Small Cell Lung Cancer

Your lungs are two sponge-like, air-filled organs located on either side of your chest. When you inhale, your lungs absorb oxygen and send it to the bloodstream for use by your cells. Carbon dioxide, a waste product of cells, travels through the bloodstream to the lungs. It is released when you exhale.

There are two major types of lung cancer—small cell lung cancer and nonsmall cell lung cancer. Small cell lung cancer (SCLC) is much more aggressive than nonsmall cell lung cancer. In SCLC, the cells grow quickly and spread to other parts of the body. There are two kinds of SCLC—oat cell cancer (also called small cell carcinoma) and combined small cell carcinoma. Oat cell cancer is diagnosed more frequently than combined small cell carcinoma.

Unfortunately, SCLC is an aggressive form of cancer that is usually only caught after it has spread through the body. As a result, survival rate is low—according to the National Institutes of Health,

SCLC represents approximately 15 percent of all lung cancers, according to the National Institutes of Health (Dugdale, et al., 2011).

Nearly all patients who are diagnosed with SCLC are smokers; it is rarely found in nonsmokers. Other individuals at risk for developing this cancer are those who are exposed to secondhand smoke and those exposed to radon or asbestos.

The symptoms of lung cancer can be similar to the symptoms of other conditions. SCLC is usually asymptomatic (meaning it has no symptoms) until it has spread extensively. Symptoms can include:

• bloody mucus from the lungs
• breathing problems
• chest pain or discomfort
• persistent cough or hoarseness
• loss of appetite
• fatigue
• facial swelling

If you have any of these symptoms, see your doctor immediately. It may not be SCLC, but if it is, it’s best to detect it early.

Physical Exam and Diagnostic Tests

Your doctor will do a complete physical exam and take a medical history. Based on your symptoms, your doctor will likely ask for your smoking history. Various tests are used to help accurately diagnose SCLC, including:

• bone scan
• chest X-ray
• complete blood count
• imaging tests (MRI, CT scan, PET scan)
• microscopic examination of sputum
• lung biopsy

Staging the Cancer

Once there is a definite diagnosis of cancer, the cancer will be staged. SCLC is usually broken down into two stages:

Limited stage: the disease is confined to one side of your chest. Your lymph nodes might also be affected.

Extensive stage: the disease has spread to the other side of the chest, involving the other lung and/or lymph nodes, or to other parts of the body.

If cancer cells are found in the fluid surrounding the lungs, the cancer would also be considered extensive stage disease. At this stage, the cancer is not curable. According to the American Cancer Society, two out of three people have extensive stage SCLC at the time of their diagnosis (ACS).

Treatment for SCLC is aggressive—quick treatment is likely to lead to better long-term outcomes. For individuals whose disease is in an extensive stage, treatment is aimed at symptom relief and not eradication of disease.

Surgery

Surgery is typically done only when there is just one tumor and cancer cells have not spread to distant parts of the body. However, this is rarely the case upon diagnosis of SCLC. As a result, surgery is not typically helpful.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. The medications may be administered intravenously or taken orally. They travel through the bloodstream to kill cancer in distant organs.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. Radiation may be combined with chemotherapy to ease pain and other symptoms. In some cases of SCLC, a person’s brain may be treated with radiation. Even in cases where a patient with SCLC does not necessarily show symptoms of brain cancer, there is a chance that the cancer has spread to the brain.

Because SCLC is such an aggressive disease, the survival rate is low. For limited stage SCLC, there is a 45 percent 2-year survival rate and a 20 percent 5-year survival rate (Arrigada, et al. 1993). For extensive stage SCLC, life expectancy drops to about 12 months. There is a 2-year survival rate of only 4.6 percent (Lally, et al., 2007).

Talk with your doctor and treatment team about the specifics of your disease and the treatment options that are best for you. Each individual is different, and your treatment will be tailored to your needs.