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Stage 4 Neuroendocrine Small Cell Lung Cancer
Neuroendocrine small cell lung cancer (SCLC) occurs when neuroendocrine tumors develop as a result of overactive, cancerous neuroendocrine cells. Stage 4 is extensive stage SCLC.
Neuroendocrine cells are specialized cells found in many parts of the body, including the gastrointestinal (GI) tract, gallbladder, and lungs.
These cells receive signals from the brain to produce and release certain hormones that control many bodily functions.
Neuroendocrine tumors (NETs) develop when neuroendocrine cells become overactive and cancerous. NETs typically involve the GI tract and the lungs.
Small cell lung cancer (SCLC), also called oat cell cancer, accounts for 10–15% of all lung cancers. It is also the most prevalent type of neuroendocrine lung tumor.
Once a doctor makes a diagnosis, they determine how much the cancer has spread through staging.
Most doctors use a two-stage system for SCLC, dividing it into limited and extensive disease. Generally, extensive disease is the same as stage 4.
Stage 4 cancer means that cancer cells have spread from an original tumor to other parts of the body.
TNM stagingSome doctors may use the TNM staging system, though this is uncommon. TNM stands for tumor, node, and metastasis.
Stage 4, also called the advanced stage, means that cancer has spread. At stage 4, the tumor can be any size and may or may not have spread to nearby lymph nodes.
Neuroendocrine lung tumors are a family of tumors that arise from the cells that line the bronchi and other parts of the lung.
This disease group has distinct clinical and pathological characteristics. It varies in cell structure, features, appearance, presence of dead cells (necrosis), and the number of dividing cells (mitotic index).
Typical carcinoid (TC)TCs are low grade, slow-growing tumors that rarely spread (metastasize) outside the lungs. This type of tumor has a good outlook. Management and treatment typically involve surgery. Smoking is not associated with TCs.
Atypical carcinoid (AC)ACs are intermediate grade tumors that commonly affect people who smoke. They grow faster and tend to spread to the bones and liver.
SCLCSCLC is the most common NET of the lungs. It is also the most aggressive. In 70% of people with SCLC, the cancer has already spread to other areas by the time they receive a diagnosis. Smoking is the most significant risk factor for developing SCLC.
Large cell neuroendocrine carcinoma (LCNEC)Similar to SCLC, LCNEC is also a fast-growing tumor. However, it is not as common as SCLC. Smoking is also a major risk factor for developing LCNEC. LCNECs have cancerous cells that look similar to SCLC, though they are larger.
A 2021 article in the Annals of Oncology explains that people with carcinoids have a better outlook compared with those with SCLC and LCNEC. People who have carcinoids are also generally younger, and the disease is not strongly associated with smoking.
The 5-year relative survival rate for people with SCLC is 7%, compared with a 25% survival rate for those with non-small cell lung cancer.
Most people receive an SCLC diagnosis when their cancer has already spread extensively. A 2020 review notes that while SCLC tends to initially respond to chemotherapy, it is likely that people with it will go on to experience relapse or the disease will progress.
A person with SCLC may have symptoms related to a localized lesion (in the lung or lungs) or distant metastases (cancer that has spread to other parts of the body). Symptoms of localized lesions typically involve airway obstruction. This is because the cancer is in one or both lungs, meaning it will affect a person's airway.
Symptoms may include:
As the disease progresses and spreads, people may experience other symptoms, such as:
SCLC may also cause:
Endocrine involvement may include:
The majority of people with SCLC contact to their doctor because they experience symptoms of the disease. Before doctors ask people to undergo tests, they will first perform a thorough physical exam and take a medical history.
BiopsyIf results suggest the possibility of lung cancer, doctors may ask a person to undergo several tests. To make a diagnosis, specialists extract lung cell samples and examine them in a lab.
These tests include:
A pathologist will evaluate the samples and examine them under a microscope to check for the cell structure and appearance unique to SCLC.
Imaging techniquesDoctors can use several imaging techniques to help diagnose and monitor SCLC and other lung cancers. These include chest X-rays, CT scans, MRIs, bone scans, and PET scans.
The imaging techniques help identify suspicious masses or tumors that may be cancerous. They also help monitor cancer spread, its response to treatment, relapse, and whether it has returned.
Treatment for SCLC depends on the cancer's aggressiveness and a person's health status.
People with limited stage SCLC typically receive a combination of chemotherapy and chest radiation therapy. Surgery may also be an option for otherwise well individuals if the tumor is limited to one area. A person also receives chemotherapy after surgery.
Since brain metastasis is common, many people also receive radiation therapy to the head, called prophylactic cranial irradiation.
Surgery and radiation are not useful as initial treatments for extensive stage SCLC. The standard of care for this condition is radiation and a combination of the chemotherapy drugs etoposide and either cisplatin or carboplatin.
A 2020 review mentions that immunotherapy combined with chemotherapy is the new frontline treatment for SCLC. This combination may significantly improve the overall outlook for people with extensive stage SCLC.
Radiation therapy can also relieve symptoms caused by cancer growth in the lungs or when cancer has spread to other areas. People with additional health problems may benefit from low chemotherapy doses or supportive care to address complications and keep them as comfortable as possible.
Stage 4 neuroendocrine SCLC is the most common NET of the lung. Doctors often diagnose it when it has already spread.
Compared with other lung cancers, it has a poorer outlook. It is likely that a person will experience relapse even after their condition responds well to initial treatments.
Lung Cancer Symptoms And Three Signs You Should See Your GP Immediately
Lung cancer is the second most commonly diagnoses cancer in both men and woman across Scotland.
The disease was the most common cancer killer across the country in 2020, according to The Scottish Public Health Observatory, with more than 43,000 people across the UK diagnosed every year.
With the huge number of diagnosis, it is important to know the warning signs, with early detection possibly saving lives. Speaking to the Express, respiratory consultant Doctor Brian O'Connor of Cromwell Hospital, explained some of the symptoms to look out for, with three signs of concern meaning you should seek medical attention as soon as you can.
The expert explained that there are two main types of lung cancer - primary and secondary.
"Primary lung cancer starts in the lungs and there are different types of primary lung cancer, the most common being non-small cell lung cancer.
"Secondary lung cancer starts in another place in the body but spreads to the lungs."
And in terms of symptoms, Doctor O'Connor warned:"Many people with lung cancer have no symptoms at first, or sometimes the early symptoms can be slight, such as a cough or feeling a bit out of breath.
"Other signs to watch out for include feeling exhausted more than usual, experiencing pain in your chest, unexplained weight loss and a loss of appetite."
"If you're coughing up blood, have a persistent cough or are short of breath, see your GP as soon as possible, especially if you're over 40".
What are the symptoms of lung cancer?
© Getty Xray of lungs According to the NHS, the main symptoms of lung cancer include:
There are also less common symptoms of lung cancer, including:
It is important to contact your GP if you have any of the symptoms noted above.
What are the risk factors of lung cancer?Dr O'Connor commented: "Smoking is the biggest cause of lung cancer although you can also develop lung cancer if you've never smoked.
"Your risk of lung cancer is related to how much you smoke, how long you've been smoking and when you started smoking. It also depends on which type of cigarettes you smoke.
"You're at a higher risk of developing lung cancer if you regularly breathe in other people's tobacco smoke (passive smoking), so it's best to keep the environment around you smoke free.
"Whilst it's far more common in older adults (often 65 and older), it is still possible to develop lung cancer at a younger age.
"This common misconception could mean young people are less likely to be screened or seek medical help for symptoms."
What treatments are available for lung cancer?When it comes to treatment, Dr O'Connor added: "Treatment for lung cancer depends on the stage and type of lung cancer you have, how far it has spread and your overall health.
"As with all cancers, if diagnosed early it can make a difference on the type of treatment you have and outcomes following treatment.
"When diagnosed early and cancerous cells are confined to a small area, surgery may be used as the best treatment to remove the affected area of the lung.
"Radiotherapy can also be used to destroy the cancerous cells, this is favoured if your overall health means that surgery is an unsuitable option.
"If the cancer has spread around the body to make surgery or radiotherapy effective, then chemotherapy is used."
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READ NEXT:What's Causing My Lung Pain?
Pain in your chest and around your lungs may relate to any organ system within your chest or abdomen. This includes the:
Here are the most common conditions that can cause pain in your lungs or chest. If your pain persists, or if you're experiencing any of the symptoms below, speak with a doctor.
Lung-related causesA variety of conditions affecting your lungs may cause symptoms of lung pain. These include infections, diseases, and other medical issues.
PleurisyPleurisy happens when the membrane, or pleura, that lines the inner side of your chest cavity and surrounding lung becomes inflamed. This is commonly a result of a lung or respiratory infection.
Symptoms include sharp chest pain. This pain is often worse while deep breathing, coughing, or sneezing.
InfectionA variety of lung infections can cause chest pain. Common infections include:
Symptoms vary among infections, but it's common to have:
Lung infections can become life threatening. If you're experiencing any of these symptoms, see a doctor.
AsthmaAsthma is a chronic and long-term lung disease that causes irritated, narrow, and inflamed airways. During an asthma attack, your chest will feel tight, causing pain.
Asthma symptoms also include:
Pulmonary embolismA pulmonary embolism is a blood clot in your lungs. This can be life threatening.
A pulmonary embolism can damage part of the lung or other organs because it restricts blood flow and lowers the blood oxygen level. The most common symptom is chest pain and shortness of breath.
It can also cause:
If you're experiencing any signs or symptoms of pulmonary embolism, seek immediate medical attention.
Lung collapsePneumothorax causes the lung to collapse. It happens when air enters the area between your chest wall and your lung.
Atelectasis is a collapse due to pressure outside the lung, stopping it from expanding properly. It can also result from a lack of surfactant. This is a foamy substance inside the sacs of the lungs that keeps them open. Atelectasis can cause short, sharp lung pains and may only affect a portion of the lung.
A partial or total collapsed lung can happen because of:
If lung collapse occurs, you may experience:
Pneumothorax can be a complication of COVID-19 and has become much more common. In these instances, a person may experience sudden onset sharp chest pain and frequently require supplementary oxygen.
Doctors may treat this with supplemental oxygen in mild cases. In severe cases, a person may require surgical intervention.
If you experience symptoms of a lung collapse, contact your local emergency services immediately.
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Fluid in the chestPleural effusion, or fluid in the chest cavity,occurs when fluid builds up between your lungs and your chest wall.
This is typically a complication from other serious problems in the body. The cause determines the type of pleural effusion you have.
In exudative effusion, fluids build up from infection, inflammation, a lung injury, or a tumor.
In contrast, in transudative pleural effusion, fluids build up because of pressure from blood vessels caused by heart failure or kidney failure.
In addition to chest pain, this can cause:
Hyperventilationcan happen during anxiety or panic attacks. It can also be a response to certain conditions in your body. When you hyperventilate, you are breathing too rapidly.
When this occurs, you upset the balance between oxygen and carbon dioxide, which can cause:
Chest wall pain can occur with chest injuries, such as broken or bruised ribs, pulled muscles, and bruising to the chest itself.
Chronic muscle and skeletal syndromes such as fibromyalgia can also cause pain throughout the chest. Musculoskeletal conditions lead to around 10 to 50 percent of chest pain.
Heart-related causesMany heart conditions can cause chest pain and shortness of breath. Sometimes it may be difficult to tell whether the issue is in your heart or your lungs.
Heart diseaseHeart disease and other heart-related conditions can cause chest pain. These conditions include:
Symptoms vary across conditions. Besides chest pain, symptoms can also include:
If you're experiencing symptoms of a heart-related condition, seek immediate medical attention. In many cases, these conditions can be life threatening.
Rheumatic heart diseaseRheumatic heart disease, in particular, can cause lung or chest pain. This condition can result from rheumatic fever, a complication of bacterial strep infection. Rheumatic heart disease can damage the valves of your heart.
If the heart valves become damaged, you may experience:
Acid reflux happens when stomach acid comes up into the esophagus. Chest pain is a common sign of acid reflux. The pain can feel intense, which leads some people to mistake acid reflux for a heart attack.
Other symptoms include:
Other causesSome conditions can cause chest pain even though they aren't related to the lungs or their function.
Costochondritis happens when the cartilage of your rib cage becomes inflamed, causing intense pain. Chest pain is a main symptom of costochondritis and can be mild or severe. The pain may worsen with movement.
Costochondritis often results from strenuous exercise or a respiratory disease.
If you think you're experiencing costochondritis, see a doctor. Although it isn't life threatening, the pain can be persistent and interfere with daily activities. As with any chest pain, it's always important to know the cause so it can be properly treated.
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