Michele R Berman, MD and Mark S Boguski, MD, PhD

2 February 2021

Actor Dustin Diamond, best known for his role as Samuel “Screech” Powers on the 1990s teen sitcom “Saved by the Bell”, was recently hospitalized in Florida after experiencing “body pain” “After extensive testing, the 44-year-old was diagnosed with stage IV small cell lung cancer (SCLC) Diamond had one round of chemotherapy and a second round was scheduled, but it was free; His death was reported this week

After his diagnosis, Mario Lopez, castmate of “Saved by the Bell”, posted a thrown back and newer picture of himself and Diamond on Instagram with the message: “I connected with Dustin tonight and despite the news of his diagnosis is heartbreaking, we remain confident that he will overcome this I pray for him, &, his family and for a speedy recovery God bless “

Lung cancer includes two main types: SCLC and non-small cell lung cancer (NSCLC) The latter is any type of epithelial lung cancer other than SCLC and accounts for about 85% of lung cancers.The most common types of NSCLC are squamous cell carcinoma, large cell carcinoma, and adenocarcinoma, with some other types Occur less frequently Although NSCLCs are associated with cigarette smoking, adenocarcinomas can occur in patients who have never smoked.As a class, NSCLCs are relatively insensitive to chemotherapy and radiation therapy compared to SCLC

SCLC accounts for approximately 15% of bronchogenic carcinomas. There are two main types: small cell carcinoma (sometimes called oat cell cancer) and combined small cell carcinoma (SCLC combined with neoplastic squamous and / or glandular components)

At the time of diagnosis, approximately 30% of patients with SCLC have tumors that are confined to the hemithorax of origin, mediastinum, or supraclavicular lymph nodes These patients have limited stage disease (LD) Patients with tumors that have spread beyond the supraclavicular areas are said to have an extended-stage disease (ED)

SCLC is more responsive to chemotherapy and radiation therapy than other lung cancer cell types Cure is difficult to achieve, however, as SCLC tends to become more prevalent at diagnosis

According to SEER, the estimated number of new cases of lung cancer (SCLC and NSCLC combined) is in the USAS in 2020 it was 228820 The number of estimated deaths was 135720

Lung cancer is the leading cause of cancer-related mortality in the USAS Approximately 6% of men and women will be diagnosed with lung and bronchial cancer at some point in their life (based on data from 2015-2017)

The 5-year overall survival rate for lung and bronchial cancers is 205%, but the stage of cancer at diagnosis is an important factor in the survival rate: 5-year survival for patients with local stage lung cancer is 59%, 317 % for regional stage and 58% for distant stage disease At diagnosis, 17% of patients had localized disease, 22% regional, and 57% distant / metastatic

Age is the most important risk factor for most types of cancer. Other risk factors for lung cancer are:

Lung cancer may be symptomatic or appear accidentally on breast imaging Symptoms and signs may arise from the site of primary local invasion or compression of adjacent breast structures, distant metastasis, or paraneoplastic phenomena.The most common symptoms when presented are worsening cough, shortness of breath, and shortness of breath in others Symptoms are:

Symptoms can be caused by local invasion or compression of adjacent breast structures, such as B. Compression of the esophagus, which causes dysphagia, compression of the laryngeal nerves, which causes hoarseness, or compression of the superior vena cava, which causes facial edema and expansion of the superficial veins of the head and neck. Symptoms of distant metastases may also be present and include neurological defects or personality changes due to brain metastases or pain due to bone metastases

Chemotherapy and radiation therapy have been shown to improve the survival of patients with small cell lung cancer Chemotherapy and radiation are the primary treatment modalities for LD and ED The combination of platinum and etoposide is the most widely used standard chemotherapeutic regimen

SCLC is highly sensitive to radiation, and thoracic radiation therapy improves the survival of patients with LD and ED tumors. Prophylactic skull irradiation prevents recurrence of the central nervous system and can improve the long-term survival of patients in good performance who have responded to chemoradiotherapy and provide relief from symptomatic metastatic disease

The role of surgery in treating patients with SCLC has not been established Small case series and population studies have reported favorable results for the minority of LD patients with very limited disease, with small tumors pathological to the original lung or lung and the ipsilateral Hilal lymph nodes were restricted due to surgical resection with adjuvant chemotherapy

In recent years, immune checkpoint inhibitors, including programmed cell death-1 inhibitors (PD-1) or programmed death ligand-1 inhibitors (PD-L1), have been used for the frontline treatment of patients with SCLC im Extensive stage added Two PD-L1 inhibitors, atezolizumab (Tecentriq) and durvalumab (Imfinzi), showed an overall survival increase when combined with platinum and etoposide compared to the same combination chemotherapy alone.Pembrolizumab (Keytruda) is also approved as a third-line treatment for metastatic SCLC in late 2020 However, another PD-1 inhibitor, nivolumab (Opdivo), was discontinued after negative test results for the SCLC indication

The National Cancer Institute has published a summary of treatment options for patients with LD, ED, and relapsed SCLC

Regardless of the stage, the current prognosis for patients with SCLC is unsatisfactory despite improvements in diagnosis and therapy over the past 25 years. Without treatment, SCLC has the most aggressive clinical course of all types of lung tumors with a mean survival from diagnosis of only 2 to 4 months About 10% of the total population of SCLC patients remain disease free in the two years from the start of therapy, the period when most relapses occur, but even these patients are at risk of death from lung cancer (both small and non-small cell types ) Overall survival at 5 years is 5% -10%

An important prognostic factor for SCLC is the extent of the disease Patients with LD have a better prognosis than patients with ED. Patients with LD have a mean survival of 16 to 24 months and a 5-year survival of 14% with current treatments reports patients diagnosed with LD who smoke should be encouraged to quit smoking before undergoing combination therapy, as continued smoking can affect survival

Long-term survival has been shown to improve long-term survival in patients with LD with combined modality therapy.Although long-term survivors have been reported in patients who received either surgery or chemotherapy alone, chemotherapy combined with chest radiation therapy (TRT) is becoming the standard Considered for treatment The addition of TRT increases absolute survival compared to chemotherapy alone by about 5% The optimal timing of TRT compared to chemotherapy has been assessed in several studies and meta-analyzes, with the weight of evidence indicating little benefit for early TRT

Patients with ED have a median survival of 6 to 12 months with currently available therapy, but long-term disease-free survival is rare

Because the outcome for lung cancer patients is so dependent on the stage at which cancer is detected, researchers have looked for ways to get the diagnosis earlier. Our story on Peter Fonda tells you what methods are being studied to advance early detection

Michele R Berman, MD and Mark S Boguski, MD, PhD, is a wife and husband team of physicians who have trained and taught at some of the best medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Your mission is both journalistic and educational: you cover common diseases that affect unusual people and sum up the evidence-based medicine behind the headlines

The material on this website is for informational purposes only and is not a substitute for medical advice, diagnosis, or treatment from a qualified health care provider
© 2021 MedPage Today, LLC All rights reserved. Medpage Today is a federally registered trademark of MedPage Today, LLC and may not be used by third parties without express permission


World News – AU – Dustin Diamonds Small Cell Lung Cancer