Small cell lung cancer

Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.

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Types

There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.

There are two main types of small cell lung cancer. These two 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).
• Combined small cell carcinoma.

Risk factors

Risk factors for lung cancer include the following:

• Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.
• Being exposed to secondhand smoke.
• Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace.
• Being exposed to radiation from any of the following:
• Radiation therapy to the breast or chest.
• Radon in the home or workplace.
• Imaging tests such as CT scans.
• Atomic bomb radiation.
• Living where there is air pollution.
• Having a family history of lung cancer.
• Being infected with the human immunodeficiency virus (HIV).
• Taking beta carotene supplements and being a heavy smoker.
• Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

When smoking is combined with other risk factors, the risk of lung cancer is increased.

Prevention

If you smoke, now is the time to quit. If you are having trouble quitting, talk with your provider. There are many methods to help you quit, from support groups to prescription medicines. Also try to avoid secondhand smoke. If you smoke or used to smoke, talk with your provider about getting screened for lung cancer. To get screened, you need to have a CT scan of the chest.

Symptoms

These and other signs and symptoms may be caused by small cell lung cancer or by other conditions. Check with your doctor if you have any of the following:

• Chest discomfort or pain.
• A cough that doesn’t go away or gets worse over time.
• Trouble breathing.
• Wheezing.
• Blood in sputum (mucus coughed up from the lungs).
• Hoarseness.
• Trouble swallowing.
• Loss of appetite.
• Weight loss for no known reason.
• Feeling very tired.
• Swelling in the face and/or veins in the neck.

Diagnosis

The health care provider will perform a physical exam and ask about your medical history. You will be asked whether you smoke, and if so, how much and for how long. When listening to your chest with a stethoscope, the provider may hear fluid around the lungs or areas where the lung has partially collapsed. Each of these findings may suggest cancer.

SCLC has usually spread to other parts of your body by the time it is diagnosed.

Tests that may be performed include:

• Bone scan
• Chest x-ray
• Complete blood count (CBC)
• CT scan
• Liver function tests
• MRI scan
• Positron emission tomography (PET) scan
• Sputum test (to look for cancer cells)
• Thoracentesis (removal of fluid from the chest cavity around the lungs)

In most cases, a piece of tissue is removed from your lungs or other areas to be examined under a microscope. This is called a biopsy. There are several ways to do a biopsy:

• Bronchoscopy combined with biopsy
• CT scan-directed needle biopsy
• Endoscopic esophageal or bronchial ultrasound with biopsy
• Mediastinoscopy with biopsy
• Open lung biopsy
• Pleural biopsy
• Video-assisted thoracoscopy

Usually, if a biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread. SCLC is classified as either:

Limited -- Cancer is only in the chest and can be treated with radiation therapy. Extensive -- Cancer has spread outside the area that can be covered by radiation.

Treatment

Because SCLC spreads quickly throughout the body, treatment will include cancer-killing drugs (chemotherapy), which are usually given through a vein (by IV).

Treatment with chemotherapy and radiation may be done for people with SCLC that has spread throughout the body (most cases). In this case, the treatment only helps relieve symptoms and prolongs life, but does not cure the disease.

Radiation therapy can be used with chemotherapy if surgery is not possible. Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells.

Radiation may be used to:

• Treat the cancer, along with chemotherapy, if surgery is not possible.
• Help relieve symptoms caused by the cancer, such as breathing problems and swelling.
• Help relieve cancer pain when the cancer has spread to the bones.

Often, SCLC may have already spread to the brain. This can occur even when there are no symptoms or other signs of cancer in the brain. As a result, some people with smaller cancers, or who had a good response in their first round of chemotherapy, may receive radiation therapy to the brain. This therapy is done to prevent spread of the cancer to the brain.

Surgery helps very few people with SCLC because the disease has often spread by the time it is diagnosed. Surgery may be done when there is only one tumor that has not spread. If surgery is done, chemotherapy or radiation therapy is still needed. The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Nivolumab(Brand name: Opdivo)nivolumab (Opdivo) was approved for the treatment of patients with metastatic small cell lung cancer (SCLC) with progression after platinum-based chemotherapy and at least one other line of therapy.

Additional images

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  Anaplastic (microcellular, oat cell) carcinoma from the lung (histopathology)

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  Histopathologic image of small-cell carcinoma of the lung. CT-guided core needle biopsy.

Prognosis

How well you do depends on how much the lung cancer has spread. SCLC is very deadly. Not many people with this type of cancer are still alive 5 years after diagnosis.

Treatment can often prolong life for 6 to 12 months, even when the cancer has spread.

In rare cases, if SCLC is diagnosed early, treatment may result in a long-term cure.

NIH genetic and rare disease info

• NIH info on Small cell lung cancer

Small cell lung cancer is a rare disease.

Small cell lung cancer Resources
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