Small cell lung cancer

What is small cell lung cancer?

Small cell lung cancer is a disease in which cancer (malignant) cells are found in the tissues of the lungs. The lungs are a pair of cone-shaped organs that take up much of the room inside the chest. The lungs bring oxygen into the body and take out carbon dioxide, which is a waste product of the body's cells. Tubes called bronchi make up the inside of the lungs. There are two kinds of lung cancer based on how the cells look under a microscope: small cell and non-small cell. Small cell lung cancer is usually found in people who smoke or who used to smoke cigarettes.

Symptoms include:

• a cough or chest pain that doesn't go away
• a wheezing sound when breathing
• shortness of breath
• coughing up blood
• hoarseness, or swelling in the face and neck.

Testing and diagnosis

If there are symptoms, a doctor may want to look into the bronchi through a special instrument, called a bronchoscope, that slides down the throat and into the bronchi. This test, called bronchoscopy, is usually done in the hospital. Before the test, the patient will be given a local anesthetic (a drug that causes a loss of feeling for a short period of time) in the back of the throat. Some pressure may be felt, usually with no pain. The doctor can take cells from the walls of the bronchi tubes or cut small pieces of tissue to look at under the microscope to see if there are any cancer cells. This is called a biopsy.

The doctor may also use a needle to remove tissue from a place in the lung that may be hard to reach with the bronchoscope. A cut will be made in the skin and the needle will be put in between the ribs. This is called a needle aspiration biopsy. The doctor will look at the tissue under the microscope to see if there are any cancer cells. Before the test, a local anesthetic will be given to keep the patient from feeling pain. The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the lung or has spread to other places), and the patient's gender and general state of health.

Stages of small cell lung cancer

Once small cell lung cancer has been found, more tests will be done to find out if cancer cells have spread from one or both lungs to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for small cell lung cancer:

• Limited stage: Cancer is found only in one lung and in nearby lymph nodes. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)
• Extensive stage: Cancer has spread outside of the lung where it began to other tissues in the chest or to other parts of the body.
• Recurrent stage: Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lungs or in another part of the body.

Treatment

There are treatments for all patients with small cell lung cancer. Three kinds of treatment are used:

• surgery (taking out the cancer)
• radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• chemotherapy (using drugs to kill cancer cells)

Surgery

Additionally, clinical trials are testing the effect of new therapies on the treatment of small cell lung cancer. Surgery may be used if the cancer is found only in one lung and in nearby lymph nodes. Because this type of lung cancer is usually not found in only one lung, surgery alone is not often used. Occasionally, surgery may be used to help determine exactly which type of lung cancer the patient has. If a patient does have surgery, the doctor may take out the cancer in one of the following operations:

• Wedge resection: removes only a small part of the lung.
• Lobectomy: removes an entire section (lobe) of the lung.
• Pneumonectomy: removes the entire lung.

During surgery, the doctor will also take out lymph nodes to see if they contain cancer.

Radiation

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation therapy for small cell lung cancer usually comes from a machine outside the body (external beam radiation therapy). It may be used to kill cancer cells in the lungs or in other parts of the body where the cancer has spread. Radiation therapy may also be used to prevent the cancer from growing in the brain. This is called prophylactic cranial irradiation ( PCI ). Because PCI may affect brain function, the doctor will help the patient decide whether to have this kind of radiation therapy. Radiation therapy can be used alone or in addition to surgery and/or chemotherapy.

Chemotherapy

Chemotherapy is the most common treatment of all stages of small cell lung cancer. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the lungs, including cancer cells that have spread to the brain.

Treatment by stage

Treatment of small cell lung cancer depends on the stage of the disease, and the patient's age and overall condition. Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Most patients are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of small cell lung cancer.

• Limited stage small cell lung cancer
  Treatment may be one of the following: 1. Chemotherapy and radiation therapy to the chest with or without radiation therapy to the brain to prevent spread of the cancer (prophylactic cranial irradiation). 2. Chemotherapy with or without prophylactic cranial irradiation. 3. Surgery followed by chemotherapy with or without prophylactic cranial irradiation. Clinical trials are testing new drugs and new ways of giving all of the above treatments.
• Extensive stage small cell lung cancer
  Treatment may be one of the following: 1. Chemotherapy with or without radiation therapy to the brain to prevent spread of the cancer (prophylactic cranial irradiation). 2. Radiation therapy to places in the body where the cancer has spread, such as the brain, bone, or spine to relieve symptoms. Clinical trials are testing new drugs and new ways of giving all of the above treatments.
• Recurrent small cell lung cancer
  Treatment may be one of the following: 1. Radiation therapy to reduce discomfort. 2. Chemotherapy to reduce discomfort. 3. Laser therapy, radiation therapy, and/or surgical implantation of devices to keep the airways open to relieve discomfort. 4. A clinical trial testing new drugs.