Small Cell Lung Cancer
(Also Called 'Small Cell Lung Cancer - Type')
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. 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. The
bronchi are sometimes also involved in lung cancer. Small tubes called
bronchioles and tiny air sacs called alveoli make up the inside of the lungs.
There are two types of lung cancer: small cell lung cancer and non-small cell lung cancer.
These two 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).
- Combined small cell carcinoma.
Smoking tobacco is the major risk factor for developing small cell lung cancer.
Anything that increases your chance of getting a disease is
called a risk factor. Having a risk factor does not mean that you will get
cancer; not having risk factors doesn’t mean that you will not get cancer.
People who think they may be at risk should discuss this with their doctor.
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 secondhand smoke.
- Being exposed to asbestos or radon.
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. Other conditions may cause the same symptoms. 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.
- Coughing up blood.
- Swelling of the face and neck.
- Loss of appetite.
- Weight loss for no known reason.
- Unusual tiredness.
Tests and procedures that examine the lungs are used to
detect (find), diagnose, and stage small cell lung cancer.
The following tests and procedures may be used:
- Chest x-ray: An x-ray of the organs and bones inside the chest.
An x-ray is a type of energy beam that can go through the body and onto film,
making a picture of areas inside the body.
- Physical exam and history: An exam of the body to check general
signs of health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient’s health habits and
past illnesses and treatments will also be taken.
- CT scan (CAT scan) of the brain, chest, and abdomen: A procedure
that makes a series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an x-ray
machine. A dye may be injected into a vein or swallowed to help the organs or
tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- PET scan (positron emission tomography scan): A procedure to
find malignant tumor cells in the body. A small amount of radioactive glucose
(sugar) is injected into a vein. The PET scanner rotates around the body and
makes a picture of where glucose is being used in the body. Malignant tumor
cells show up brighter in the picture because they are more active and take up
more glucose than normal cells do.
- Sputum cytology: A microscope is used to check for cancer cells
in the sputum (mucus coughed up from the lungs).
- Bronchoscopy: A procedure to look inside the trachea and large
airways in the lung for abnormal areas. A bronchoscope is inserted through the
nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like
instrument with a light and a lens for viewing. It may also have a tool to
remove tissue samples, which are checked under a microscope for signs of cancer.
- Fine-needle aspiration (FNA) biopsy of the lung: The removal of
tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or
other imaging procedure is used to locate the abnormal tissue or fluid in the
lung. A small incision may be made in the skin where the biopsy needle is
inserted into the abnormal tissue or fluid. A sample is removed with the needle
and sent to the laboratory. A pathologist then views the sample under a
microscope to look for cancer cells. A chest x-ray is done after the procedure
to make sure no air is leaking from the lung into the chest.
- Thoracoscopy: A surgical procedure to look at the organs inside
the chest to check for abnormal areas. An incision (cut) is made between two
ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin,
tube-like instrument with a light and a lens for viewing. It may also have a
tool to remove tissue or lymph node samples, which are checked under a
microscope for signs of cancer. In some cases, this procedure is used to remove
part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t
be reached, a thoracotomy may be done. In this procedure, a larger incision is
made between the ribs and the chest is opened.
- Thoracentesis: The removal of fluid from the space between the
lining of the chest and the lung, using a needle. A pathologist views the fluid
under a microscope to look for cancer cells.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- 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.
- The blood level of lactate dehydrogenase (LDH), a substance found in the
blood that may indicate cancer when the level is higher than normal.
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 treatment. Some of the tests used to diagnose
small cell lung cancer are also used to stage the disease. Other tests and
procedures that may be used in the staging process include the following:
- Laboratory tests: Medical procedures that test samples of
tissue, blood, urine, or other substances in the body. These tests help to
diagnose disease, plan and check treatment, or monitor the disease over time.
- Bone marrow aspiration and biopsy: The removal of bone marrow,
blood, and a small piece of bone by inserting a hollow needle into the hipbone
or breastbone. A pathologist views the bone marrow, blood, and bone under a
microscope to look for signs of cancer.
- MRI (magnetic resonance imaging) of the brain: A procedure that
uses a magnet, radio waves, and a computer to make a series of detailed pictures
of areas inside the body. This procedure is also called nuclear magnetic
resonance imaging (NMRI)
- Endoscopic ultrasound (EUS): A procedure in which an endoscope
is inserted into the body. An endoscope is a thin, tube-like instrument with a
light and a lens for viewing. A probe at the end of the endoscope is used to
bounce high-energy sound waves (ultrasound) off internal tissues or organs and
make echoes. The echoes form a picture of body tissues called a sonogram. This
procedure is also called endosonography. EUS may be used to guide fine-needle
aspiration (FNA) biopsy of the lung, lymph nodes, or other areas.
- Lymph node biopsy: The removal of all or part of a lymph node.
A pathologist views the tissue under a microscope to look for cancer cells.
- Radionuclide bone scan: A procedure to check if there are
rapidly dividing cells, such as cancer cells, in the bone. A very small amount
of radioactive material is injected into a vein and travels through the bloodstream.
The radioactive material collects in the bones and is detected by a scanner.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels
through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels
through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor
and travel through the lymph or blood to other places in the body, another
(secondary) tumor may form. This process is called metastasis. The secondary
(metastatic) tumor is the same type of cancer as the primary tumor.
For example, if breast cancer spreads to the bones, the cancer cells in the
bones are actually breast cancer cells. The disease is metastatic breast cancer,
not bone cancer.
The following stages are used for small cell lung cancer:
- Limited-Stage Small Cell Lung Cancer
In limited-stage, cancer is found in one lung, the tissues between the lungs,
and nearby lymph nodes only.
- Extensive-Stage Small Cell Lung Cancer
In extensive-stage, cancer has spread outside of the lung in which 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. 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. Patients may want to think about
taking part in a clinical trial. Some clinical trials are open only to patients
who have not started treatment.
Five types of standard treatment are used:
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.
Even if the doctor removes all the cancer that can be seen at
the time of the operation, some patients may be given chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to lower the risk that the cancer will come back, is called
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping them from
dividing. When chemotherapy is taken by mouth or injected into a vein or muscle,
the drugs enter the bloodstream and can reach cancer cells throughout the body
(systemic chemotherapy). When chemotherapy is placed directly into the spinal
column, an organ, or a body cavity such as the abdomen, the drugs mainly affect
cancer cells in those areas (regional chemotherapy). The way the chemotherapy is
given depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy
x-rays or other types of radiation to kill cancer cells or keep them from
growing. There are two types of radiation therapy. External radiation therapy
uses a machine outside the body to send radiation toward the cancer. Internal
radiation therapy uses a radioactive substance sealed in needles, seeds, wires,
or catheters that are placed directly into or near the cancer. Prophylactic
cranial irradiation (radiation therapy to the brain to reduce the risk that
cancer will spread to the brain) may also be given. The way the radiation
therapy is given depends on the type and stage of the cancer being treated.
Laser therapy is a cancer treatment that uses a laser beam (a
narrow beam of intense light) to kill cancer cells.
Endoscopic stent placement
An endoscope is a thin, tube-like instrument used to look at
tissues inside the body. An endoscope has a light and a lens for viewing and may
be used to place a stent in a body structure to keep the structure open.
Endoscopic stent placement can be used to open an airway blocked by abnormal tissue.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the
best treatment choice. Clinical trials are part of the cancer research process.
Clinical trials are done to find out if new cancer treatments are safe and
effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on
earlier clinical trials. Patients who take part in a clinical trial may receive
the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the
way cancer will be treated in the future. Even when clinical trials do not lead
to effective new treatments, they often answer important questions and help move
Patients can enter clinical trials before, during, or after
starting their cancer treatment.
Some clinical trials only include patients who have not yet
received treatment. Other trials test treatments for patients whose cancer has
not gotten better. There are also clinical trials that test new ways to stop
cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to
find out the stage of the cancer may be repeated. Some tests will be repeated in
order to see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of these tests.
This is sometimes called re-staging.
Some of the tests will continue to be done from time to time
after treatment has ended. The results of these tests can show if your condition
has changed or if the cancer has recurred (come back). These tests are sometimes
called follow-up tests or check-ups.
Treatment Options by Stage
For some types or stages of cancer, there may not be any
clinical trials listed. Check with your doctor for clinical trials that are not
listed here but may be right for you.
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. Radiation
therapy to the brain may later be given to patients with complete responses.
- Combination chemotherapy for patients with lung problems or who are very
ill. Radiation therapy to the brain may later be given to patients with
- Surgery followed by chemotherapy or chemotherapy plus radiation therapy
to the chest. Radiation therapy to the brain may later be given to patients
with complete responses.
- Clinical trials of new chemotherapy, surgery, and radiation treatments.
Extensive-Stage Small Cell Lung Cancer
Treatment of extensive-stage small cell lung cancer may include the following:
- Combination chemotherapy. Radiation therapy to the brain may later be
given to patients with complete responses.
- 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.
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.
- Laser therapy, stent placement to keep airways open, and/or internal
radiation therapy as palliative therapy to relieve symptoms and improve
quality of life.
- Clinical trials of new chemotherapy treatments.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with small cell lung cancer. For
more specific results, refine the search by using other search features, such as
the location of the trial, the type of treatment, or the name of the drug.
For more information from the NCI, please write to this address:
NCI Public Inquiries Office
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
U.S. residents may call the National Cancer Institute's (NCI's) Cancer
Information Service toll-free at 1.800.4.CANCER (1.800.422.6237) Monday through
Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY
equipment may call 1.800.332.8615. Information about ongoing clinical trials is available from the NCI Web site.
Source: National Institutes of Health; National Cancer Institute
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/28/2009…#6202