Question on Intro to SCLC - 1273407

Sun, 03/27/2016 - 07:25

Hi Faculty, I posted a question early this morning on the Intro to SCLC topic http://cancergrace.org/lung/2010/08/03/intro-to-sclcref-lib/
As it didn't show on recent forum topics I assumed that you wouldn't have visibility of it. I hope that you can get to the question from this posting. Thank you.

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JimC

Hi frey,

Welcome to GRACE. Although he may not have directly addressed the question Simon posted, I think the answer is there within Dr. West's comments. The unfortunate problem with lung cancer, whether SCLC or NSCLC, is that by the time symptoms are seen the cancer is usually advanced. As Dr. West mentions, the window for detecting NSCLC tends to be longer because NSCLC is usually slower growing than SCLC, but many cases of early-stage NSCLC are detected by chance, as when a scan is done prior to an unrelated surgery or condition. Small tumors which have not spread usually do not cause much, if anything, in the way of symptoms.

If you're talking about early symptoms, these can be so non-specific that they wouldn't necessarily lead you to diagnose lung cancer, as it is much more likely that they point to something else. Once those symptoms more emphatically suggest lung cancer, it tends to be advanced.

And just a tip for the future: If you have a question after reading a post such as the one by Dr. Gadgeel, it is best to start a new topic (as you did here).

JimC
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frey

Thank you for such a quick reply and also for the tip. We had a talk on lung cancer recently from nursing staff, they explained that from their experience that small cell growth can be seen in weeks rather than months or years, hence the need to get treatment started as soon as possible. It just seemed strange, that some people like Simon sensed that there was something going on 2 years prior to diagnosis, also one of our group felt that they had symptoms 3 years prior to diagnosis, this made us think that there may have been a period or dormancy or slow growth before the "explosive" period that we know so well. Unfortunately this may be wishful thinking or would imaging done at the first sign of symptoms (oh for the ability to harness and act on hindsight) have led to diagnosis of limited stage rather than extensive stage? Thank you.

JimC

Hi frey,

I think it's easier to view such early detection in hindsight, as you suspect. Many people have minor symptoms which are consistent with lung cancer, but could also indicate many other conditions. It would be difficult for physicians to order scans on everyone who presents with such symptoms, when the odds are that the patient has a cold, the flu, musculoskeletal issues or migraines, to list just a few. To provide an example, the recent move to low-dose screening CTs has been limited to patients with a significant smoking history (those most at risk) because when such scans are done, they show lung nodules in many patients, the great majority of whom do not have cancer. As a result, you have many patients needlessly undergoing uncomfortable, expensive and often risky procedures. If you increase those screenings to include patients not at high risk, you would get an even larger percentage of benign nodules.

Certainly it's good to have regular visits to your primary care physician, especially when there are troublesome symptoms, but not only is it not that likely that cancer will be suspected, but also if those symptoms clearly suggest cancer, there's a high probability that if it's cancer it is advanced.

JimC
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