NY Times’ David Carr Died of Lung Cancer

Many were shocked last week when NY Times culture and media reporter David Carr collapsed at his desk and died.

An autopsy performed on Carr revealed that the 58 year old died of complications from metastatic lung cancer, specifically small cell neuroendocrine carcinoma of the lung. A spokeswoman for the New York City medical examiner’s office, Julie Bolcer,  said the autopsy showed that heart disease also contributed to his death.

Carr joined The New York Times in 2002, where he  wrote The New York Times Media Equation blog. He was known for his plainspoken style that was often blunt, while being “searingly honest about himself.”

In 2008, he wrote his memoir, The Night of the Gun, which detailed his past experiences with cocaine addiction, and as a cancer patient successfully treated for Hodgkin’s Lymphoma.

What is small cell neuroendocrine carcinoma of the lung?

There are two types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
In addition, there are two main types of small cell lung cancer: Small cell carcinoma ( formerly called oat cell cancer) and Combined small cell carcinoma.

Smoking increases the risk of small cell lung cancer. Smoking cigarettes, pipes, or cigars is the most common cause of lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer. If a person has stopped smoking, the risk becomes lower as the years pass.

neuroendocrine cellSmall cell lung cancer is believed to originate from specialized neuroendocrine cells that surround the bronchi. Neuroendocrine cells contain little sacs called secretory granules that release substances such as hormones and peptides. Tumors that arise from overgrowth of neuroendocrine cells are called carcinoid tumors.

Up to 25% of all carcinoid tumors are found in the lungs. They form in the major bronchi, the large tubes between the trachea (windpipe) and the lung tissue.

What are the symptoms of SCLC?

Signs and symptoms of small cell lung cancer include:

  • Chest discomfort or pain.
  • A cough that doesn’t go away or gets worse over time.
  • Trouble breathing.
  • Wheezing.
  • Blood in sputum (mucus coughed up from the lungs).
  • Hoarseness.
  • Trouble swallowing.
  • Loss of appetite.
  • Weight loss for no known reason.
  • Feeling very tired.
  • Swelling in the face and/or veins in the neck.

Because the tumors are formed from neuroendocrine cells, they can cause an increase in secretion of certain hormones. Overproduction of adrenocorticotropic hormone (a hormone from the adrenal gland), can cause Cushing’s disease.  The symptoms of Cushing’s disease include a puffy face, weight gain, a hump on the lower neck, or elevated blood sugar levels. Excess secretion of antidiuretic hormone can lead to water retention and low sodium, which can cause confusion.

What is the prognosis of SCLC?

Unfortunately small cell lung cancer can spread easily because of the rich network of blood vessels and lymphatics in the lungs. Blood and lymph can carry the cancer cells to other organs outside the lungs.

Regardless of stage, the current prognosis for patients with SCLC is unsatisfactory despite improvements in diagnosis and therapy made during the past 25 years. Without treatment, SCLC has the most aggressive clinical course of any type of pulmonary tumor, with median survival from diagnosis of only 2 to 4 months.

Only about 10% of the total population of SCLC patients remains free of disease during the 2 years from the start of therapy, which is the time period during which most relapses occur. Even these patients, however, are at risk of dying from lung cancer (both small and non-small cell types). The overall survival at 5 years is 5% to 10%.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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