Management of small-cell lung cancer

SCLC typically presents as a central endobronchial lesion in chronic cigarette smokers with hilar enlargement and disseminated disease. The diagnostic pathology should be reviewed by a pathologist who is accomplished in reading pulmonary pathology and if any doubt exists in the diagnosis, additional special stains and/or diagnostic material should be obtained. Patients with extensive stage disease should be managed by combination chemotherapy, whereas patients with limited stage disease should be treated with combination chemotherapy and chest radiotherapy. The chemotherapy should be administered for 4 to 6 months and discontinued; patients should be retreated with chemotherapy if they relapse. Prophylactic cranial radiation is an appropriate option for patients who achieve a complete remission. The patients who are in complete remission should be carefully observed for second cancers and appropriate therapy should be administered if the cancers appear.