The lungs are two organs in the chest that are responsible for breathing. Lung cancer is the second most common cancer in both men and women and the leading cause of cancer-related deaths in the United States. There are two main types of lung cancer:
- Non-Small Cell Lung Cancer (NSCLC)
- Small Cell Lung Cancer (SCLC)
What is Small Cell Lung Cancer?
Small cell lung cancer is a form of lung cancer that typically grows faster than non-small cell lung cancer and spreads to the lymph nodes and other organs more quickly. It is seen mostly in people who currently or formerly smoked (about 98 percent of cases are attributed to smoking).
At the time of diagnosis, the cancer usually has spread and is considered a systemic disease. SCLC often can be treated with chemotherapy drugs.
Risk Factors, Symptoms and Screening
Research is improving our understanding of lung cancer and its causes. The following are known risk factors for disease:
- History of Smoking - The risk of developing lung cancer is related to the total lifetime exposure to cigarette smoke. People who smoke more cigarettes or over more years have a higher risk.
- Secondhand Smoke - People who have had regular exposure to secondhand smoke are at high risk. Exposure can come from living or working in a place where people smoke.
- Age - Most people are older than 65 years when diagnosed with lung cancer.
- Environment - Exposure to high levels of certain natural gases and chemicals such as radon, uranium, arsenic, bischloromethyl ether, asbestos, chromium, nickel, soot, tar and other substances can cause lung cancer.
- Family History - People with a family history of lung cancer may be at risk. It is important to tell your doctor about your family’s cancer history.
Signs and Symptoms
Some people with lung cancer may develop one or more of the following symptoms. These symptoms may also be associated with other medical conditions. If you notice any of these symptoms, please speak with your doctor.
- Persistent and intense coughing or coughing blood
- Pain in chest, shoulder or back
- Change in color and amount of sputum
- Shortness of breath
- Change in voice
- Weight loss
- Stomach or bone pain
- Central nervous system (CNS) changes (i.e. one-sided weakness)
Lung cancer screening (in the form of a CT scan) is recommended for high-risk groups. The U.S. Services Task Force recommends screening for people ages 55-80 who:
- Currently smoke
- Previously smoked and have quit within the last 15 years
- Have a history of more than 30 pack years (e.g., 1 pack-per day for 30 years or 2 packs-per day for 15 years)
If you are considering screening for lung cancer, talk to your doctor so you have a clear understanding of the process.
Diagnosis and Staging
The first step in diagnosing lung cancer is a physical exam. A doctor will listen to your lungs and the sounds of your breathing, check for swollen lymph nodes in the neck or the region above the collarbones and feel the liver to see if it is enlarged or if any masses are present in the stomach area. One or more tests may follow.
Staging is used to find out whether the cancer has spread, and if so, to which parts of the body. Small cell lung cancer is staged differently from NSCLC, and guidelines around its staging are changing. In general, in order to decide on the best treatment, doctors classify the disease as either limited-stage or extensive-stage disease.
- Limited-stage: The cancer is in one lung, and may be within the surrounding area on the same side of the chest or adjacent lymph nodes.
- Extensive-stage: The cancer has spread outside the lung to the surrounding area or to other areas of the body.
In addition, The American Joint Committee on Cancer TNM staging system also may be used to collect information on the tumor (T), the lymph nodes involved (N) and metastasis or how the cancer has spread (M).
Treatment and Side Effects
Treatment depends on the extent, or spread, of the cancer but generally follows these guidelines.
Newly Diagnosed Limited-Stage SCLC
According to the National Cancer Institute, current treatment for people with newly diagnosed limited-stage SCLC should be four cycles of combination chemotherapy containing VP16 (etoposide) and cisplatin at the same time as chest radiation. Combination chemotherapy means that more than one drug is given at the same time.
When chemotherapy and radiation are successful, people with SCLC may be eligible for prophylactic cranial irradiation (PCI). Prophylactic cranial radiation is radiation therapy to the brain. PCI can keep the cancer from spreading to the brain, a common and serious outcome of SCLC.
Newly Diagnosed Extensive-Stage SCLC
Extensive-stage SCLC is treated using the same chemotherapy as in limited-stage SCLC but without the additional radiation therapy. If SCLC does not respond to the first treatment, it is considered resistant. If it returns within two years of successful treatment, it is considered recurrent.
Resistant or Recurrent SCLC
The goal of therapy in these cases is to improve quality of life and prolong survival. Chemotherapy may be used.
Lung cancer treatment is a very active area of research. You or your doctor may be interested in trying a clinical trial. Clinical trials can offer the opportunity to benefit from the latest treatments or combinations of treatments while helping advance knowledge of the disease and its treatment options. Ask if a clinical trial might be right for you.
Clinical trials have specific guidelines and eligibility criteria. Your doctor or nurse can explain what participating in a clinical will involve and how it may affect your care and daily life. Learn more about clinical trials.
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