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 outside the lung and is considered a systemic disease. If your cancer spreads to the bone, visit our bone metastases page. 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 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.
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. The diagnosis can only be established with a biopsy, however. Once a biopsy is done that shows small cell lung cancer, the next thing to establish is whether the cancer has spread outside the lung, known as “staging”. One or more tests may be done to stage the cancer.
Small cell lung cancer is staged differently from NSCLC. Guidelines around its staging are changing. 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 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
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.
Clinical trials are research studies to test new treatments or learn how to use current treatments better. The newest treatment may only be available through a clinical trial. Learn more about clinical trials.
Palliative (supportive) care
Palliative (supportive) care focuses on reducing symptoms and stress of a serious illness. It does not treat the cancer itself. It is for people of any age and at any stage. You can get it along with cancer treatment. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by trained doctors, nurses, and other specialists. They work with your other doctors to provide an extra layer of support.
Ask about the side effects of every treatment you consider. There may be steps you can take or choices you can make to help make treatment a little easier.
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