21st February 2025

An 81-year-old woman with a 6-month history of weight loss and cough presents to A&E with a 2-week history of severe shortness of breath and a worsening of her cough.

An 81-year-old woman with a 6-month history of weight loss and cough presents to A&E with a 2-week history of severe shortness of breath and a worsening of her cough. She also reports 1 month of worsening back pain. A CT chest performed in A&E demonstrates a large right-sided lung mass with an associated pleural effusion and patches of interstitial changes, which are reported as likely lymphangitis carcinomatosa. There are also numerous bony lesions throughout the thoracic spine. The effusion is aspirated and cytology confirms a small cell lung cancer. 

In the context of lung cancer, which of the following features incurs the poorest prognosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.