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Small Cell Lung Cancer Treatments

Treatment for limited-stage small cell lung cancer (SCLC) often aims to cure the cancer. Extensive-stage SCLC treatment usually aims to prolong your life and reduce your symptoms.

Small cell lung cancer (SCLC) makes up 10–15% of all lung cancers. It tends to spread quickly and has a poor outlook.

In the United States, people diagnosed with SCLC from 2012–2018 lived at least 5 years about 7% as often as people without SCLC.

It's important to note that a person's individual outlook depends on the stage of cancer when it's diagnosed and how it responds to treatment. As newer or improved treatments are available, survival rates may continue to increase.

Some of the most common treatments for SCLC include:

Doctors are also trying many new treatments in clinical trials to see if they're more effective than current options.

Read on to learn more about what types of treatments are used to treat SCLC and when these treatments might be recommended.

SCLC is usually divided into two types: limited-stage or extensive-stage. It's classified as extensive-stage if it has spread:

  • throughout your lung
  • to your other lung
  • to lymph nodes on the other side of your chest
  • About two-thirds of people have extensive-stage SCLC when they receive a diagnosis. Treatment for extensive-stage SCLC usually revolves around trying to extend your life and reduce symptoms.

    Treatment for limited-stage SCLC often aims to cure the cancer.

    Chemotherapy is used to treat limited- or extensive-stage SCLC, often in combination with other treatments. Chemotherapy drugs are usually given as an intravenous (IV) infusion or an injection. They're sometimes administered through larger IVs called central venous catheters.

    For limited-stage SCLC

    Treatment for limited-stage SCLC may include:

  • chemotherapy with or without radiation therapy to the chest
  • chemotherapy after surgery with or without radiation therapy
  • For extensive-stage SCLC

    Treatment for extensive-stage SCLC may include:

    Doctors often administer a combination of chemotherapy drugs to target cancer cells in different ways. Some of the most common combinations in people with SCLC include:

  • cisplatin and etoposide
  • carboplatin and etoposide
  • cisplatin and irinotecan
  • carboplatin and irinotecan
  • Learn more about how chemotherapy is used to treat SCLC.

    Immunotherapy medications stimulate your immune system to attack cancer cells. Doctors use a type of immunotherapy called immune checkpoint inhibitors to treat extensive-stage SCLC, often in combination with chemotherapy.

    Immune checkpoint inhibitors work by blocking proteins made by cancer cells that allow them to hide from your immune cells. In the case of SCLC, doctors administer atezolizumab or durvalumab to block the protein PD-L1.

    These drugs are usually given through an IV every 2–4 weeks.

    Learn more about immunotherapy for lung cancer.

    Radiation therapy is one of the most common treatments for SCLC. It involves aiming high energy rays at cancer cells to kill them. Doctors usually use external beam radiation therapy to treat lung cancer. This type of radiation therapy involves administering radiation from a machine outside of your body.

    For limited-stage SCLC

    Radiation therapy may be used to treat limited-stage SCLC:

  • in combination with chemotherapy
  • in combination with chemotherapy after surgery
  • as cranial irradiation to prevent the spread to your brain
  • For extensive-stage SCLC

    For extensive-stage disease, it may be administered:

  • to your chest if you respond to chemotherapy
  • to your brain, spine, bones, or other body parts as a palliative therapy
  • to your brain if you had a complete response to other treatments
  • Radiation as an initial SCLC treatment is usually given 1–2 times daily, 5 days per week for 3–7 weeks, according to the American Cancer Society (ACS). Cranial irradiation is usually administered for fewer than 3 weeks, the ACS says.

    Research from 2021 estimates that in 10–20% of people with SCLC, the cancer has spread (metastasized) to the brain by the time of diagnosis, while 50–80% eventually develop metastasis during treatment.

    Research from 2020 supports that cranial irradiation reduces the chances of cancer spreading to the brain, but it's less clear whether it improves survival.

    Learn more about radiation therapy for lung cancer.

    SCLC has usually spread too far to be treated surgically when it is diagnosed. Surgery may be used for limited-stage disease:

  • before chemotherapy
  • before chemotherapy in combination with radiation therapy
  • Surgery is usually performed under general anesthesia through a large incision in your back or chest. Doctors can use different types of surgery to treat lung cancer such as:

  • Pneumonectomy: This is a procedure where your entire lung is removed.
  • Lobectomy: This procedure to remove one of the lobes of your lung. Your right lung has three lobes and your left lung has two.
  • Sleeve resection: This is a procedure to treat tumors in large airways. It involves cutting above and below the tumor and reattaching the two ends of your airway.
  • Segmentectomy: This is a procedure to remove the part of a lobe that contains the tumor.
  • You may also have lymph nodes removed during any of these procedures.

    Learn more about types of surgery for lung cancer.

    Palliative procedures can help reduce your symptoms and increase your survival time. They don't aim to cure the cancer.

    Palliative procedures include:

  • radiation therapy to treat cancer that has spread to distant body parts
  • photodynamic therapy to improve your breathing, which involves injecting a light-activated drug into a vein
  • laser therapy to open blocked airways
  • stent placement to open up airways
  • treatments for fluid buildup around your lungs such as:
  • treatments for fluid buildup around the heart such as:
  • Learn more about the final stages of lung cancer.

    Researchers are continuing to examine new treatments for SCLC in clinical trials. These treatments will become the new standard treatments if researchers find they're more effective than current options.

    Some clinical trials currently underway include:

  • examining whether brain scans alone are as effective as brain scans with cranial irradiation for improving survival
  • examining whether the addition of radiation therapy to immune therapy improves survival of extensive-stage SCLC
  • examining the potential benefit of adding the drug BAY 1895344 to usual chemotherapy for advanced solid tumors (in particular, SCLC tumors)
  • examining the benefit of adding the immunotherapy drug atezolizumab to usual chemoradiation therapy
  • examining the drug tazemetostat combined with topotecan and pembrolizumab for recurrent SCLC
  • Learn more about clinical trials for SCLC.

    SCLC is an aggressive form of lung cancer. It has usually already spread beyond the lungs when it's diagnosed.

    Treatment for limited-stage SCLC often includes some combination of chemotherapy, surgery, and radiation therapy to try to cure the cancer.

    Extensive-stage disease is usually treated with a combination of chemotherapy, radiation therapy, and immunotherapy.


    Small-Cell Lung Cancer: Staging And Outlook

    Small-cell lung cancer is an invasive cancer that usually affects long-term smokers. It has two stages: limited and extensive. Each stage has a different outlook.

    Small-cell lung cancer (SCLC) is a rare, aggressive lung cancer that accounts for 10–15% of all lung cancers in the United States. It usually affects people with a long history of smoking, but anyone can develop it.

    Once someone receives a diagnosis of SCLC, doctors will try to see whether and where the cancer has spread. This is called staging. Doctors use the cancer stage to describe how much cancer is in a person's body and to decide how best to treat it.

    SCLC has two stages: limited stage and extensive stage. Doctors may use physical exams, imaging tests, biopsies, and other tests to determine the stage of cancer.

    In limited stage SCLC, the cancer is on only one side of the chest and is usually in only one lung. It may also have reached the lymph nodes on that side.

    Limited stage SCLC is usually contained enough to be treated with a single radiation field. Only 1 in 3 people with SCLC receive a diagnosis when their cancer is in the limited stage. In this stage, treatment may involve a combination of surgery, radiation, and chemotherapy.

    Doctors diagnose SCLC in the extensive stage in 2 out of 3 people who have this type of cancer. At this stage, the cancer has spread:

  • throughout one lung
  • into the other lung
  • to lymph nodes on the other side of the chest
  • to other parts of the body
  • The cancer may also be considered extensive stage SCLC if it has spread to the fluid surrounding the lungs.

    The goal of treatment for extensive stage SCLC is not to cure the cancer but to shrink it and help you live longer. Treatment at this stage of SCLC may include chemotherapy and, possibly, immunotherapy as first-line treatments.

    The American Cancer Society uses a more formal staging system to describe lung cancer progression. It's known as the TNM staging system and involves the following three factors:

  • Tumor (T): What are the size and extent of the main tumor? Has it grown into other areas?
  • Nodes (N): Has the tumor grown into nearby lymph nodes?
  • Metastasis (M): How far has the cancer spread to other organs, such as the adrenal glands, brain, liver, bones, or other lung?
  • Numbers or letters will appear with the T, N, and M to give more detail about each factor. In the TNM system, the earliest stage is stage 0 and the most advanced is stage 4.

    This staging system is used for both non-small cell lung cancer and SCLC, but it's considered less important for SCLC. The specifics of this system can be complex, so be sure to ask your doctor for a full explanation.

    The outlook for someone with SCLC depends on the stage of the cancer, the person's overall health, and the cancer's overall response to treatment. In general, the outlook for people with limited stage SCLC is better than for those with extensive stage SCLC.

    The SEER database tracks 5-year relative survival rates for various cancers. This system categorizes cancers into three groups:

  • Localized: The cancer has not spread outside the lung. This would relate to limited stage SCLC.
  • Regional: The cancer has spread beyond the lung to nearby lymph nodes or organs. This would relate to extensive stage SCLC.
  • Distant: The cancer has spread to other areas, such as the liver, bones, brain, or other lung. This would relate to a more advanced phase of extensive stage SCLC.
  • Here are the 5-year relative survival rates for SCLC based on SEER stage:

    However, these numbers don't take everything into account.

    People who receive an SCLC diagnosis now may have a better outcome, as treatments have improved over time. Your overall health and your specific cancer will also factor into your outlook.

    SCLC is an aggressive form of lung cancer that mainly affects people with a long history of smoking. It has two stages: limited stage SCLC and extensive stage SCLC.

    More people receive a diagnosis at the extensive stage since this type of lung cancer often does not have early symptoms.

    People who receive a diagnosis of limited stage SCLC usually have a more favorable outlook than those who receive a diagnosis of extensive stage SCLC. However, every person's response to treatment is different, and treatment options continue to improve over time.


    What's The Difference Between Small-cell Lung Cancer (SCLC) And Non-small Cell Lung Cancer (NSCLC)?

    Small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are the two main types of lung cancer. SCLC typically spreads more quickly and is more aggressive than NSCLC.

    Lung cancer — including both SCLC and NSCLC — is the third most common form of cancer among adults in the United States. Lung cancers account for about 12% of new cancer diagnoses.

    Learn the differences between the two types, including stages, treatment options, and outlook.

    In a person with SCLC, cancerous cells appear small and round under a microscope. The cells of NSCLC are larger.

    Both SCLC and NSCLC have several subtypes. More common NSCLC subtypes include:

  • adenocarcinoma
  • squamous cell carcinoma
  • large cell carcinoma
  • While SCLC also has subtypes, researchers do not typically distinguish between them.

    Some NSCLC subtypes may be more aggressive than others, but generally, SCLC is more aggressive than NSCLC.

    Smoking is a major risk factor for both types of lung cancer. Very few people who have never smoked receive a diagnosis of SCLC.

    Diagnosis

    If a person consults a doctor about possible symptoms of lung cancer, the doctor may ask questions, take a medical history, and perform a physical examination.

    If they suspect lung cancer, the doctor may request imaging scans, such as an X-ray or CT scan, and look for signs of a tumor, scarring, or a buildup of fluid.

    They may also request samples of phlegm to perform a sputum test. This can indicate whether cancer is present. The doctor may ask the person to provide a sample every morning for 3 days in a row.

    Doctors may also perform a biopsy. This involves using a needle to take a sample of cells from the lungs for examination under a microscope. They may do this during surgery.

    A biopsy can show whether cells are cancerous and what type of cancer is present, if any.

    Sometimes, the doctor requests a bronchoscopy. This procedure involves inserting a tool with a built-in camera through the mouth or nose and into the lungs. This helps healthcare professionals see the area and take tissue samples.

    Healthcare professionals may also carry out other tests to determine whether the cancer has spread beyond the lungs.

    What does lung cancer look like? Find out more.

    SCLC and NSCLC have similar symptoms. Sometimes, symptoms do not appear until the cancer reaches a later stage.

    Possible symptoms include:

  • hoarse voice
  • persistent cough
  • fatigue
  • shortness of breath and wheezing
  • difficulty swallowing
  • loss of appetite
  • chest pain and discomfort
  • a cough that brings up bloody mucus
  • swelling in the veins of the face and neck
  • Although the symptoms of the two types are similar, SCLC spreads more rapidly.

    A person may be more likely to experience symptoms once lung cancer has reached a later stage.

    Does lung cancer affect women differently? Learn more.

    Can shoulder pain be a sign of lung cancer? Find out more.

    The causes and risk factors for SCLC and NSCLC tend to be similar.

    Smoking is the main risk factor. Cigarette smoke and the chemicals it contains can damage the lungs, leading to cellular changes that may result in cancer.

    Additional risk factors include:

  • exposure to secondhand smoke
  • significant air pollution in the local area
  • older age
  • past exposure to radiation
  • exposure to arsenic and other chemicals, such as radon
  • exposure to asbestos, nickel, chromium, soot, or tar
  • a family history of lung cancer
  • HIV
  • Smoking is a major risk factor for lung cancer. Find some ideas for how to quit.

    The stage of cancer describes how far it has spread within the body.

    There are different ways to describe the stages. One simple way is:

  • In situ: Healthcare professionals have detected abnormal cells, but these cells have not yet become cancerous or spread.
  • Localized: The cancer is in only one place in the body.
  • Regional: The cancer has spread to nearby tissues or lymph nodes.
  • Distant: The cancer has spread to other parts of the body, such as the bones, brain, liver, or the other lung.
  • Unknown: There is not enough information to determine the stage.
  • However, each type of lung cancer has its own specific method of staging.

    Stages of NSCLC

    For this type of cancer, doctors typically use a 5-stage system:

  • Stage 0: Similar to "in situ," this means a doctor cannot detect cancerous cells through traditional imaging methods, but tests have revealed precancerous cells in the mucus or elsewhere in the body.
  • Stage 1: The cancer is in the lungs only.
  • Stage 2: The cancer has reached nearby lymph nodes or has grown larger than in stage 1 without spreading to the lymph nodes.
  • Stage 3: The cancer has spread to other lymph nodes in the chest, possibly to those in the middle or on the other side of the chest.
  • Stage 4: The cancer is present in both lungs, in other parts of the body, or both.
  • Stages of SCLC

    Doctors generally categorize SCLC into one of two stages:

  • The limited stage: The cancer is on one side of the chest. It may be in one lung and possibly in nearby lymph nodes.
  • The extensive stage: The cancer has spread either to the other lung or to other organs outside the original tumor.
  • Some doctors use further staging for SCLC.

    Can a person have both types?

    Researchers estimate that 5–28% of SCLC cases are "mixed." This means the person has both SCLC and NSCLC. Research suggests that mixed lung cancer may be easier to treat than SCLC alone.

    After making a diagnosis, a doctor can describe the treatment options and develop a treatment plan.

    Factors that affect the plan include:

  • the type of cancer
  • how far it has spread
  • the person's age and overall health
  • the availability of therapies
  • personal preferences
  • Each person's situation is different, and treatment will vary accordingly.

    NSCLC treatment options

    Treatment options for NSCLC include:

  • Surgery: A surgeon removes cancerous cells and any nearby lymph nodes that the cancer may affect. If cancer affects a large portion of the lungs, surgery may not be possible.
  • Radiation therapy: A radiologist directs a beam of radiation toward cancerous cells to destroy them.
  • Chemotherapy: A doctor gives a person powerful drugs that can kill cancer cells.
  • Endoscopic stents: If a tumor has blocked part of the airway, a surgeon may insert a stent to keep the airway open.
  • Targeted treatments: These drugs target specific genes or other factors that enhance cancer's ability to grow. Blocking these factors can help stop or delay the growth of some types of cancer.
  • Immunotherapy: This treatment aims to boost the immune system's ability to defend the body against cancer.
  • SCLC treatment options

    For SCLC, treatment mainly aims to manage the disease.

    Options include:

  • chemotherapy, which is the main treatment
  • radiation therapy, which may help boost the effectiveness of chemotherapy or help prevent the cancer from spreading to the brain
  • a combination of surgery and chemotherapy — doctors will use this approach when the cancer has not yet reached the lymph nodes, which is rare
  • immunotherapy
  • Doctors may use a combination of treatments for lung cancer, depending on the person's needs, the stage of cancer, and the tumor's location. Treatment may also include palliative care, or procedures and medications to relieve symptoms and improve a person's quality of life.

    Experts use past statistics to estimate the percentage of people who are likely to live for 5 or more years after a diagnosis of cancer. These estimations are called survival rates.

    They represent averages and do not account for factors such as a person's age or overall health.

    Researchers developed the following survival rates for 2023 based on people who received a lung cancer diagnosis between 2012 and 2018.

    NSCLC survival rates

    For NSCLC, the American Cancer Society (ACS) reports the following 5-year relative survival rates:

  • Localized cancer: 65%
  • Regional cancer: 37%
  • Distant cancer: 9%
  • The overall average likelihood of living for at least 5 years after NSCLC diagnosis is 28%.

    SCLC survival rates

    The ACS estimates the following 5-year survival rates for people with SCLC:

  • Localized cancer: 30%
  • Regional cancer: 18%
  • Distant cancer: 3%
  • The overall average likelihood of living for at least 5 years after a diagnosis of SCLC is 7%.

    Other factors that may affect survival rates include a person's age and whether the cancer has come back after treatment. Recurring cancer and advanced age can have a negative effect on survival rates.

    People who receive a diagnosis of NSCLC or SCLC now may have a better outlook than these numbers show, based on improved treatments and other factors.

    There are two main types of lung cancer: small-cell and non-small cell. Small-cell lung cancer is less common and more aggressive.

    Quitting smoking — or never smoking at all — can significantly reduce the risk of developing any type of lung cancer.

    Read this article in Spanish.






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