Small cell carcinoma of the lung history and symptoms

Small cell lung cancer (SCLC) is characterized by a relatively rapid onset of symptoms. Patients usually present within 8 to 12 weeks of the onset of symptoms, which can be related either to the tumor growth in the thorax or to the distant spread of the tumor. In addition, SCLC is associated with the occurrence of paraneoplastic syndromes such as the syndrome of inappropriate antidiuresis (SIADH).

• SCLC is characterized by a relatively rapid onset of symptoms.
• Patients with SCLC usually present within 8 to 12 weeks of the onset of symptoms.
• A typical SCLC patient is a 70 year old male who is either a smoker or an ex-smoker.^[1]
• A full medical history should be obtained.
• Information should be obtained regarding:
  • Tobacco smoking status
  • Family history of lung cancer

• Cough (most common symptom)^[1][2]
• Wheezing^[1]
• Difficulty breathing^[1]
• Bloody cough^[1]
• Chest pain^[1]

• Fatigue
• Anorexia
• Weight loss
• Low grade fever

• Syndrome of inappropriate antidiuresis (SIADH) (frequency: 15 – 40%):^[1]
  • Weakness
• Hypercalcemia (frequency: 8 – 12%):^[1]
  • Nausea
  • Vomiting
  • Abdominal pain
  • Constipation
  • Polyuria
  • Thirst
  • Dehydration
  • Confusion
  • Irritability
• Cushing’s syndrome (frequency: 2 – 5%):^[1]
  • Rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity)
  • A round face often referred to as a “moon face“
  • Excessive sweating
  • Insomnia
  • Reduced libido
  • Amenorrhoea
• Lambert-Eaton syndrome (frequency: 3%):^[1]
  • Weakness of the proximal muscles of lower extremities
  • Abnormal gait
  • Autonomic dysfunction
  • Paresthesia
• Limbic encephalitis and encephalomyelitis (frequency < 1%):^[1]
  • Altered mental status
  • Seizures
  • Memory loss
  • Space and time disorientation with or without dementia
• Paraneoplastic cerebellar degeneration (frequency < 1%):^[1]
  • Ataxia
  • Dysarthria
  • Severe vertigo
• Amenorrhea (due to production of prolactin or growth hormone)^[3]
• Galactorrhea (due to production of prolactin or growth hormone)^[3]

• Hoarseness (involvement of the recurrent laryngeal nerve)^[4]
• Dyspnea (one of the causes is the involvement of the phrenic nerve and subsequent elevation of the hemi-diaphragm)^[4]
• Pain, muscle wasting, or change in the skin temperature in areas corresponding to cervical spinal nerve C8 or thoracic nerve T2 to T4 (involvement of the brachial plexus)^[4]
• Chest pain (one of the causes is the involvement of the chest wall)^[4]
• Pleuritic chest pain^[4]
• Horner syndrome manifested by unilateral miosis, ptosis and anhydrosis (involvement of the sympathetic trunk)^[4]
• Arrhythmia (involvement of the pericardium)^[4]
• Cardiac tamponade manifested by chest pain, altered mental status, cold extremities, peripheral cyanosis (involvement of the pericardium)^[4]
• Dysphagia (compression of the esophagus)^[4]
• Superior vena cava syndrome manifested by dyspnea, headache, and swelling of the face, neck, trunk, and arms^[4]
• Localized bone pain most commonly on the axial skeleton and proximal long bones (suggestive of bone metastasis)
• Jaundice (suggestive of liver metastasis)
• Headache, nausea and vomiting, focal neurologic symptoms, seizures, confusion, and personality changes (suggestive of brain metastasis)
• Palpable masses, particularly in the supraclavicular area (suggestive of lymphadenopathy)

• Abdominal discomfort due to bilateral adrenal mass^[5]
• Facial nerve palsy due to metastasis to the facial nerve^[6]

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