Date:
Patient:
Reason for Visit:
Initial diagnosis of small cell lung cancer (SCLC)
Follow-up for established SCLC
Assessment of treatment response or disease progression
Management plan discussion
History:
Presenting Illness: (For initial evaluation)
Onset and duration of symptoms (cough, shortness of breath, chest pain, hemoptysis – coughing up blood, weight loss)
Smoking history (major risk factor)
Other risk factors (e.g., exposure to radon, occupational carcinogens)
Past Medical History (PMH):
Comorbid conditions (e.g., COPD, heart disease)
Previous surgeries or procedures (relevant to chest)
Social History:
Smoking history (quit date if applicable)
Occupational exposures
Physical Exam:
General: Assess vital signs (temperature, heart signs, respiratory rate, oxygen saturation). Look for signs of respiratory distress.
Chest: Evaluate for chest wall symmetry, breath sounds (presence of wheezing or crackles), signs of pleural effusion (fluid in the pleural space).
Lymph Nodes: Palpate for enlarged or tender lymph nodes in the neck, supraclavicular fossa (above the clavicle), or axillae (armpits).
Diagnostic Tests (may be ordered depending on clinical suspicion):
Imaging Studies:
Chest X-ray – may show signs of mass or lung consolidation.
CT scan of chest, abdomen, and pelvis – most important imaging study for diagnosis, staging, and identifying potential spread of cancer.
PET scan (may be used for staging or evaluating for recurrence)
Bronchoscopy: Direct visualization of the airways with biopsy for tissue diagnosis.
Sputum cytology (if productive cough): Microscopic examination of coughed-up mucus for cancer cells.
Blood tests: Complete blood count (CBC), electrolytes, liver function tests (LFTs).
Assessment:
Confirmation of SCLC: Requires histopathological examination of a biopsy specimen.
Staging (if diagnosis confirmed): Determines the extent of cancer spread (limited – confined to one lung and nearby lymph nodes, or extensive – spread beyond one lung). Staging is crucial for treatment planning and prognosis.
Performance status: Evaluates the patient’s functional ability using a standardized scale (e.g., ECOG performance status).
Plan:
Treatment approach depends on several factors:
Stage of disease
Performance status
Patient’s overall health
Standard treatment for SCLC is typically chemoradiation therapy:
Chemotherapy – a combination of multiple chemotherapy drugs is used to target cancer cells throughout the body.
Radiation therapy – may be delivered to the chest (thoracic radiation) to shrink the tumor and kill cancer cells in the area.
Other treatment options may be considered:
Surgery (for very limited stage disease)
Targeted therapies or immunotherapy (may be used in specific situations)
Palliative care (to manage symptoms and improve quality of life in advanced stages)
Smoking cessation counseling: Strongly encouraged for all patients with SCLC.
Follow-up:
Regular follow-up appointments to monitor for response to treatment, disease progression, and manage side effects.
Imaging studies (CT scans) to assess treatment response and detect recurrence.
Additional treatment decisions based on follow-up findings.
Patient education: Provide information about SCLC, its diagnosis, treatment options, potential side effects, and importance of smoking cessation.
Discuss the importance of a healthy lifestyle and maintaining a positive outlook.
Encourage open communication about any concerns or questions.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of small cell lung cancer.