Small cell carcinoma of the lung diagnostic study of choice: Difference between revisions

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Latest revision as of 22:32, 3 September 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]Rim Halaby, M.D. [3]

Overview

The confirmation of the diagnosis of SCLC relies on the histopathological findings of the tumor biopsy. All patients with confirmed diagnosis of SCLC by histopathological findings should undergo a CT scan of the abdomen for staging purposes. CT scan of the abdomen helps identify metastasis to organs, such as the liver or the adrenal glands. Staging schemes for small cell lung cancer (SCLC) have been developed by the Veterans Administration Lung Study Group (VALG), the American Joint Committee on Cancer (AJCC), and the National Comprehensive Cancer Network (NCCN).

Diagnostic Study of Choice

Biopsy

The confirmation of the diagnosis of SCLC relies on the histopathological findings of the tumor biopsy.^[1]
In SCLC, the tumor cells are small and round, but they can sometimes be ovoid or spindle shaped. They have a scant cytoplasm with a high mitotic count and a hyperchromatic nuclei. Nearly all SCLC are immunoreactive for keratin, thyroid transcription factor 1, and epithelial membrane antigen. Neuroendocrine and neural differentiation result in the expression of molecules like dopa-decarboxylase, calcitonin, neuron-specific enolase, chromogranin A, CD56 (also known as nucleosomal histone kinase 1 or neural-cell adhesion molecule), gastrin-releasing peptide, and insulin-like growth factor 1. One or more markers of neuroendocrine differentiation can be found in approximately 75% of SCLC.^[2]

Histopathologic image of small cell carcinoma of the lung. CT-guided core needle biopsy. H & E stain.By No machine-readable author provided. KGH assumed (based on copyright claims),via Wikimedia Commons ^[3]	Micrograph of a small-cell carcinoma of the lung showing cells with nuclear moulding, minimal amount of cytoplasm and stippled chromatin. FNA specimen. Field stain.By No machine-readable author provided. KGH assumed (based on copyright claims), via Wikimedia Commons ^[4]

CT

Chest CT scan, preferably with intravenous contrast administration, may be helpful in the diagnosis of small cell carcinoma. Findings on CT scan suggestive of small cell carcinoma include:^[1]

Hilar mass
Mediastinal involvement
Numerous lymphadenopathy
Direct infiltration of adjacent structures
Necrosis
Hemorrhage
The most common cause of SVC obstruction is SCLC, because of both compression or thrombosis and or direct infiltration.
CT is used to stage small cell lung cancer.
CT scan of the abdomen helps identify metastasis to organs, such as the liver or the adrenal glands.
Brain imaging is also mandatory for staging however a brain MRI is preferred over brain CT scan due to its superior sensitivity for the detection of brain metastasis.
PET CT scan should be performed if limited stage small cell lung cancer is suspected.

Staging

The Veterans Administration Lung Study Group (VALG) staging, also known as VA staging, is an old staging system that has been previously used in most clinical trials. Shown below is a table depicting the VA staging system which classifies SCLC into two stages.^[6]

Stage	Characteristics
Limited SCLC	Limited SCLC is characterized by the strict involvement of the ipsilateral lung.
Extensive SCLC	Extensive SCLC extends beyond the ipsilateral lung and may involve the contralateral lung, or can be associated with pleural effusion, pericardial effusion, or hematogenous spread.

AJCC and TNM Staging

Shown below is a table summarizing the staging of lung cancer according to the American Joint Committee on Cancer (AJCC). This staging scheme is the same for both SCLC and non small cell lung cancer.^[7]

For more information about the TNM staging, click here.

Stage	T	N	M
Occult carcinoma	TX	N0	M0
Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2	N0	M0
Stage IIA	T1	N1	M0
Stage IIB	T2	N1	M0
Stage IIB	T3	N0	M0
Stage IIIA	T1, T2	N2	M0
Stage IIIA	T3	N1, N2	M0
Stage IIIB	Any T	N3	M0
Stage IIIB	T4	Any N	M0
Stage IV	Any T	Any N	M1

NCCN Staging

The National Comprehensive Cancer Network (NCCN) staging system combines the staging scheme of the AJCC and that of the VALG. Although the AJCC staging scheme is newer than that of the VALG, clinicians commonly use the VALG staging system because it has been commonly referred to in clinical trials. Shown below is a table depicting the NCNN staging which classifies SCLC into two stages.^[1]

Stage	Characteristics
Limited SCLC	Limited SCLC includes lung cancer cases of stage I, II, or III which can be treated with radiation therapy. This stage does not include tumor T3 or T4 with multiple lung nodules, as well as tumor or lymph nodes that are too large to fit in the radiation plan.
Extensive SCLC	Extensive SCLC includes all SCLC categorized as stage IV, or Tumor T3 or T4 with multiple lung nodules, or Tumor or lymph nodes that are too large to fit in the radiation plan

References

↑ ^1.0 ^1.1 ^1.2 NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
↑ National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.
↑ href="http://www.gnu.org/copyleft/fdl.html">GFDL</a> or <a href="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0</a>], <a href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">
↑ href="http://www.gnu.org/copyleft/fdl.html">GFDL ="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0], href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">
↑ href="https://commons.wikimedia.org/wiki/File:Carcinoma_microcellulare_oatcell_carcinoma_or_anaplastic_carcinoma_(lung)H%26E_magn_200x.jpg
↑ Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG; et al. (2002). "Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease?". Lung Cancer. 37 (3): 271–6. PMID 12234695.
↑ Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, Chansky K; et al. (2007). "The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer". J Thorac Oncol. 2 (12): 1067–77. doi:10.1097/JTO.0b013e31815bdc0d. PMID 18090577.

Template:WikiDoc Sources

[NCCN-1] 1.0 ^1.1 ^1.2 NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014

[NCI-2] National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.

[3] ref="http://www.gnu.org/copyleft/fdl.html">GFDL</a> or <a href="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0</a>], <a href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">

[4] ref="http://www.gnu.org/copyleft/fdl.html">GFDL ="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0], href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg">

[5] ref="https://commons.wikimedia.org/wiki/File:Carcinoma_microcellulare_oatcell_carcinoma_or_anaplastic_carcinoma_(lung)H%26E_magn_200x.jpg

[pmid12234695-6] Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG; et al. (2002). "Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease?". Lung Cancer. 37 (3): 271–6. PMID 12234695.

[pmid18090577-7] Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, Chansky K; et al. (2007). "The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer". J Thorac Oncol. 2 (12): 1067–77. doi:10.1097/JTO.0b013e31815bdc0d. PMID 18090577.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Small cell carcinoma of the lung}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}} {{SH}}{{Rim}}
 == Overview ==
+The confirmation of the diagnosis of SCLC relies on the histopathological findings of the tumor [[biopsy]]. All patients with confirmed diagnosis of SCLC by [[histopathological]] findings should undergo a [[CT scan]] of the [[abdomen]] for staging purposes. [[Computed tomography|CT scan]] of the [[abdomen]] helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]]. Staging schemes for small cell lung cancer (SCLC) have been developed by the Veterans Administration Lung Study Group (VALG), the American Joint Committee on Cancer (AJCC), and the National Comprehensive Cancer Network (NCCN).
 == Diagnostic Study of Choice ==
+===Biopsy===
+* The confirmation of the diagnosis of SCLC relies on the histopathological findings of the tumor [[biopsy]].<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+* In SCLC, the [[Tumor cell|tumor cells]] are small and round, but they can sometimes be ovoid or spindle shaped.  They have a scant [[cytoplasm]] with a high [[mitotic]] count and a hyperchromatic [[nuclei]].  Nearly all SCLC are immunoreactive for [[keratin]], [[thyroid transcription factor 1]], and [[Epithelial cells|epithelial]] membrane [[antigen]]. [[Neuroendocrine]] and [[neural]] [[differentiation]] result in the expression of molecules like [[Dopamine beta-hydroxylase|dopa-decarboxylase]], [[calcitonin]], [[neuron-specific enolase]], [[chromogranin A]], [[CD56]] (also known as nucleosomal [[histone]] kinase 1 or [[neural]]-[[cell]] adhesion molecule), [[gastrin]]-releasing [[peptide]], and [[insulin-like growth factor 1]]. One or more markers of [[neuroendocrine]] differentiation can be found in approximately 75% of SCLC.<ref name="NCI">National Cancer Institute: PDQ® Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute.  Available at: http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional.</ref>
-===== Template statements =====
-=== Study of choice: ===
+{| class="wikitable"
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+|[[Image:Lung small cell carcinoma (1) by core needle biopsy.jpg|300px|thumb| Histopathologic image of small cell carcinoma of the lung. CT-guided core needle biopsy. H & E stain.By No machine-readable author provided. KGH assumed (based on copyright claims),via Wikimedia Commons <ref>href="http://www.gnu.org/copyleft/fdl.html">GFDL<nowiki></a></nowiki> or <nowiki><a href="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0</a></nowiki>], <nowiki><a href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg"></nowiki></ref>]]
-* The following result of [gold standard test] is confirmatory of [disease name]:
+|[[Image:Lung small cell cancer 01.jpeg|300px|thumb| Micrograph of a small-cell carcinoma of the lung showing cells with nuclear moulding, minimal amount of cytoplasm and stippled chromatin. FNA specimen. Field stain.By No machine-readable author provided. KGH assumed (based on copyright claims), via Wikimedia Commons <ref>href="http://www.gnu.org/copyleft/fdl.html">GFDL ="http://creativecommons.org/licenses/by-sa/3.0/">CC-BY-SA-3.0], href="https://commons.wikimedia.org/wiki/File%3ALung_small_cell_carcinoma_(1)_by_core_needle_biopsy.jpg"></ref>]]
-** Result 1
+|- [[Image:Lung small cell cancer 03.jpeg|300px|thumb| Anaplastic (microcellular, oat cell) carcinoma from the lung., via Wikimedia Commons <ref>href="https://commons.wikimedia.org/wiki/File:Carcinoma_microcellulare_oatcell_carcinoma_or_anaplastic_carcinoma_(lung)H%26E_magn_200x.jpg</ref>]]
-** Result 2
+|
-* The [name of the investigation] should be performed when:
+|
-** The patient presented with symptoms/signs 1. 2, 3.
+|}
-** A positive [test] is detected in the patient.
-* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+===CT===
-* The diagnostic study of choice for [disease name] is [name of the investigation].
+Chest [[Computed tomography|CT scan]], preferably with [[intravenous]] [[contrast]] administration, may be helpful in the [[diagnosis]] of small cell carcinoma. Findings on [[Computed tomography|CT scan]] suggestive of small cell carcinoma include:<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
-* There is no single diagnostic study of choice for the diagnosis of [disease name].
+*[[Hilum|Hilar]] mass
-* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
+*[[Mediastinum|Mediastinal]] involvement
-* [Disease name] is mainly diagnosed based on clinical presentation.
+*Numerous [[lymphadenopathy]]
-* Investigations:
+*Direct infiltration of adjacent structures
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
+*[[Necrosis]]
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
+*[[Hemorrhage]]
-** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
+*The most common cause of [[SVC obstruction]] is SCLC, because of both compression or [[thrombosis]] and or direct infiltration.
+*[[CT-scans|CT]] is used to stage small cell lung cancer.
+*CT scan of the abdomen helps identify [[metastasis]] to organs, such as the [[liver]] or the [[adrenal glands]].
+*[[Brain]] imaging is also mandatory for staging however a brain [[MRI]] is preferred over brain [[CT scan]] due to its superior [[sensitivity]] for the detection of [[brain]] [[metastasis]].
+*[[PET]] [[CT-scans|CT]] scan should be performed if limited stage small cell lung cancer is suspected.
+===Staging===
+The Veterans Administration Lung Study Group (VALG) staging, also known as VA staging, is an old staging system that has been previously used in most clinical trials.  Shown below is a table depicting the VA staging system which classifies SCLC into two stages.<ref name="pmid12234695">{{cite journal| author=Micke P, Faldum A, Metz T, Beeh KM, Bittinger F, Hengstler JG et al.| title=Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer--what limits limited disease? | journal=Lung Cancer | year= 2002 | volume= 37 | issue= 3 | pages= 271-6 | pmid=12234695 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12234695  }} </ref>
-==== The comparison table for diagnostic studies of choice for [disease name] ====
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Characteristics'''
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''Limited SCLC''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+* Limited SCLC is characterized by the strict involvement of the ipsilateral lung.
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''Extensive SCLC''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |
+* Extensive SCLC extends beyond the ipsilateral [[lung]] and may involve the contralateral lung, or can be associated with [[pleural effusion]], [[pericardial effusion]], or hematogenous spread.
 |}
-<small> ✔= The best test based on the feature </small>
-===== Diagnostic results =====
+===AJCC and TNM Staging===
-The following result of [investigation name] is confirmatory of [disease name]:
+Shown below is a table summarizing the staging of lung cancer according to the American Joint Committee on Cancer (AJCC).  This staging scheme is the same for both SCLC and [[non small cell lung cancer]].<ref name="pmid18090577">{{cite journal| author=Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, Chansky K et al.| title=The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer. | journal=J Thorac Oncol | year= 2007 | volume= 2 | issue= 12 | pages= 1067-77 | pmid=18090577 | doi=10.1097/JTO.0b013e31815bdc0d | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18090577  }} </ref>
-* Result 1
-* Result 2
-===== Sequence of Diagnostic Studies =====
+''For more information about the TNM staging, click '''[[lung cancer staging|here]]'''.''
-The [name of investigation] should be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-=== Diagnostic Criteria ===
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-* Here you should describe the details of the diagnostic criteria.
+|-
-*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''N'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''M'''
-*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
+|-
-*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Occult carcinoma''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center|TX|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N0|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
-*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
+|-
-*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Stage 0''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |Tis ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center | N0 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
-*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
+|-
-*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Stage IA''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T1 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N0 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
-* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
+|-
-* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Stage IB''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T2 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N0 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center | M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Stage IIA''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T1 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N1 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center rowspan="2"|'''Stage IIB''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T2 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N1 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center | M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T3 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N0 || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center rowspan="2" |'''Stage IIIA''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T1, T2|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N2 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T3|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N1, N2 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center rowspan="2"|'''Stage IIIB''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |Any T|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |N3 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |T4 ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center|Any N ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M0
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=center |'''Stage IV'''|| style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |Any T ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |Any N ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=center |M1
+|}
-* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+===NCCN Staging===
-* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
+The National Comprehensive Cancer Network (NCCN) staging system combines the staging scheme of the AJCC and that of the VALG.  Although the AJCC staging scheme is newer than that of the VALG, clinicians commonly use the VALG staging system because it has been commonly referred to in clinical trials.  Shown below is a table depicting the NCNN staging which classifies SCLC into two stages.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
-* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-** Criteria 1
+|-
-** Criteria 2
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Stage'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Characteristics'''
-** Criteria 3
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''Limited SCLC''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left|
+* Limited SCLC includes lung cancer cases of stage I, II, or III which can be treated with [[radiation therapy]].
+* This stage does not include tumor [[Lung cancer staging#T:Primary Tumor|T3]] or [[Lung cancer staging#T:Primary Tumor|T4]] with multiple lung nodules, as well as tumor or [[lymph node]]s that are too large to fit in the radiation plan.
+|-
+|style="font-size: 100; padding: 0 5px; background: #DCDCDC" align=left |'''Extensive SCLC''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left |
+* Extensive SCLC includes all SCLC categorized as stage IV, '''or'''
+* Tumor [[Lung cancer staging#T:Primary Tumor|T3]] or [[Lung cancer staging#T:Primary Tumor|T4]] with multiple lung nodules, '''or'''
+* [[Tumor]] or [[lymph node]]s that are too large to fit in the radiation plan
+|}
-IF there are clear, established diagnostic criteria:
+==References==
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+{{Reflist|2}}
-*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-IF there are no established diagnostic criteria:
-*There are no established criteria for the diagnosis of [disease name].
+[[Category:Disease]]
+[[Category:Types of cancer]]
+[[Category:Pulmonology]]
+[[Category:Lung cancer]]
-==References==
+{{WikiDoc Help Menu}}
-{{Reflist|2}}
+{{WikiDoc Sources}}
-{{WH}}
+[[Category:Up-To-Date]]
-{{WS}}
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Pulmonology]]
+[[Category:Surgery]]