SMALL CELL LUNG CARCINOMA WITH CORONARY ARTERY DISEASE AND SUPERIOR VENA CAVA SYNDROME IN NON SMOKER, ELDERLY WOMAN PATIENT : A CASE REPORT

I Gede Arya Yoga Dharma  Wiguna; Bagus Agung Arya Dharma Pramana Dwi Sutanegara; I Putu Angga Manik Pratama; Luh Gede Janny Resista Yani; Ni Made Dwita Yaniswari

doi:10.31539/8g6wrd93

Authors

I Gede Arya Yoga Dharma Wiguna RSUD Wangaya
Bagus Agung Arya Dharma Pramana Dwi Sutanegara RSUD Wangaya
I Putu Angga Manik Pratama RSUD Wangaya
Luh Gede Janny Resista Yani RSUD Wangaya
Ni Made Dwita Yaniswari RSUD Wangaya

DOI:

https://doi.org/10.31539/8g6wrd93

Keywords:

Small cell lung carcinoma, non-smoker risk factors, coronary artery disease, superior vena cava syndrome.

Abstract

Small cell lung carcinoma (SCLC) is an aggressive form of lung cancer typically associated with tobacco exposure; however, a subset of patients develops SCLC without a history of smoking. This case report describes an elderly non-smoking female with SCLC complicated by coronary artery disease and superior vena cava (SVC) syndrome treated at Wangaya General Hospital. The patient presented with progressive dyspnea, facial swelling, and productive cough. Thoracic computed tomography revealed a large right lung mass compressing both the superior and inferior vena cava, accompanied by pleural effusion. Histopathological examination confirmed SCLC. The patient also had underlying coronary artery disease and electrolyte disturbances. Clinical and imaging findings were consistent with advanced-stage disease (T4N3M1) complicated by SVC syndrome. This case highlights a non-smoker SCLC phenotype with vascular compression and cardiovascular comorbidity, suggesting potential oncogenic mechanisms beyond smoking exposure. The coexistence of coronary artery disease and SVC obstruction posed challenges in clinical management, emphasizing the importance of individualized treatment strategies. Non-smoker SCLC remains underrepresented in the literature despite its increasing incidence and distinct biological characteristics. In conclusion, non-smoking–related SCLC with concurrent cardiovascular disease and SVC syndrome presents significant diagnostic and therapeutic challenges, and further documentation is essential to improve clinical understanding and guide future management approaches.

References

[1] S. Affo et al. (2017). Macrophage populations in the fibrotic liver: density, heterogeneity, and origin. Journal of Hepatology.

[2] A. Balci et al. (2008). The effect of hepatic steatosis on portal venous blood flow hemodynamics. European Journal of Radiology.

[3] M. Baikpour et al. (2020). Liver steatosis severity and changes in portal venous Doppler indices. Abdominal Imaging.

[4] J. Bosch, J.G. Abraldes & A. Berzigotti. (2020). The clinical use of HVPG measurement in chronic liver disease. Nature Reviews Gastroenterology & Hepatology.

[5] X. Chen et al. (2020). Polymorphisms in DNA repair genes increase susceptibility to small cell lung cancer in non-smokers. Nature Communications.

[6] ESMO. (2021). Clinical Practice Guidelines: Small Cell Lung Cancer. European Society for Medical Oncology.

[7] Y. Fan et al. (2022). Paraneoplastic syndrome of inappropriate antidiuretic hormone secretion in non-smoker small cell lung cancer cases. Cancer Immunology, Immunotherapy.

[8] J. George et al. (2015). Comprehensive genomic profiles of small cell lung cancer. Nature.

[9] J. George et al. (2022). Molecular profiling of small cell lung cancer reveals distinct features in non-smoker patients. Nature.

[10] GLOBOCAN. (2020). Indonesia Fact Sheet: Lung Cancer. International Agency for Research on Cancer.

[11] G. Gulati et al. (2022). Preserved ejection fraction reduces cardiac events during platinum-based chemotherapy in small cell lung cancer patients. Journal of the American College of Cardiology.

[12] L. Horn et al. (2023). Immune checkpoint inhibitor efficacy in non-smoker patients with small cell lung cancer: a phase III trial. New England Journal of Medicine.

[13] K. Ito et al. (2020). Clinical features and staging of non-smoking small cell lung cancer patients. Japanese Journal of Clinical Oncology.

[14] S. Kim et al. (2023). Thyroid hormone receptor beta downregulation and pulmonary neuroendocrine cell proliferation in hypothyroidism. Endocrinology.

[15] A.R. Lyon et al. (2021). Cardio-oncology research: impact of pre-existing coronary artery disease on chemotherapy toxicity in small cell lung cancer. European Heart Journal.

[16] O. Martinez-Iglesias et al. (2023). Thyroid hormone deficiency promotes small cell lung cancer progression via altered HIF-1α signaling. EBioMedicine.

[17] Z. Miao et al. (2022). Sinusoidal endothelial dysfunction in NASH and portal hypertension. Hepatology.

[18] K.D. Miller & N.H. Hanna. (2022). Epidemiology and biology of lung cancer subtypes. Cancer Journal.

[19] J.R. Molina et al. (2008). Small cell lung cancer: Epidemiology, risk factors, clinical features, and diagnosis. Mayo Clinic Proceedings.

[20] R.S. Nababa & C. Lesmana. (2022). Perubahan hemodinamik portal pada NAFLD: telaah literatur. Indonesian Journal of Gastroenterology.

[21] NCCN. (2024). Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. National Comprehensive Cancer Network.

[22] J.J. Nieto et al. (2021). Gastroesophageal reflux disease increases lung cancer risk through chronic microaspiration inflammation: a meta-analysis. Gastroenterology.

[23] S.Y. Park et al. (2021). Radiogenomic analysis in non-smoker small cell lung cancer indicating pulmonary vein invasion. Radiology.

[24] M.A. Perazella et al. (2022). Hyponatremia predicts increased nephrotoxicity risk from cisplatin chemotherapy. Clinical Journal of the American Society of Nephrology.

[25] R.N. Pillai et al. (2023). Thyroid hormone replacement therapy in small cell lung cancer: effect on disease progression. EBioMedicine.

[26] S.C. Powell et al. (2019). Clinical suspicion and diagnosis delay in non-smokers with small cell lung cancer. BMC Cancer.

[27] C.M. Rudin et al. (2021). Neuroendocrine differentiation and RB1 loss in non-smoker small cell lung cancer. Nature Reviews Cancer.

[28] J.K. Sabari et al. (2020). Paraneoplastic syndromes in small cell lung cancer. JCO Oncology Practice.

[29] D. Schuppan & J.M. Schattenberg. (2013). Non-alcoholic steatohepatitis: Pathogenesis and novel therapeutic approaches. Journal of Hepatology.

[30] B.J. Schneider et al. (2021). Immunotherapy toxicity risk in elderly small cell lung cancer patients over 75 years old. Journal of Clinical Oncology.

[31] R.L. Siegel et al. (2024). Cancer statistics 2024. CA: A Cancer Journal for Clinicians.

[32] L. Song et al. (2021). IL-17A pathway activation and GERD-related chronic inflammation in lung cancer pathogenesis. Cancer Research.

[33] K. Sonehara et al. (2022). Neutrophil-to-lymphocyte ratio as a prognostic factor in non-smoker small cell lung cancer. Lung Cancer.

[34] Y. Wang et al. (2020). Proteomic analysis of pleural effusion in non-smoker small cell lung cancer patients. Respiratory Research.

[35] I.R. Wanless & K. Shiota. (2018). Fibrosis distribution patterns in NAFLD and implications for portal hypertension. Hepatology.

[36] WHO. (2023). Tobacco and Lung Cancer: Global Evidence Summary. World Health Organization.

[37] J. Zhang et al. (2021). Epidemiology of small cell lung cancer in older female non-smokers. Lung Cancer.

[38] Y. Zhang et al. (2023). Interleukin-6 levels inversely correlate with anemia in non-smoker small cell lung cancer patients. Blood Advances.

[39] C. Zhou et al. (2022). Obstructive symptoms in non-smoker small cell lung cancer associated with larger tumor size. The Annals of Thoracic Surgery.