E-38. Historical milestones in small cell lung cancer

Abstract

Small cell carcinoma of the lung was first recognized as a distinct malignant disease entity different from the other common types of lung cancer in 1926 by W.G. Barnard under the name of “oat cell carcinoma of the mediastinum” [l]. The term “oat cells” was used because of the resemblance of the malignant cells to grains of oats. Long before, however, Harting and Heese [2] described a fatal chronic pulmonary disorder of endemic occupational hazard of the mountain region entitled: “Bronchialkatharr” in the Schneeberg mines of Saxony. The authors conclude that the cause was long years of exposure to arsenic and other metals. In 1917 the miners’ disease was proved to be lung cancer, presumably small cell lung cancer, linked to the exposure of radiation in the mines, as subsequently shown by Saccomanni et al. [3] in studies from the silvermines in Colorado. The histopathologic classification of small cell lung cancer has since evolved, first through the classification made in 1962 by Kreiberg [4] who categorized SCLC into 2 subtypes: oat and fusiform. In 1967, the WHO classification (revised in 1981) appeared with 4 subtypes: oat cell, intermediate and combined oat cell carcinoma. In 1988, the IASLC Pathology Panel recommended that the terms “oat cell carcinoma” and “mediate cell type” be replaced by 3 subtypes: “small cell”, “mixed small cell/large cell carcinoma” and “combined small cell carcinoma”. Compared to the other types of lung cancer, SCLC is characterized clinically by a high propensity to disseminate to organs such as lymph nodes, bone marrow, brain, liver, etc. already at the time of diagnosis. Patients with SCLC often have various paraneoplastic syndromes, most frequently mediated by production of peptide hormones or antibodies linked to the neuroendocrine origin of SCLC. Because of the disseminated nature of the disease, the corner stone for management is combination chemotherapy, which started to develop around 1970 after it had been demonstrated that SCLC was more sensitive to cytostatic agents than the other histologic types of lung cancer [5]. Since then, modest progress has taken place (Table 1) with the incorporation in the late 1980s of Table 1