Research Paper: Small Cell Lung Cancer

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Small Cell Lung Cancer: An Overview

There are two different forms of lung cancer: small and non-small cell lung cancer. Non-small cell lung cancer is by far the most common form of the disorder. Only "about 10% to 15% of all lung cancers are small cell lung cancer (SCLC), named for the size of the cancer cells when seen under a microscope" (What is small cell lung cancer, 2013, the American Cancer Society). In contrast to NSCLC, SCLC is diffuse. NSCLC is more likely to be large, slow-moving, discrete, and relegated to a specific area of the lungs. SCLC has a very distinct appearance. "Other names for SCLC are oat cell cancer, oat cell carcinoma, and small cell undifferentiated carcinoma. SCLC often starts in the bronchi near the center of the chest. It tends to grow and spread quickly, and it has almost always spread to distant parts of the body before it is found" and therefore can be the more deadly of the two forms of the disease (What is small cell lung cancer, 2013, the American Cancer Society). All forms of lung cancer pose serious health threats. In the U.S. lung cancer affects about 1.37 million every year (Chouaid 2009).

Although smoking exponentially raises one's risk for contracting lung cancer in almost all instances. -- 80% of all lung cancer deaths are thought to result from smoking -- this is particularly true of SCLC. Almost all victims of SCLC are or were smokers (What are the risk factors for small-cell lung cancer, 2013, the American Cancer Society). But while the cause of SCLC is well-known, diagnosis can be extremely difficult. Small cell lung cancer does not always cause 'classic' signs of cancer. For example, in addition to shortness of breath, the patient may experience numbness in the shoulder. "The superior vena cava (SVC) is a large vein that carries blood from the head and arms back to the heart. It passes next to the upper part of the right lung and the lymph nodes inside the chest. Tumors in this area may push on the SVC, which can cause the blood to back up in the veins. This can cause swelling" (How is small cell lung cancer diagnosed, 2013, the American Cancer Society). Cancers can cause hormonal changes which give rise to various endocrine imbalances, such as Cushing's disease. This may impede accurate diagnosis as the healthcare provider's first attention may be drawn to the secondary illness, rather than the primary cause. Small cell lung cancer can also cause the immune system to attack the nervous system, which can further lead to a series of diffuse symptoms (headaches, general malaise) which further hampers diagnosis (How is small cell lung cancer diagnosed, 2013, the American Cancer Society).

Standard therapy for lung cancer encompasses chemotherapy, drug treatment, and if possible, surgery (How is small cell lung cancer diagnosed, 2013, the American Cancer Society). In some rare instances, surgery is possible if the cancer has not penetrated the lymph nodes or caused other complaints. However, because of its nature, small cell lung cancer is often inoperable. "If you are in good health, the standard treatment is chemo plus radiation (given at the same time). People given these treatments at the same time tend to live longer and have a better chance of cure than people who are given one treatment at a time, but this treatment combination is hard to take. If you have lung problems or other major health problems, chemotherapy might be given alone" (Treatment choices, 2013, the American Cancer Society).

Lung cancer is not confined to a specific demographic group; however the strong association with smoking and the development of the illness does affect who contracts the disease. It is thought that specific segments of the population have a genetic vulnerability to developing lung cancer in the presence of cigarette smoke. But while severity of the illness is a critical component of determining the survival rate, socio-economic status is strongly correlated with survival rates. One study of lung cancer patients revealed that "patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations" (Greenwald 1998:1681). However, while it might be assumed that persons of greater socio-economic status benefited from improved screening, statistical evidence indicates this is not the case and that other factors may be involved. Regarding the effects of screening, in one study of patients with SCLC, (7 out of a general population of 4782 at one hospital and 8 of 1520 at another) "four cases were detected on enrolment scan, four on annual computed tomography scans, and two on interim scans" and the findings indicated that "computed tomography screening is ineffective for SCLC. Efforts to reduce mortality of SCLC should instead focus on prevention through tobacco reduction programs, as well as the development of improved treatment options" (Cuffe 2011).

In the cases of patients who do experience a complete eradication of the illness, constant vigilance is required to prevent remission. "Patients who have achieved a complete remission can be considered for administration of Prophylactic cranial irradiation (PCI) PCI" (Limited-stage small cell lung cancer treatment, 2013, National Cancer Institute). Because there is a 60% likelihood of patients developing central nervous system (CNS) metastases within 2 to 3 years after starting treatment, PCI is strongly suggested (Limited-stage small cell lung cancer treatment, 2013, National Cancer Institute).

Annotated Bibliography

Chouaid, C., Atsou, K., Hejblum, G., & Vergnenegre, a. (2009). Economics of treatments for non-small cell lung cancer. PharmacoEconomics, 27(2), 113-25.

[PUBLISHED ABSTRACT] the purpose of this article is to review the economics of treatments for non-small cell lung cancer (NSCLC). We systematically analysed the cost effectiveness of treatments for the different stages of NSCLC, with particular emphasis on more recently approved agents. Numerous economic analyses in NSCLC have been conducted, with a variety of methods and in a number of countries. In patients with localized disease, adjuvant chemotherapy appears to have greater cost effectiveness than observation; however, there are few published data. In locally advanced disease, combined modalities (chemotherapy, surgery and/or radiotherapy) are probably cost effective, but high-quality economic analyses are lacking. In advanced NSCLC, third-generation chemotherapies used in the first-line setting can be administered with acceptable incremental cost effectiveness. In the second-line setting, new agents (docetaxel, pemetrexed and erlotinib) have acceptable cost effectiveness. The lack of cost-utility analyses for elderly patients and patients with a poor prognosis rules out firm conclusions. This review suggests that most therapies for NSCLC are cost effective when the patient has a good performance status, with an incremental cost-effectiveness ratio under $US50 000 per life-year gained in the majority of cases.

Cuffe, S. (et al. 2011). Characteristics and outcomes of small cell lung cancer patients diagnosed during two lung cancer computed tomographic screening programs in heavy smokers. Journal of Thoracic Oncology; 6(4):818-22. doi: 10.1097/JTO.0b013e31820c2f2e.

[PUBLISHED ABSTRACT] Small cell lung cancer (SCLC) is considered an inappropriate screening target due to its short preclinical phase and high rate of relapse despite optimal therapy. However, while intuitively screening for SCLC is inadvisable, in reality, there is a scarcity of data focusing on screen-detected SCLC and whether this intervention leads to diagnosis at an earlier clinical stage or alters outcome.

Greenwald, H.P., Polissar, N.L., Borgatta, E.F., McCorkle, R., & Goodman, G. (1998).

Social factors, treatment, and survival in early-stage non-small cell lung cancer. American Journal of Public Health, 88(11), 1681-4.

[PUBLISHED ABSTRACT] This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small cell lung cancer. Analyses focused on Black and White individuals 75 years of age and younger (n = 5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality.

How is small cell lung cancer diagnosed? (2013). The American Cancer Society.

Retrieved:

http://www.cancer.org/cancer/lungcancer-smallcell/detailedguide/small-cell-lung-cancer-diagnosis

This article published by the American Cancer Society discusses different warning signs of small cell lung cancer. One of the difficult aspects of treating this form of the disease is that the symptoms which it presents are not always the classical hacking cough and shortness of breath one associates with lung cancer. SCLC affects multiple organ systems.

Limited-stage small cell lung cancer treatment. (2013). National Cancer Institute.

Retrieved:

http://www.cancer.gov/cancertopics/pdq/treatment/small-cell- lung/healthprofessional/page5

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