Limited-stage small cell lung carcinoma (LS-SCLC) is a type of small-cell lung cancer (SCLC) that is confined to an area which is small enough to be encompassed within a radiation portal. This generally includes cancer to one side of the lung and those might have reached the lymph nodes on the same side of the lung. 33% patients with small cell lung cancer are diagnosed with limited-stage small cell lung carcinoma when it is first found. Common symptoms include but are not limited to persistent cough, chest pain, rust-coloured sputum, shortness of breath, fatigue, weight loss, wheezing, hoarseness and recurrent respiratory tract infections such as pneumonia and bronchitis. Nervous system problems, Cushing syndrome and SIADH (syndrome of inappropriate anti-diuretic hormone) can also be associated with small cell lung cancer. Unlike extensive-stage small cell lung cancer, limited-stage small cell lung carcinoma is potentially curable. Standard treatments consist of surgery, platinum-based combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation. Patient five-year survival rate has significantly increased from 1% with surgery to 26% after the application of combination chemotherapy.
Classification Small cell lung cancer is often treated as a systematic disease due to its tendency for early dissemination, thus, instead of the traditional TNM staging system, the Veterans' Administration Lung Study Group (VALSG) introduced a simplified 2-stage system in the 1950s to divide small cell lung cancer into limited stage and extensive stage. As a result of the change in policy from targeting all nodal stations by radiotherapy ports to target only obviously involved nodal stations, the definition of the limited disease varies. According to a broad medical consensus, limited-stage small cell lung carcinoma is generally considered to be encompassed within a radiation portal. Variability in categorising small-cell lung cancer as limited or extensive occurs with reference to the extent of pleural effusion and nodal stations involvement. In addition, patients with an ipsilateral pleural effusion are frequently excluded from the limited-disease category. In rare cases, patients with minimal pleural effusions are included in the limited-disease protocols; this includes those with demonstrated effusions only on chest CT, as well as those with blunting of the costophrenic angle on chest radiographs. In most cases, all patients demonstrated any positive sign of pleural effusion on any type of imaging tests are excluded. Likewise, ambiguities in the definition of limited disease also occurs in classification of the limited disease with reference to the extent of lymphadenopathy. For instance, patients with bilateral supraclavicular adenopathy are included in the limited-disease category in some cases, others include only those with ipsilateral adenopathy. Similarly, the presence of contralateral hilar adenopathy frequently, though not uniformly, includes patients in the limited-disease category. The traditional TNM classification system is preferred over the 2-stage system when surgery is the recommended treatment option.
Signs and symptoms Similar to other lung cancers, according to the American Cancer Society, the most common symptoms of limited-stage of lung cancer are:
Progressive and persistent cough Coughing up blood or rust-coloured sputum Shortness of breath Chest pain that is often worse with deep breathing, coughing, or laughing Weight loss and loss of appetite Fatigue New onset of wheezing Recurrent respiratory tract infections such as pneumonia and bronchitis In addition, patients diagnosed with small cell lung carcinoma has an increased vulnerability to nervous system problems (i.e. Lambert-Eaton syndrome, paraneoplastic cerebellar degeneration), Cushing syndrome and Syndrome of Inappropriate Anti-diuretic Hormone (SIADH) and can demonstrate relevant symptoms .
Diagnosis
Imaging tests are often the first diagnostic step if a patient reports symptoms that may be suggestive of lung cancer. A chest x-ray is the most standard imaging test to look for any abnormality within the lung. If abnormality is present, a computed tomography (CT) scan is frequently ordered to reveal the size, shape, and position of any lung tumour and can help locate enlarged lymph nodes that might contain cancer metastasised from the lung origin. Most patients with limited-stage small cell lung cancer will receive a CT scan of the chest and abdomen to search for abnormality within the lungs and lymph nodes, as well as abnormal areas in more distal organs such as adrenal glands and liver that might arise from the metastasis of lung cancer. For patients with limited-stage small cell lung cancer, a positron emission tomography (PET) scan is a useful diagnostic tool to investigate the extent of lymph node involvements, which can help determine treatment options. Though results of imaging test might be suggestive of lung cancer, the actual diagnosis is made by investigating the lung cells under the microscope via lab tests. The cells can be obtained from lung secretions (sputum cytology), fluid removed from pleural effusion (thoracentesis), or from a suspicious area (needle biopsy).
Treatment The standard treatments of limited-stage small cell lung cancer are surgery, platinum-based combination chemotherapy, thoracic irradiation, and prophylactic cranial irradiation.
Surgery Up until the late 1960s, surgical resection remained as the mainstay treatment for both limited and extensive small cell lung cancer. The principle of surgical resection in limited‐stage small cell lung carcinoma aimed to remove all viable tumors with curative intent. Consideration of surgery is recommended for Stage 1 limited-stage small cell lung cancer patient with a solitary nodule, no hilar or mediastinal involvement, absence of distant metastases, and no contraindications to surgery classified by the TNM staging system. Surgery is normally followed by chemotherapy. In cases where tumour were found in the lymph nodes, radiation therapy to the chest is usually advised after resection. The International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project demonstrated five‐year survival rates after resection as below:
… excerpt ends here. Continue reading the full article.
