Lung cancer - small cell
There are three different types of small cell lung cancer:
- Small cell carcinoma (oat cell cancer)
- Mixed small cell/large cell carcinoma
- Combined small cell carcinoma
Most small cell lung cancers are the oat cell type.
Cancer - lung - small cell; Small cell lung cancer; SCLC
Causes, incidence, and risk factors
About 15% of all lung cancer cases are small cell lung cancer. Small cell lung cancer is slightly more common in men than women.
Almost all cases of SCLC are due to cigarette smoking. SCLC is rare in those who have never smoked.
SCLC is the most aggressive form of lung cancer. It usually starts in the breathing tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow very quickly and create large tumors. These tumors often spread rapidly (metastasize) to other parts of the body, including the brain, liver, and bone.
Other symptoms that may occur with this disease:
Signs and tests
Your health care provider will perform a physical exam and ask questions about your medical history. You will be asked whether you smoke, and if so, how much and for how long you have smoked.
When listening to your chest with a stethoscope, your health care provider can sometimes hear fluid around the lungs or areas of partial lung collapse. Each of these findings could (but does not always) suggest cancer.
Small cell lung cancer 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
- Positron emission tomography (PET) scan
- Sputum test (cytology, looking for cancer cells)
- Thoracentesis (removal of fluid from the chest cavity around the lungs)
In some cases, your health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:
- Bronchoscopy combined with biopsy
- CT scan-directed needle biopsy
- Endoscopic esophageal ultrasound (EUS) with biopsy
- Mediastinoscopy with biopsy
- Open lung biopsy
- Pleural biopsy
Usually, if a biopsy reveals 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 chest)
The majority of cases are extensive.
Because SCLC spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Usually, the chemotherapy drug etoposide is combined with either cisplatin or carboplatin.
Combination chemotherapy and radiation treatment is given to people with extensive SCLC. However, the treatment only helps relieve symptoms. It does not cure the disease.
Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells. Radiation therapy can be used with chemotherapy if surgery is not possible. 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, even when there are no symptoms or other signs of cancer in the brain. As a result, radiation therapy to the brain may be given to some patients with smaller cancers, or to those who had a good response in the first round of chemotherapy. This method is called prophylactic cranial irradiation (PCI).
Very few patients with SCLC are helped by having surgery because the disease has often spread by the time of diagnosis. Surgery may be done when there is only one tumor that has not spread. If surgery is done, chemotherapy or radiation therapy will still be needed.
For additional information and resources, see cancer support group.
How well you do depends on how much the lung cancer has spread. This type of cancer is very deadly. Only about 6% of people with this type of cancer are still alive 5 years after diagnosis.
Treatment can often prolong life for 6 - 12 months, even when the cancer has spread.
Calling your health care provider
Call your health care provider if you have symptoms of lung cancer (particularly if you smoke).
If you smoke, stop smoking. It's never too late to quit. In addition, you should try to avoid secondhand smoke.
See also: Lung Cancer
Johnson DH, Blot WJ, Carbone DP, et al. Cancer of the lung: Non-small cell lung cancer and small cell lung cancer. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff’sClinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 76.
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.