This Manchester score for small cell lung cancer calculator prognoses 2 year survival in patients with SCLC based on laboratory data and the Karnofsky score. Below the form there is more information on the score interpretation and guidelines for this type of lung malignancy.


Elevated serum LDH


Serum Na <132 mmol/L


Elevated serum alkaline phosphatase >1.5x normal


Serum bicarbonate <24


Extensive stage disease


Karnofsky performance status

How does this Manchester score for small cell lung cancer calculator work?

This health tool predicts survival rates in patients with small cell lung cancer in the following 2 year period.

The Manchester score for small cell lung cancer calculator consists of 5 clinical parameters and one performance score for cancer patients receiving chemotherapy: the Karnofsky score.

■ Elevated serum LDH – overexpression characteristic to lung cancers;

■ Serum Na <132 mmol/L - Hyponatremia is a negative prognostic factor in several cancers, with overall 5 year survival rate of 74.8% in the case of patients with SCLC and high serum sodium concentration and 59.7% survival rate for patients with hyponatremia;

■ Elevated serum alkaline phosphatase ALP >1.5x normal;

Serum bicarbonate <24;

■ Extensive stage disease;

■ Karnofsky performance status.

The original study consisted of 407 patients with small cell lung cancer, diagnosed between 1979 and 1985, which have received short term treatment with cyclophosphamide, etoposide and methotrexate or ifosfamide and etoposide and thoracic irradiation.

The Manchester score has been successfully used in clinical practice in the initiation of chemotherapy for ICU patients with lung cancer.

Manchester score interpretation

The five parameters are awarded each 1 point when positive and the Karnofsky scores less than 60 are assigned 1 point. These are all summed to reveal an overall score which is then correlated with the three prognostic groups to determine the two-year survival rate applicable to the case.

Manchester score Prognosis 2 year survival rate
≤ 1 Good 16.20%
2, 3 Medium 2.50%
≥ 4 Poor 0%

Small cell lung cancer

This is defined as a primary lung cancer because it starts in the lung, more precise in the bronchi which are the breathing tubes. There is another main group of lung cancer, the non small cell lung cancer NSCLC type.

SCLC accounts for 15% of diagnosed cases and carries the name from the fact that microscopically, the malignancy cells present themselves as small cells with nucleus covering most of the surface. The cells also known as oat cell cancer due to their appearance, tend to cluster and create large tumors.

The main cause is smoking, this being the lung cancer that is particular to smokers, with a higher incidence in males than females.

Symptoms of this type of cancer include bloody sputum, chest pain, shortness of breath, loss of appetite, weight loss, wheezing, fever, difficulty swallowing and a general feeling of malaise.

Diagnosis consists in clinical exams, i.e. stethoscope listening evidencing fluid or partial collapse of lung; chest x-ray, complete blood count, MRI, sputum test or thoracentesis amongst others.

In most cases a biopsy will be required with tissue collected from the lungs via bronchoscopy, CT scan directed needle biopsy, pleural or open lung biopsy.

Usually, the main therapeutic route is chemotherapy due to the fact that this type spreads early on and is the most aggressive type of lung cancer with metastasis in other parts of the body such as the brain or the liver.

Usually, radiation treatment can prolong life for half an year, a year in most cases.

As reflected in the Manchester score, prognosis depends highly on how much the cancer has spread and how early has been diagnosed as SCLC is a highly lethal type of malignancy with very low survival rates after 5 years.

The following table presents the 5 year survival rate based on TNM (tumour, nodes, metastasized) staging for SCLC:

Stage 5-year relative survival rate
I 31%
II 19%
III 8%
IV 2%


1) Kawahara M, Fukuoka M, Saijo N, Nishiwaki Y, Ikegami H, Tamura T, Shimoyama M, Suemasu K, Furuse K. (1997) Jpn J Clin Oncol; 27(3):158-65. Prognostic factors and prognostic staging system for small cell lung cancer.

2) Cerny T, Blair V, Anderson H, Bramwell V, Thatcher N. (1987) Pretreatment prognostic factors and scoring system in 407 small-cell lung cancer patients. Int J Cancer; 39(2):146-9.

3) Naito T, Tanaka F, Ono A, Yoneda K, Takahashi T, Murakami H, Nakamura Y, Tsuya A, Kenmotsu H, Shukuya T, Kaira K, Koh Y, Endo M, Hasegawa S, Yamamoto N. (2012) Prognostic impact of circulating tumor cells in patients with small cell lung cancer. J Thorac Oncol; 7(3):512-9.

4) Kobayashi N, Usui S, Yamaoka M, Suzuki H, Kikuchi S, Goto Y, Sakai M, Sato Y. (2014) The influence of serum sodium concentration on prognosis in resected non-small cell lung cancer. Thorac Cardiovasc Surg; 62(4):338-43.

24 Feb, 2016