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Chapter 085. Neoplasms of the Lung (Part 8)

Small Cell Lung Cancer A simple two-stage system is used. In this system, limited-stage disease (seen in about 30% of all patients with SCLC) is defined as disease confined to one hemithorax and regional lymph nodes (including mediastinal, contralateral hilar, and usually ipsilateral supraclavicular nodes), while extensive-stage disease (seen in about 70% of patients) is defined as disease exceeding those boundaries. Clinical studies such as physical examination, x-rays, CT and bone scans, and bone marrow examination are used in staging. In part, the definition of limitedstage disease relates to whether the known tumor can be encompassed within a tolerable radiation. | Chapter 085. Neoplasms of the Lung Part 8 Small Cell Lung Cancer A simple two-stage system is used. In this system limited-stage disease seen in about 30 of all patients with SCLC is defined as disease confined to one hemithorax and regional lymph nodes including mediastinal contralateral hilar and usually ipsilateral supraclavicular nodes while extensive-stage disease seen in about 70 of patients is defined as disease exceeding those boundaries. Clinical studies such as physical examination x-rays CT and bone scans and bone marrow examination are used in staging. In part the definition of limitedstage disease relates to whether the known tumor can be encompassed within a tolerable radiation therapy port. Thus contralateral supraclavicular nodes recurrent laryngeal nerve involvement and superior vena caval obstruction can all be part of limited-stage disease. However cardiac tamponade malignant pleural effusion and bilateral pulmonary parenchymal involvement generally qualify disease as extensive-stage because the organs within a curative radiation therapy port cannot safely tolerate curative radiation doses. Lung Cancer Staging Procedures Table 85-3 All patients with lung cancer should have a complete history and physical examination with evaluation of all other medical problems determination of performance status and history of weight loss and a CT scan of the chest and abdomen with contrast. Positron emission tomography PET scans are sensitive in detecting both intrathoracic and metastatic disease. PET is useful in assessing the mediastinum and solitary pulmonary nodules. A standardized uptake value SUV of 2.5 is highly suspicious for malignancy. False negatives can be seen in diabetes in slow-growing tumors such as BAC in concurrent infection such as tuberculosis and in lesions 8 mm. False positives can also be seen in infections and granulomatous disease. Thus PET should never be used alone to diagnose lung cancer mediastinal involvement or metastases. Instead