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April 2, 2016 By Steven Halls

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 stagingThe 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.

 

Talking Moose
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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%).

 

Talking Moose
Talking Moose
Sometimes I wrestle with my demons, other times we just hug and eat pancakes.


 
 

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 stagingSmall 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)

 

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

Dr. Halls Dr. Halls
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 staging12,000 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.

 

Talking Moose
Where do you find a dog with no legs? Right where you left him!


 
 

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 26th 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 26th 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 30th April 2015): https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq
American Cancer Society Staging for small cell lung cancer (Retrieved 1st 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

 

 

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