Fergus Vincent Gleeson MBBS, Presenter: Alliance Medical Ltd Consultant

1) To learn the clinical manifestations, staging and prognostic factors of small cell lung cancer. 2) To become familiar with the role of PET-CT in the investigation and management of small cell lung cancer. 3) To review unusual presentations of small cell lung cancer and their investigation and treatment.

Small cell lung cancer, SCLC, accounts for approximately 15% of all lung cancers, with its overall incidence decreasing, although it is increasing in women, with the male to female incidence ratio now 1:1. Small cell lung cancer has a more rapid doubling time than non-small cell lung cancer, with most patients presenting with hematogenous metastases, and only approximately one-third presenting with limited-stage disease confined to the chest. Small cell lung cancer uncommonly presents with a solitary pulmonary nodule, and the disease does not appear to have benefited from Lung Cancer Screening. There are multiple neurologic and endocrine paraneoplastic syndromes associated with small cell lung cancer, with marked improvement on treatment of the underlying tumour. Historically SCLC was staged according to the Veteran's Administration Lung Group's 2 stage classification of 1) extensive-stage disease or 2) limited-stage disease, and this classification used to guide therapy. More recently it has been recommended that SCLC is staged according to the International Association of the Study of Lung Cancer (IASLC) and the AJCC Cancer Staging Manual 7th edition, using the same staging system for NSCLC and SCLC. Whilst contrast enhanced CT scan of the chest and abdomen remain routine as the initial method for staging SCLC, FDG PET-CT now plays a more important role in staging and management. SCLC is a highly metabolic disease, and PET-CT both upstages and downstages disease, potentially altering management

Gleeson, F, Contemporary Concepts in Small Cell Lung Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000760.html