosphonates are used in the treatment. [7]
References
  1. STOCK K. W., JACOB A. L., PROSKE M., BOLLIGER C. T., ROCHLITZ C., STEINBRICH W. Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent. Thorax. [online] Nov 1995; 50(11): 1151–1156. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475086/
  2. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  3. DOLL R, PETO R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health. [online] 1978 Dec;32(4):303-13. [viewed 30 April 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/744822
  4. KONSTANTINOS ZAROGOULIDIS, PAUL ZAROGOULIDIS, KAID DARWICHE, KOSMAS TSAKIRIDIS, NIKOLAOS MACHAIRIOTIS at al. Malignant pleural effusion and algorithm management. Journal of Thoracic Disease [online] 2013: 5 (4) [viewed 30 April 2014] Available from: doi: 10.3978/j.issn.2072-1439.2013.09.04
  5. JAUME SAGRISTÀ-SAULEDA, AXEL SARRIAS MERCÉ, JORDI SOLER-SOLER. Diagnosis and management of pericardial effusion. World J Cardiol. [online] May 26, 2011; 3(5): 135–143. [viewed 4 May 2014] Available from: doi: 10.4330/wjc.v3.i5.135
  6. AKINOSOGLOU KS, KARKOULIAS K, MARANGOS M. Infectious complications in patients with lung cancer. Eur Rev Med Pharmacol Sci. [online] 2013 Jan;17(1):8-18. [viewed 4 May 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23329518
  7. JESSICA TANA, ALEJANDRO CALVO. Small Cell Lung Cancer (SCLC) Presenting as Acute Pancreatitis: The Role of Hypercalcemia. World Journal of Oncology. [online] February 2012: 3 (1) 42-44. [viewed 4 May 2014] Available from: doi:10.4021/wjon266w

Management - Specific Treatments

Fact Explanation
Surgical resection of the tumor (lobectomy and pneumonectomy) Patients with early limited disease benefit from surgical excision of the primary tumor.
Chemotherapy Combinations of chemotherapeutic agents are used in chemotherapy. For limited disease etoposide/platinum and etoposide/cisplatin combinations are used. Extensive disease is treated with cisplatin or carboplatin in combination with etoposide. Chemotherapy after the surgical resection improves survival. [3] Prognosis of extensive disease is considered very poor. (median survival of 10 months and a 2-year survival rate of 10%) [4]
Radiotherapy Useful to control the primary tumor and skeletal metastasis. [1,2] Often chemoradiation therapy is used in treatment. Prophylactic cranial irradiation is given for patients with limited disease to prevent the occurrence of intracranial metastasis. It is proven to improve the survival.
Surgical resection of the metastasis Resectable brain metastasis can be surgically removed in stage IIIB and IV. This is combined with removal of the T1 primary tumor. [1]
Molecular targeted therapy There are identified genetic mutations in small cell lung carcinoma. These mutations cause unregulated cellular proliferation and disease can recur even after successful chemoradiotherapy. Molecular targeted therapy has proven value in treatment of small cell lung carcinoma. [2]
References
  1. LAUREN G. C., CHRISTOPHER H., ROBERT P., ROBERT E. E. Lung Cancer: Diagnosis and Management. Am Fam Physician [online] 2007 Jan 1;75(1):56-63. [viewed 30 April 2014] Available from: http://www.aafp.org/afp/2007/0101/p56.html
  2. AIDALENA Z. ABIDIN, MARINA C. GARASSINO, FIONA BLACKHALL. Targeted therapies in small cell lung cancer: a review. Ther Adv Med Oncol. [online] Jan 2010; 2(1): 25–37. [viewed 30 April 2014] Available from: doi: 10.1177/1758834009356014
  3. SORENSEN M, FELIP E. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol [online] 2009: 20 (4). [viewed 30 April 2014] Available from: doi: 10.1093/annonc/mdp133
  4. SORENSEN M, PIJLS-JOHANNESMA M, FELIP E. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol [online] 2010: 21 (5) 120-125. [viewed 30 April 2014] Available from: doi: 10.1093/annonc/mdq172