A central hilar and mediastinal mass (often bulky nodes with a small or invisible primary), SVC compression, and early metastases to liver, adrenals, bone and brain — staged as limited or extensive disease.
Orient first
- Strongly associated with smoking; neuroendocrine, fast-growing, often metastatic at presentation.
- Limited disease fits within one radiotherapy field; extensive does not (VALG — verify use alongside TNM).
- Paraneoplastic syndromes (SIADH, Cushing, Lambert–Eaton) may bring the patient.
Acquire the study
- Contrast-enhanced CT chest and abdomen; MRI brain; PET-CT for staging where available.
The manoeuvre
- Mediastinal and hilar mass on the post-contrast series: size in cm; encasement of vessels and airways.
- SVC patency; collateral veins in the chest wall.
- Lung window: primary lesion (may be small), lymphangitic spread.
- Liver, adrenal and bone metastases on the same study.
- Pleural and pericardial effusion.
What confirms it
- Histology or cytology with staging.
What licenses you to exclude it
- A peripheral solitary nodule without nodes is an unusual SCLC presentation.
The classic misread
- Missing brain metastases — MRI brain is part of staging.