Small-cell carcinoma

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Small-cell carcinoma
Classification and external resources
Small cell lung cancer - cytology.jpg
ICD-O: M8041/3
MedlinePlus 000122
eMedicine med/1336
MeSH D018288

Small-cell carcinoma (also known as "small-cell lung cancer", or "oat-cell carcinoma") is a type of highly malignant cancer that most commonly arises within the lung,[1] although it can occasionally arise in other body sites, such as the cervix,[2] prostate,[3] and gastrointestinal tract.




Paraneoplastic syndromes[edit]






It is thought to originate from neuroendocrine cells (APUD cells) in the bronchus called Feyrter cells (named for Friedrich Feyrter).[6] Hence, they express a variety of neuroendocrine markers, and may lead to ectopic production of hormones like ADH and ACTH that may result in paraneoplastic syndromes and Cushing's syndrome.[7] Approximately half of all individuals diagnosed with Lambert-Eaton myasthenic syndrome (LEMS) will eventually be found to have a small-cell carcinoma of the lung.[5]

Small-cell carcinoma is most often more rapidly and widely metastatic than non-small cell lung carcinoma[8] (and hence staged differently). There is usually early involvement of the hilar and mediastinal lymph nodes. [7]


Small-cell lung carcinoma can occur in combination with a wide variety of other histological variants of lung cancer,[9] including extremely complex malignant tissue admixtures.[10] .[11] When it is found with one or more differentiated forms of lung cancer, such as squamous cell carcinoma or adenocarcinoma, the malignant tumor is then diagnosed and classified as a combined small cell lung carcinoma (c-SCLC).[9] C-SCLC is the only currently recognized subtype of SCLC.[9]


Smoking is a significant etiological factor.


Extrapulmonary small-cell carcinoma[edit]

Very rarely, the primary site for small-cell carcinoma is outside of the lungs and pleural space, it is referred to as extrapulmonary small-cell carcinoma (EPSCC). Outside of the respiratory tract, small cell carcinoma can appear in the cervix, prostate, liver, pancreas, gastrointestinal tract, or bladder.[12] It is estimated to account for 1,000 new cases a year in the U.S. Histologically similar to small-cell lung cancer, therapies for small-cell lung cancer are usually used to treat EPSCC.[13] First line treatment is usually with cisplatin and etoposide. In Japan, the first line treatment is shifting to irinotecan and cisplatin.

When the primary site is in the skin, it is referred to as Merkel cell carcinoma.

Small-cell carcinoma of the prostate[edit]


It can metastasize to the brain.[15]



In cases of LS-SCLC, combination chemotherapy (often including cyclophosphamide, cisplatinum, doxorubicin, etoposide, vincristine and/or paclitaxel) is administered together with concurrent chest radiotherapy (RT).


Exceptionally high objective initial response rates (RR) of between 60% and 90% are seen in LS-SCLC using chemotherapy alone, with between 45% and 75% of individuals showing a "complete response" (CR), which is defined as the disappearance of all radiological and clinical signs of tumor. Unfortunately, relapse is the rule, and median survival is only 18 to 24 months.

Because SCLC usually metastasizes widely very early on in the natural history of the tumor, and because nearly all cases respond dramatically to CT and/or RT, there has been little role for surgery in this disease since the 1970s.[17] However, recent work suggests that in cases of small, asymptomatic, node-negative SCLC's ("very limited stage"), surgical excision may improve survival when used prior to chemotherapy.("adjuvant chemotherapy").[18]

In ES-SCLC, combination chemotherapy is the standard of care, with radiotherapy added only to palliate symptoms such as dyspnea, pain from liver or bone metastases, or for treatment of brain metastases, which, in small-cell lung carcinoma, typically have a rapid, if temporary, response to whole brain radiotherapy.








See also[edit]


  2. ^ Nasu K, Hirakawa T, Okamoto M, et al. (2011). "Advanced small cell carcinoma of the uterine cervix treated by neoadjuvant chemotherapy with irinotecan and cisplatin followed by radical surgery". Rare Tumors 3 (1): e6. doi:10.4081/rt.2011.e6. PMC 3070456. PMID 21464879. 
  3. ^ Capizzello A, Peponi E, Simou N, et al. (2011). "Pure small cell carcinoma of the prostate: a case report and literature review". Case Rep Oncol 4 (1): 88–95. doi:10.1159/000324717. PMC 3072185. PMID 21475596. 
  4. ^ Leslie M (November 2011). "Mysteries of the cell. How does a cell know its size?". Science 334 (6059): 1047–8. doi:10.1126/science.334.6059.1047. PMID 22116854. 
  6. ^ Champaneria MC, Modlin IM, Kidd M, Eick GN (2006). "Friedrich Feyrter: a precise intellect in a diffuse system". Neuroendocrinology 83 (5-6): 394–404. doi:10.1159/000096050. PMID 17028417. 
  11. ^ Gotoh M, Yamamoto Y, Huang CL, Yokomise H (November 2004). "A combined small cell carcinoma of the lung containing three components: small cell, spindle cell and squamous cell carcinoma". Eur J Cardiothorac Surg 26 (5): 1047–9. doi:10.1016/j.ejcts.2004.08.002. PMID 15519208. 
  12. ^ Ismaili N (November 2011). "A rare bladder cancer – small cell carcinoma: review and update". Orphanet Journal of Rare Diseases 6 (75). doi:10.1186/1750-1172-6-75. PMC 3253713. PMID 22078012. 
  13. ^ Extrapulmonary Small Cell Carcinoma at eMedicine
  15. ^ Erasmus CE, Verhagen WI, Wauters CA, van Lindert EJ (November 2002). "Brain metastasis from prostate small-cell carcinoma: not to be neglected". Can J Neurol Sci 29 (4): 375–7. PMID 12463494. 
  16. ^ Argiris A, Murren JR (2001). "Staging and clinical prognostic factors for small-cell lung cancer". Cancer J 7 (5): 437–47. PMID 11693903. 
  18. ^ Shepherd FA (February 2010). "Surgery for limited stage small cell lung cancer: time to fish or cut bait". J Thorac Oncol 5 (2): 147–9. doi:10.1097/JTO.0b013e3181c8cbf5. PMID 20101141. 


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