Cancer - lung - small cell

Definition

Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It tends to spread much more quickly than non-small cell lung cancer

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.

Alternative Names

Causes

About 15% of all lung cancer cases are small cell lung cancer, according to the American Cancer Society. Small cell lung cancer is a bit more common in men than women.

Smoking almost always causes small cell lung cancer. This type of lung cancer is rare in those who have never smoked.

Small cell lung cancer usually starts in the air tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow quickly and create large masses (tumors) that can rapidly spread to other parts of the body, including the brain, liver, and bone.

Symptoms

• Cough
• Bloody sputum
• Shortness of breath
• Wheezing
• Chest pain
• Loss of appetite
• Weight loss

Additional symptoms that may be associated with this disease:

• Weakness
• Swallowing difficulty
• Nail abnormalities
• Hoarseness or changing voice
• Fever
• Facial swelling

Exams and Tests

The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.

When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.

Small cell lung cancer has usually spread by the time it is diagnosed.

Tests that may be performed include:

• Chest x-ray
• CBC
• Sputum test
• Bone scan
• CT scan
• MRI
• Positron emission tomography (PET) scan
• Thoracentesis

In some cases, the 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
• Pleural biopsy
• CT scan directed needle biopsy
• Mediastinoscopy with biopsy
• Open lung biopsy
• Endoscopic esophageal ultrasound (EUS) with 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's spread.) However, the traditional staging system, which uses numbers to tell how bad the cancer is, is usually not used for patients with SCLC. Instead, SCLC is grouped as either:

• Limited (cancer is only in the chest)
• Extensive (cancer has spread outside the chest)

Most cases are extensive.

Treatment

Because small cell lung cancer spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Chemotherapy may be combined with high-powered x-rays (radiation therapy).

Surgery is rarely used to treat small cell lung cancer. It is only considered if it is limited small cell lung cancer with only one tumor that hasn't spread. Chemotherapy or radiation will be needed after surgery. However, because the disease has usually spread by the time it is diagnosed, very few patients with small cell lung cancer are candidates for surgery.

Combination chemotherapy and radiation treatment is given to persons with extensive small cell lung cancer. However, the treatment only helps relieve symptoms; it does not cure the disease.

Some patients with limited small cell lung cancer may receive radiation therapy to the head after they have completed treatment for the lung area. This method, called prophylactic cranial irradiation (PCI), helps prevent any lung cancer from spreading to the brain.

Support Groups

For additional information and resources, see cancer support group.

Outlook (Prognosis)

How well a patient does 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 after 5 years.

Possible Complications

• Cancer spreads to other parts of the body
• Side effects of surgery, chemotherapy, or radiation therapy

When to Contact a Medical Professional

Call your health care provider if you have symptoms of lung cancer (particularly if you smoke).

Prevention

If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke.

Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not help improve a person's chance for a cure.

American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.

U.S. Preventive Services Task Force. Lung cancer screening. Ann Int Med. 2004;140:738-739.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:1708-1722.

Jackman DM, Johnson BE. Small-cell lung cancer. Lancet. 2005;366:1385-1396.