SMALL CELL LUNG CANCER

Combined Small Cell Lung Carcinoma; Mixed Small Cell/Large Cell Lung Carcinoma; Oat Cell Lung Cancer; Small Cell Lung Carcinoma

There are two types of lung cancers: Small cell and non small cell. Small cell lung cancer is an aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. Small cell lung cancer looks small and oval-shaped under a microscope.

Risk factors for small cell lung cancer include: smoking cigarettes, cigars or pipes, now or in the past, exposure to second-hand smoke and exposure to asbestos, or radon.

Diagnostic testing: The diagnosis of small cell lung cancer is confirmed by a pathologist using laboratory studies obtained by bronchoscopy or a computed tomography (CT)-guided procedure (fine-needle biopsy). Specimens (stains) for chromogranin, neuron-specific enolase and synaptophysin are usually positive. Staging of the cancer is performed by imaging studies (CT scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans). These studies provide the information needed for staging at diagnosis, response to treatment, resectionability, and metastases.

Physical findings:

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  Persistent cough;

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  Wheezing;

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  Hoarseness;

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  Hemoptysis (expectoration of blood or of blood-stained sputum);

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  Dyspnea (shortness of breath);

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  Chest pain;

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  Fatigue;

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  Decreased appetite; and

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  Weight loss.

ICD-9: 162.9

ICD-10: C34.90

Although this disease is very responsive to chemotherapy, the overall survival rate is poor. Of those diagnosed with extensive small cell lung cancer (most patients) the 2 year survival rate is < 2%.

Management of limited stage small cell lung cancer involves a combination of chemotherapy and thoracic radiation therapies. Treatment can involve either a single modality or a series of multiple modalities. If a complete remission is obtained, prophylactic cranial radiation is offered. At this level of treatment, the disease is potentially curable. However, most individuals are diagnosed with extensive disease and are generally considered incurable but may achieve remission with the use of a combination chemotherapy regimen.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation: A pathology report of a lung biopsy.

Suggested Listings for Evaluation:

REMARKS

Small cell lung cancer currently meets the criteria in listing 13.14.