Lung Cancer (Small Cell)


General Information

What is small cell lung cancer?

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. There is a right lung and a left lung. 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. Small tubes called bronchioles and tiny air sacs called alveoli make up the inside of the lungs. The bronchi are sometimes also involved in lung cancer.

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 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, radon, coal tar, or benzene.

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 can help diagnose small cell lung cancer:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Physical examination: A check of general signs of health, including looking for anything unusual such as lumps or growths.

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 involve testing samples of blood, urine, or other substances or tissues in the body to help determine the diagnosis, plan and check treatment, or monitor the course of disease over time.

Bronchoscopy: A procedure in which a thin, lighted tube is inserted through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lung). This allows the inside of the trachea, bronchi, and lung to be examined. A biopsy may also be done at this time.

Fine needle aspiration: The removal of a sample of tissue or fluid with a very thin needle. An incision (cut) is made in the skin of the chest wall and the needle is inserted into the lung tissue or chest cavity.

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 choice of treatment. The prognosis (chance of recovery) and choice of treatment depend on 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, and LDH (lactate dehydrogenase, a substance found in the blood that may indicate cancer when blood levels are higher than normal) level.

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.

Stages of Small Cell Lung Cancer

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 the best treatment. The following tests and procedures may be used in the staging process:

Bone marrow biopsy: The removal of a sample of tissue from the bone marrow with a needle for examination under a microscope.

CT scan (CAT scan) of brain, chest, and abdomen. A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).

Radionuclide bone scan: A procedure used to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into a vein and the PET scanner rotates around the patient to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

The following stages are used for small cell lung cancer:

Limited Stage
In limited stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Extensive Stage
In extensive stage, cancer has spread outside of the lung where it began or to other parts of the body.

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.

Treatment Option Overview

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. 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 offered 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 the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Small cell lung cancer is treated with internal and external-beam radiation. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given.

Other types of treatment are being tested in clinical trials.

Treatment Options By Stage

Limited Stage Small Cell Lung Cancer
Treatment of limited stage small cell lung cancer may include the following:

1.Combination chemotherapy and radiation therapy to the chest, with or without radiation therapy to the brain.
2.Combination chemotherapy with or without radiation therapy to the brain in patients with complete response.
3.Combination chemotherapy with or without radiation therapy to the chest.
4.Surgery followed by chemotherapy or chemotherapy plus radiation therapy to the chest, with or without radiation therapy to the brain.
5.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.

Extensive Stage Small Cell Lung Cancer
Treatment of extensive stage small cell lung cancer may include the following:

1.Chemotherapy.
2.Combination chemotherapy.
3.Combination chemotherapy with or without radiation therapy to the brain for patients with complete response.
4.Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.
5.Clinical trials of new chemotherapy treatments.

This summary refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Small Cell Lung Cancer
Treatment of recurrent small cell lung cancer may include the following:

1.Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
2.Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
3.Laser therapy, surgical placement of devices to keep the airways open, and/or internal radiation therapy, as palliative therapy to relieve symptoms and improve quality of life.
4.Clinical trials of chemotherapy.

This summary refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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