I'm 5-4 and about 150 these days. I think my cab is small. However, I've also sat three across so it is really bigger than it feels. I like the fact that I can reach the pedals without adjusting the seat, but I'm not to up close and personal with the steering wheel. In terms of the height, It' fine for me as long as I remember that speed bumps actually work against older trucks.
Mine's all stock, but with a tilt column and the other things discussed you certainly could make it work.
