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 the
PDQ summary on 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.
Information about ongoing clinical trials
is available from NCI Cancer.gov Web site
Stages of Small Cell Lung Cancer
Key Points for This Section
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 following stages are used for small
cell lung cancer:
Limited Stage
Extensive Stage
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
Key Points for This Section
There are different types of treatment for
patients with small cell lung cancer.
Three types of standard treatment are
used:
Surgery
Chemotherapy
Radiation therapy
Other types of treatment are being tested
in clinical trials.
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. Information about
ongoing clinical trials is available from
NCI Cancer.gov Web site. 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.
Information about ongoing clinical trials
is available from the NCI Cancer.gov Web
site.
Treatment Options By Stage
Limited Stage Small Cell Lung Cancer
Treatment of limited stage small cell lung
cancer may include the following:
Combination chemotherapy and radiation
therapy to the chest, with or without
radiation therapy to the brain.
Combination chemotherapy with or without
radiation therapy to the brain in patients
with complete response.
Combination chemotherapy with or without
radiation therapy to the chest.
Surgery followed by chemotherapy or
chemotherapy plus radiation therapy to the
chest, with or without radiation therapy
to the brain.
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. Information about ongoing
clinical trials is available from NCI
Cancer.gov Web site.
Extensive Stage Small Cell Lung Cancer
Treatment of extensive stage small cell
lung cancer may include the following:
Chemotherapy.
Combination chemotherapy.
Combination chemotherapy with or without
radiation therapy to the brain for
patients with complete response.
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.
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. Information about ongoing
clinical trials is available from the NCI
Cancer.gov Web site.
Treatment Options for Recurrent Small Cell
Lung Cancer
Treatment of recurrent small cell lung
cancer may include the following:
Radiation therapy as palliative therapy to
relieve symptoms and improve quality of
life.
Chemotherapy as palliative therapy to
relieve symptoms and improve quality of
life.
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.
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. Information about ongoing
clinical trials is available from the NCI
Cancer.gov Web site.
