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Patients with small cell lung cancer (SCLC) experience a wide range of signs and symptoms, the most common of which include a persistent cough and shortness of breath. Approximately 30% of patients develop pneumonia due to the compression of the tumor on the bronchi leading to bronchial obstruction and lung infection (pneumonia). Patients may also experience systemic symptoms of the disease including loss of appetite, unintentional weight loss, and a generalized feeling of fatigue and weakness.

The standard diagnostic "workup" for patients with suspected lung cancer include:

• Complete medical history and physical evaluation
• Chest X-ray
• Computed tomography (CT) scan of the chest and abdomen
• Magnetic Resonance Imaging (MRI) of the brain to determine if cancer has spread to the brain
• Biopsy - If a lung tumor is detected, a biopsy is necessary to determine if the tumor is malignant (cancerous) or benign (non-cancerous). A biopsy involves removing a small sample of the tumor and examining the specimen under a microscope to look for the presence of cancer cells.

Biopsy Techniques

Several different methods can be used to perform a biopsy including:

• Needle biopsy - A sample of tissue is obtained by inserting a fine needle through the chest wall and the tissue is examined under a microscope to look for the presence of cancer cells.

• Bronchoscopy - While the patient is sedated, a flexible, lighted tube called a bronchoscope is inserted through the nose or mouth into the trachea and lungs. A sample of tissue is then obtained and examined for the presence of cancer cells.

• Mediastinoscopy - This is a surgical procedure that allows the doctor to view the mediastinum - the space within the chest located between the lungs that contains the heart, major blood vessels, trachea, and esophagus. With the patient under general anesthesia, the surgeon makes a small incision just below the neck and inserts a special lighted tube called a mediastinoscope through the incision. A sample of tissue is then obtained from the mediastinal lymph nodes and the specimen is examined under a microscope for the presence of cancer cells. Complications of this procedure, which occur in about 2% of patients, include:

  • pneumothorax - partial or complete collapse of the lung
  • injury to the left recurrent laryngeal nerve
  • bleeding
  • infection

• Video-assisted thoracic surgery (VATS) - This is a new, minimally invasive surgical procedure that enables surgeons to perform an operation through 2 to 4 tiny openings between the ribs while at the same time viewing the patient's internal organs on a television monitor. Video-assisted thoracic surgery can be used to obtain a sample of tissue from a lung tumor to check for the presence of cancer.

• Thoracentesis - This is a procedure where a needle is inserted through the skin of the chest wall into the pleural space (the space between the lining of the outside of the lungs) and fluid is removed and checked for the presence of cancer cells.