What are the lungs?
The lungs are two organs in the chest that are responsible for breathing. They move oxygen from the air into the blood and carbon dioxide from the blood out of the body into the air. The lungs are divided into sections called lobes. There are three lobes in the right lung and two lobes in the left lung. A thin lining called the pleura surrounds the lobes. Air flows through your windpipe to the lung’s many tubes to help you breathe.
What is Small Cell Lung Cancer (SCLC)?
SCLC is found in fewer than 15 percent of people with lung cancer. As the name suggests, it is defined by smaller size of the cancer cells. It is sometimes called oat cell cancer. Most people who develop SCLC are current or former smokers. About 15 percent of lung cancers in the U.S. are small cell lung cancers.
SCLC tends to grow and spread to the lymph nodes and other organs faster than non-small cell lung cancer (NSCLC). At the time of diagnosis, the cancer usually has spread outside the lung and is considered a systemic disease. If your cancer spreads to the bone, visit our bone metastases page.
A risk factor is something that increases your chances of developing a disease. Tobacco smoke is the main risk factor for small cell lung cancer. People who smoke more cigarettes or smoke for more years have a higher risk of developing lung cancer. Those who live or work in places where people smoke are also at risk. The risk increases with the amount time spent using tobacco or breathing in tobacco smoke. Smokers and former smokers with high lifetime exposure may be eligible for lung cancer screening in the form of a low-dose CT scan. Talk with your doctor about the current guidelines and process for screening.
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 and has been shown to reduce deaths from lung cancer. 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.
Your doctor may use several different tests to determine if you have lung cancer, what type, and where it has spread. They include:
Physical exam – The exam will include questions about your medical history and any symptoms, such as cough, pain, or shortness of breath. Your doctor will listen to your breathing, check for swollen lymph nodes in or near the neck or collarbones, and feel your liver and stomach area for swelling or masses.
Imaging (scans) - Scans provide a picture of the lungs and other areas. They are used to look for tumors or abnormal cells. They help determine the extent or spread of the cancer. Common ones include:
- Chest x-ray – This is likely to be used first but does not provide as clear a picture as other scans.
- CT scan and MRI - CT (computed tomography) and MRI (magnetic resonance imaging) use computers to produce detailed, 3-D images. These images help diagnose lung cancer by determining the size, shape, and location of a tumor.
- PET scan - PET (positron emission tomography) uses a sugar substance and special camera to see if and where cancer has spread.
Samples of tissue, blood, or mucus – A sample of tissue or fluid will be needed to confirm cancer and identify its type and stage. There are many ways to obtain a sample. Common ones include:
- Needle biopsy - A small piece of tissue is removed and looked at under a microscope. This may be taken from the lung or a part of the body where the cancer has spread.
- Sputum cytology - A sample of sputum (mucus produced by a cough) is collected and looked at under a microscope.
- Thoracentesis - If there is fluid build-up around the lungs (called pleural effusion), a doctor can use a needle to remove some of the fluid. This can help you breathe better by expanding your lungs. A sample of the fluid can be sent to a lab to be tested for cancer cells.
- Bronchoscopy - A bronchoscope (a thin, lighted tube) is used to view the airways into the lungs and to collect tissue samples. Local anesthesia and mild sedation are generally used.
- Navigational bronchoscopy - This new technology uses a bronchoscope to provide a 3-D virtual “roadmap.” It is used to biopsy hard-to-reach parts of the lungs.
- Liquid biopsy - This new technology helps detect tumor DNA in your blood. It is still being studied and is best not used alone (without other types of biopsy) because it is not as sensitive as other types of biopsies.
Biomarker Testing - Biomarkers are features of your tumor cells that can be measured. The results of positive biomarker tests are used to match patients to targeted therapy. At this time, there are no approved targeted therapies for small cell lung cancer. Ask your health care team about clinical trials.
Small cell lung cancer is staged differently from non-small cell lung cancer. Doctors classify the disease as either limited-stage or extensive-stage disease. This helps them decide on the best treatment.
- 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 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
As of 2018, new drugs are being used to treat small cell lung cancer (SCLC). Treatment still depends on the extent, or spread, of the cancer. It generally follows these guidelines.
Limited-Stage SCLC (Newly Diagnosed)
Doctors use chemotherapy and radiation to treat limited-stage SCLC. Surgery is seldom used but may be an option when the cancer is found at an early stage.
- Chemotherapy uses drugs to destroy cancer cells anywhere in your body. It is most effective against cancer cells but can harm healthy cells too, causing side effects. There are many different chemo drugs to treat SCLC. Talk to your doctor about your options.
- Radiation should be used at the same time as chemotherapy. You may be eligible for prophylactic cranial irradiation (PCI). This form of radiation can keep the cancer from spreading to the brain, a common and serious outcome of SCLC.
Extensive-Stage SCLC (Newly Diagnosed)
Treatment is likely to include immunotherapy and chemotherapy. They are often given at the same time. Radiation may be used as well.
- Immunotherapy works by making the immune system stronger so it can fight cancer better. Several drugs in this class are approved to treat advanced or extensive-stage SCLC. Ask if they are an option for you.
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