Basic treatment considerations using chemotherapy for patients with small cell lung cancer

Small cell lung cancer (SCLC) was initially recognized as an entity distinct from other types of lung cancer by pathologic examination in 1926 by Dr. Barnard [1]. It has been commonly referred to as oat cell carcinoma because of its cytologic resemblance to grains of oats. The World Health Organization International Histological Classification of Tumours has now adopted the designation of small cell carcinoma rather than oat cell carcinoma [2]. SCLC is recognized as a malignant epithelial tumor consisting of small cells with scant cytoplasm, ill-defined borders, finely granular nuclear chrornatin, and absent or inconspicuous nucleoli [2-4]. The cells are round, oval, and spindle-shaped, and nuclear molding is prominent (Fig. 1). The mitotic rate is high. The most effective treatment for most lung cancer is surgical resection. Most patients cured of their localized lung cancer undergo a surgical resection; nearly all have non-SCLC (NSCLC). SCLC represents approximately 15% of the lung cancers presenting in patients in the United States [5]. SCLC rarely is treated successfully with surgery because SCLC is typically disseminated at the time of presentation. The patients who appear to have localized disease and are treated with surgical resection relapse and die of their SCLC most of the time [6,7]. The natural history of SCLC from the time of diagnosis to death is very short. The survival of patients diagnosed with SCLC and followed within the Veterans Administration Medical System was 2 months for patients with extensive-stage SCLC and 3 months for patients with limited-stage SCLC [8]. These fundamental observations on the clinical behavior of SCLC have led to adoptions of combination chemotherapy as the initial effective therapy in most Fig. 1. Photomicrograph of SCLC. The specimen is a diagnostic specimen from a patient with limited-stage SCLC. The small cells are round or oval with scant cytoplasm, ill-defined borders, finely granular nuclear chromatin, and inconspicuous nucleoli with prominent nuclear molding. (Hematoxylin-eosin, original magnification x 100).