Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, California, USA.
Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, California, USA.
BMC Pulm Med. 2018 Nov 14;18(1):169. doi: 10.1186/s12890-018-0729-y.
Small cell lung carcinoma (SCLC) is one of the deadliest forms of lung cancer due to its poor prognosis upon diagnosis, rapid doubling time, and affinity for metastasis. As 60-70% of patients with SCLC have disseminated disease upon presentation, it is imperative to determine the extent of disease burden for treatment. As a neuroendocrine carcinoma, clinicians must pay close attention to abnormal findings in a smoker that could lead to earlier diagnosis and better prognostication.
A 64 year-old 20-pack year smoker presented to the emergency department with nausea and vomiting for 3 days. No inciting events were elicited. History and review of symptoms were negative including symptoms most-commonly associated with malignancy such as fevers and weight loss. He also denied any pulmonary symptoms. Physical examination was benign except for right lung end-expiratory wheezing. Our patient was clinically euvolemic. Initial blood laboratories showed a sodium 110, serum osmolarity 227, and urine osmolarity of 579. Fluid restriction led to normalization of his sodium and resolution of nausea & vomiting. Chest radiography was obtained to follow-up on the wheezing, which was read as no acute cardiopulmonary disease by radiology. Due to high suspicion of SIADH from malignancy, a CT of the chest was performed which showed a conglomerate of nodules and opacities in the right upper lobe. Biopsy revealed SCLC. At outpatient follow-up, patient had a PET-CT showing one active mediastinal lymph node as the only site of metastasis. He received three round of chemotherapy, chest and prophylactic cranial radiation, and deemed in remission by oncology.
Due to its affinity for metastases, 70% of patients with SCLC present with symptoms related to the spread of cancer to affected organ systems. Given the aggressive nature of this disease, screening measures have been implemented to help diagnose limited stage SCLC. Unfortunately, in our patient and many others, screening guidelines may fail to identify appropriate patients to scan. It is therefore imperative to use our clinical index of suspicion and identify any early presentations (including paraneoplastic syndromes) which may tip off the beginning stages of SCLC. This could improve survival rates by up to 45%.
小细胞肺癌（SCLC）是肺癌中最致命的形式之一，因为其诊断时预后不良、倍增时间快且易于转移。由于 60-70%的 SCLC 患者在就诊时已发生扩散性疾病，因此确定疾病负担的程度至关重要。作为一种神经内分泌癌，临床医生必须密切关注吸烟者的异常发现，这可能导致更早的诊断和更好的预后。
一位 64 岁、吸烟 20 包/年的患者因恶心和呕吐 3 天而到急诊就诊。未引出任何诱发事件。病史和症状回顾均为阴性，包括与恶性肿瘤最常见相关的症状，如发热和体重减轻。他也没有任何肺部症状。体格检查除右肺呼气末哮鸣音外无其他异常。患者临床情况为血容量正常。初始血液实验室检查显示血清钠 110、血清渗透压 227，尿渗透压 579。液体限制导致血清钠正常化并缓解恶心和呕吐。进行胸部 X 线检查以随访哮鸣音，放射科报告为无急性心肺疾病。由于高度怀疑恶性肿瘤导致的抗利尿激素不适当分泌综合征（SIADH），因此进行了胸部 CT 检查，显示右肺上叶有一团结节和混浊。活检显示为小细胞肺癌。在门诊随访时，患者进行了 PET-CT 检查，显示一个活跃的纵隔淋巴结是唯一的转移部位。他接受了三轮化疗、胸部和预防性颅脑放疗，肿瘤学评估认为已缓解。
由于其易于转移，70%的 SCLC 患者出现与癌症扩散至受影响的器官系统相关的症状。鉴于这种疾病的侵袭性，已经实施了筛查措施以帮助诊断局限性 SCLC。不幸的是，在我们的患者和许多其他患者中，筛查指南可能无法识别适合扫描的患者。因此，使用我们的临床怀疑指数并识别任何早期表现（包括副肿瘤综合征）至关重要，这可能将 SCLC 的早期阶段提示出来。这可以将生存率提高多达 45%。
