Staging, prognostic factors, and special considerations in small cell lung cancer

New treatment approaches in the fight against SCLC are clearly on the horizon and some are already in clinical trials. With this in mind, several comments concerning future directions in staging this disease can be made: 1. Staging is important and complete staging is needed in order to continue to build meaningful information. 2. Limited/Extensive disease categories are in use and remain important; yet this system is not completely adequate. There are subsets within each group that do better: minimal disease versus bulky disease in limited stage, extraabdominal v intraabdominal in extensive disease, and single organ versus multiple organ involvement. Therefore, a new staging system is needed. The TNM system is designed primarily to define surgical resectability and will thus not adequately address the issues for SCLC unless the N and M categories are markedly enlarged. A staging symposium was recently held in Europe to begin to address potential approaches to staging and an American staging conference is planned. 3. Biomarkers: In the broad range of possible markers, most are not sufficiently sensitive or specific to supplant clinical exam and routine testing. But newer tests such as NSE, CK-BB and tumor surface antigen expression and recognition may impact on staging in the near future. 4. Finally, as the biology of SCLC is further understood, much of the derived understanding will likely change the staging and prognostic factors.