Microcitoma (Small Cell Lung Cancer)

1 GENERAL INFORMATION

1.1Epidemiological data

1.1.1 Epidemiological data
It represents about 20% of primary lung tumors. Three quarters of patients with SCLC present between the ages of 50 and 70, with a huge male preponderance (however, male to female ratio is decreasing as a result of the increasing incidence of lung cancer among women).

1.2 Etiologic and risk factors

1.2.1 General data
There is no evidence of genetic susceptibility. The specific etiologic factors known for SCLC are:

tobacco smoking
radiation
occupational carcinogens

1.2.2 Smoking
The predominant risk factor for SCLC is cigarette smoking. More than 95% of patients with SCLC are current or past smokers and there is an increased risk with both the number of cigarettes smoked per day and the duration of smoking.

1.2.3 Radiation
Ionising radiations increase the risk of lung carcinomas and SCLC to a greater extent especially among smokers, since a synergistic action between smoking and radiation exposure exists.

1.2.4 Occupational carcinogens
Among the many substances encountered in the workplace that have been discovered as causes of human lung cancer, the most frequent occupational cause appears to be asbestosis, although its causative role among different histologic subtypes is not as yet firmly established.

1.3 Screening and case finding

1.3.1 Screening and case finding
Screening with chest X-ray and/or sputum cytology of populations or of high risk patients (such as heavy smokers) is of no value in reducing lung cancer specific mortality. SCLC is an aggressive, generally unresectable tumor and is not considered a target for early detection or screening (1.III)

1.4 Referral

1.4.1 Referral
Institutions diagnosing and treating SCLC should have access to bronchoscopy, mediastinoscopy and thoracic surgery. Modern imaging techniques are essential. Treatment facilities must include the ability to give cytotoxic chemotherapy and to manage its consequences. Radiation therapy and, less commonly, thoracic surgery, may be an integral part of treatment, and access to these facilities is essential.

1.5 Selected reviews

1.5.1
Ihde DC. Small cell lung cancer. State-of-the-art therapy. Chest 1995; 107:243S-248S.

1.5.2
Hansen H. Management of small cell cancer of the lung. Lancet 1992;339: 846-849.

1.5.3
Kristensen C, Jensen P, Poulsen H,Hansen H. Small cell lung cancer: biological and therapeutic aspects. Critical Reviews in Oncology/Hematology 1996; 22:27-60.

References

1.I
Fontana RS, Sanderson DR, Woolner LB et al. Screening for lung cancer: a critique of the Mayo cancer project. A clinicopathologic study. Cancer 1991; 67: 1155-1164.

1.II
Watkin SW Temporal demographic and epidemiologic variation in histologic subtypes of lung cancer: a literature review. Lung Cancer 1989; 5: 69-81.

1.III
Wolpaw DR. Early detection in lung cancer. Case finding and screening. Medical Clinics of North America, 1996: 80; 63-82

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