Small Cell Lung Cancer Staging

CONTENT:

7.4 Small Cell Lung Cancer Staging (the 2-stage VALSG system)
7.4.1 Clinical Staging Workup for Small Cell Lung Cancer
7.4.2 Limited-Stage Small Cell Lung Cancer (LS-SCLC)
7.4.3 Extensive-Stage Small Cell Lung Cancer (ES-SCLC)
7.4.4 The IASLC Recommendations for Future TNM Small Cell Lung Cancer Staging

Forward to 8A Treatment of Non-Small Cell Lung Cancer . Back to 7C The Diagnostic Approach to Staging

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7.4 Small Cell Lung Cancer Staging (the 2-stage VALSG system)

For Small-Cell lung cancer (and for most cancers) oncologists do not use the TNM staging system. At present, small cell lung cancer has two stages: ‘limited-stage’ and ‘extensive-stage.’

small cell lung cancer staging The Veterans Administration Lung Study Group (VALSG) two-stage classification scheme has been used routinely for the clinical staging of Small-Cell Lung Cancer (SCLC) for the past forty years.

In 1989, the International Association for the Study of Lung Cancer (IASLC) proposed a modification to the VALSG system in which limited-stage SCLC was expanded to include contralateral mediastinal or supraclavicular lymph node metastases and ipsilateral pleural effusions.

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7.4.1 Clinical Staging Workup for Small Cell Lung Cancer

The clinical staging workup for small cell lung cancer is still very thorough and involves:

Full medical history
Full physical examination
Bone marrow aspiration, in some cases
Full blood tests
Complete blood count (CBC) with differential
Serum chemistry including creatinine, blood urea nitrogen, calcium, and a metabolic panel
Liver function tests (LFTs)
Serum lactate dehydrogenase (LDH)
Chest X-ray
CT scan of the chest, pelvis, and abdomen
MRI scan of the brain
Bone scan
PET (the high metabolic activity of SCLC, means that the sensitivity of PET for the detection of primary tumors can be 100%).

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7.4.2 Limited-Stage Small Cell Lung Cancer (LS-SCLC)

small cell lung cancer staging ‘Limited-stage‘ Small-Cell Lung Cancer is confined to one side of the chest; within one lung, the mediastinum, and local lymph nodes.

The National Cancer Institute (NCI) defines ‘local lymph nodes’ as those within a single radiation field, when treating the primary tumor. Malignant pleural effusion also qualifies as extensive-stage small cell lung cancer.

7.4.3 Extensive-Stage Small Cell Lung Cancer (ES-SCLC)

‘Extensive-stage‘ small cell lung cancer has spread beyond one side of the lung (limited stage), and which has spread to the opposite lung or metastasized to distant sites.

small cell lung cancer staging Small cell lung cancer is sensitive to radiation therapy. So, the staging system gives an indication of whether a single radiation port can treat the tumor.

For limited-stage small cell lung cancer, radiation therapy is the treatment of choice. Thus, surgery is rarely necessary for limited- or extensive-stage small cell lung cancer; chemotherapy is indicated for both limited- and extensive-stage small cell lung cancer. (See Treatment Options Section 8)

So in Small-Cell lung cancer there is either limited or extensive Stage?

Yes, that’s right. Sadly around 2 out of 3 cases are classified as extensive stage on diagnosis.

7.4.4 The IASLC Recommendations for Future TNM Small Cell Lung Cancer Staging

In 2009, the International Association for the Study of Lung Cancer (IASLC) conducted an analysis of more than small cell lung cancer staging 12,000 cases of small cell lung cancer where TNM staging was available for more than 8,000 patients. The study showed that patient survival correlated with both T and N staging status; the nodal status (N) had a stronger influence on survival.

The IASLC currently recommends that the TNM staging system for small cell lung cancer should be considered in future, as described in the 7th edition of the American Joint Committee on Cancer (AJCC) staging classification.

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References

Micke P, Faldum A, Metz T, et al. (2002). Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer – what limits limited disease? Lung Cancer 37, 271–276. (Retrieved 26^th Feb 2015): https://www.ncbi.nlm.nih.gov/pubmed/12234695

Vallieres E, Shepherd FA, Crowley J, et al. (2009). The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 4, 1049-59. (Retrieved 26^th Feb 2015): http://www.ncbi.nlm.nih.gov/pubmed/19652623

More references for this section are on this page .

PATIENT INFORMATION
National Cancer Institute Small Cell Lung Cancer Treatment: Stage Information for SCLC. (Retrieved 30^th April 2015): http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page3

American Cancer Society Staging for small cell lung cancer (Retrieved 1^st May 2015): http://www.cancer.org/cancer/lungcancer-smallcell/overviewguide/lung-cancer-small-cell-overview-staging

More patient information for this section is on this page .

Forward to 8A Treatment of Non-Small Cell Lung Cancer . Back to 7C The Diagnostic Approach to Staging