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Small Cell Lung Cancer Treatment (PDQ®)
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General Information About Small Cell Lung Cancer
Key Points:
Small cell lung cancer is a disease in which malignant (cancer)
cells form in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs that are found
within the chest. The lungs bring oxygen into the body when breathing in and
take out carbon dioxide when breathing out. Each lung has sections called lobes. The left lung has two lobes. The right
lung, which is slightly larger, has three. A thin membrane called the
pleura surrounds the lungs. Two
tubes called bronchi lead from the
trachea (windpipe) to the right and
left lungs. The bronchi are sometimes also involved in lung
cancer. Small tubes called bronchioles and tiny air sacs called
alveoli make up the inside of the
lungs.
Respiratory anatomy; drawing shows right lung with upper, middle, and lower lobes; left lung with upper and lower lobes; and the trachea, bronchi, lymph nodes, and diaphragm. Inset shows bronchioles, alveoli, artery, and vein.
There are two types of lung cancer:
small cell lung cancer and
non-small cell lung cancer. This
summary provides information on small cell lung cancer. (Refer to the PDQ
summary on Non-Small Cell Lung Cancer
Treatment for more information.)
There are three types of small cell lung cancer.
These three types include many different types of
cells. The cancer cells of each type
grow and spread in different ways. The types of small cell lung cancer are
named for the kinds of cells found in the cancer and how the cells look when
viewed under a microscope:
- Small cell carcinoma (oat cell
cancer).
- Mixed small cell/large cell
carcinoma.
- Combined small cell carcinoma.
Smoking tobacco is the major risk factor for developing small
cell lung cancer.
Cigarette smoking is the most common cause of lung cancer.
Risk factors for small cell lung
cancer include:
- Smoking cigarettes, cigars, or pipes now or in the
past.
- Being exposed to second hand smoke.
- Being exposed to asbestos or radon.
Possible signs of small cell lung cancer include coughing,
chest pain, and shortness of breath.
These and other symptoms may be caused by small cell lung cancer
or by other conditions. A doctor should be consulted if any of the following
problems occur:
- A cough that doesn’t go away.
- Shortness of breath.
- Chest pain that doesn’t go away.
- Wheezing.
- Coughing up blood.
- Hoarseness.
- Swelling of the face and neck.
- Loss of appetite.
- Unexplained weight loss.
- Unusual tiredness.
Tests and procedures that examine the lungs are used to detect
(find) and diagnose small cell lung cancer.
The following tests and procedures may be used:
-
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Chest x-ray; shows patient standing with back to the x-ray machine. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
-
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
-
Sputum cytology: A
microscope is used to check for cancer cells in the sputum (mucus coughed up
from the lungs).
-
Laboratory tests:
Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.
-
Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
Bronchoscopy; drawing shows a bronchoscope inserted through the mouth, trachea, and bronchus into the lung; lymph nodes along trachea and bronchi; and cancer in one lung. Inset shows patient lying on a table having a bronchoscopy.
-
Fine needle
aspiration biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. A pathologist views the tissue or fluid under a microscope to look for cancer cells. This procedure is also called a needle biopsy.
Lung biopsy; drawing shows a patient lying on a table that slides through the computed tomography (CT) machine with an x-ray picture of a cross-section of the lung on a monitor above the patient. Drawing also shows a doctor using the x-ray picture to help place the biopsy needle through the chest wall and into the area of abnormal lung tissue. Inset shows a side view of the chest cavity and lungs with the biopsy needle inserted into the area of abnormal tissue.
-
Thoracentesis:
Removal of fluid from the pleural
cavity (the space between the lungs and chest wall) through a
needle inserted between the ribs.
Certain factors affect prognosis (chance of recovery) and
treatment options.
The prognosis (chance of
recovery) and treatment options depend on the following:
- The stage of the cancer (whether it is in the chest
cavity only or has spread to other places in the body).
- The patient’s gender
and general health.
- The blood level of lactate dehydrogenase (LDH), a substance found in the
blood that may indicate cancer when the level is higher than normal.
For most patients with small cell lung cancer, current
treatments do not cure the cancer.
If lung cancer is found, participation in one of the many
clinical trials being done to
improve treatment should be considered. Clinical trials are taking place in
most parts of the country for patients with all stages of small cell lung
cancer. Information about ongoing clinical trials is available from
NCI Web
site
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Stages of Small Cell Lung Cancer
Key Points:
After small cell lung cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the chest or to other parts of
the body.
The process used to find out if cancer has spread within the chest or to other parts
of the body is called staging. The
information gathered from the staging process determines the
stage of the disease. It is
important to know the stage in order to plan treatment. The following
tests and procedures may be used in the staging process:
The following stages are used for small cell lung cancer:
Limited-Stage Small Cell Lung Cancer
In limited-stage,
cancer is found in one lung, the tissues between the lungs, and nearby
lymph nodes only.
Extensive-Stage Small Cell Lung Cancer
In extensive-stage,
cancer has spread outside of the lung in which it began or to other parts of the
body.
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Recurrent Small Cell Lung Cancer
Recurrent
small cell lung cancer is
cancer that has recurred (come back)
after it has been treated. The cancer may come back in the chest,
central nervous system, or in other
parts of the body.
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Treatment Option Overview
Key Points:
There are different types of treatment for patients with small
cell lung cancer.
Different types of treatment are available for patients with
small cell lung cancer. Some
treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before
starting treatment, patients may want to think about taking part in a clinical
trial. A treatment clinical trial is a research study meant to help improve
current treatments or obtain information on new treatments for patients with
cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from
NCI Web
site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Three types of standard treatment are used:
Surgery
Surgery may be used if
the cancer is found in one lung and in nearby lymph
nodes only. Because this type of lung cancer is usually found in
both lungs, surgery alone is not often used. Occasionally, surgery may be used
to help determine the patient’s exact type of lung cancer. During surgery, the
doctor will also remove lymph nodes to see if they contain cancer.
Laser therapy (the use of an
intensely powerful beam of light to kill cancer cells) may be used.
Even if the doctor removes all the cancer that can be seen at the
time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer
cells that are left. Treatment given after the surgery, to increase the chances
of a cure, is called adjuvant
therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation
(radiation therapy to the brain to reduce the risk that cancer will spread to
the brain) may also be given. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Other types of treatment are being tested in clinical trials.
Information about ongoing clinical trials is available from the
NCI Web
site.
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Treatment Options by Stage
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Limited-Stage Small Cell Lung Cancer
Treatment of limited-stage small cell
lung cancer may include the following:
-
Combination
chemotherapy and radiation
therapy to the chest, with or without radiation therapy to the
brain.
- Combination chemotherapy with or without radiation therapy to
the brain in patients with complete
response.
- Combination chemotherapy with or without radiation therapy to
the chest.
-
Surgery followed by chemotherapy or chemotherapy plus
radiation therapy to the chest, with or without radiation therapy to the
brain.
-
Clinical trials of
new chemotherapy, surgery, and radiation treatments.
This summary refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from
NCI Web
site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with limited stage small cell lung cancer.
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Extensive-Stage Small Cell Lung Cancer
Treatment of extensive-stage small cell
lung cancer may include the following:
This summary refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the
NCI Web
site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with extensive stage small cell lung cancer.
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Treatment Options for Recurrent Small Cell Lung Cancer
Treatment of recurrent
small cell lung cancer may include the following:
This summary refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the
NCI Web
site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent small cell lung cancer.
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Changes to This Summary (08/02/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Images were added to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
