Lung Cancer — Small Cell MCQ — NEET PG Practice Question | NEETPGAI
Lung Cancer — Small Cell
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microscope Pathology
A 58-year-old male smoker from Delhi presents with a 3-month history of progressive dyspnea, chest pain, and hemoptysis. Chest X-ray shows a central hilar mass with mediastinal widening. Bronchoscopic biopsy confirms small cell lung cancer (SCLC) with extensive involvement of mediastinal lymph nodes. CT chest and abdomen are normal. MRI brain shows no intracranial lesions. What is the most appropriate next step in management?
A. Immediate chemotherapy with cisplatin and etoposide
B. Palliative radiotherapy to the primary site
C. Surgical resection of the primary tumor followed by adjuvant chemotherapy
D. Staging with PET-CT and lumbar puncture before treatment initiation
Explanation
Management of Small Cell Lung Cancer (SCLC)
Key Point
Small cell lung cancer is staged as limited-stage (LD-SCLC) or extensive-stage (ED-SCLC). In this patient, CT chest/abdomen is normal and MRI brain is negative — standard staging is already complete. The confirmed diagnosis with mediastinal nodal involvement but no distant metastases places this patient in limited-stage SCLC, for which the standard of care is concurrent chemoradiotherapy. However, since thoracic radiotherapy planning is pending, initiating chemotherapy with cisplatin and etoposide is the most appropriate immediate next step.
Why Option A is Correct
High-YieldNEET PG
Once SCLC is diagnosed and standard staging (CT chest/abdomen + MRI brain) is complete and negative for distant metastases, treatment should not be delayed. Cisplatin + etoposide is the backbone of SCLC chemotherapy for both limited and extensive stage disease. In limited-stage SCLC, thoracic radiotherapy is added concurrently (ideally from cycle 1 or 2), but chemotherapy initiation is the immediate priority.
Clinical Pearl
SCLC is a rapidly proliferating tumor with a doubling time of ~30 days. Delay in treatment initiation significantly worsens prognosis. Standard staging in SCLC per NCCN and Indian guidelines includes CT chest/abdomen/pelvis and MRI brain — both of which have already been performed here.
Why Other Options Are Incorrect
Table
Option
Reason Incorrect
B) Surgical resection
Surgery is contraindicated in SCLC with mediastinal nodal involvement; SCLC is a systemic disease at presentation in >95% of cases
C) Palliative radiotherapy alone
Inappropriate as primary treatment; SCLC is chemosensitive and systemic therapy is mandatory
D) PET-CT + lumbar puncture
PET-CT may upstage disease but is NOT mandatory before initiating treatment when standard staging is already complete. Lumbar puncture is NOT a routine pre-treatment staging requirement in SCLC — it is reserved for symptomatic patients with suspected leptomeningeal disease. Delaying treatment for LP is not evidence-based.
SCLC Treatment Summary
Table
Stage
Treatment
Limited-stage
Concurrent cisplatin/etoposide + thoracic RT → PCI if complete response
Extensive-stage
Cisplatin/carboplatin + etoposide ± atezolizumab → PCI if complete response
Warning
The claim that LP is "mandatory" before treatment in limited-stage SCLC is not supported by Harrison's, NCCN guidelines, or standard Indian oncology practice. LP is performed only when leptomeningeal disease is clinically suspected.
Harrison 21e Ch 111; NCCN Guidelines SCLC v2024; DeVita Cancer: Principles & Practice of Oncology, 11e
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