Small Cell Lung Cancer

Small cell lung cancer (SCLC) is a rare, fast-growing type of lung cancer. Healthcare providers may call it small cell carcinoma of the lung. Anyone can have this condition, but it most often affects people with a long history of tobacco use, especially smoking cigarettes.

SCLC gets its name from the way the cells look under a microscope. The cells are much smaller than the cancerous cells in non-small cell lung cancer (NSCLC). Healthcare providers may also call SCLC oat cell carcinoma because the cells look like flat oat grains under a microscope.

The two types of SCLC are:

• Small cell carcinoma: This is the most common type.
• Combined small cell carcinoma: This type is a combination of non-small cell and small cell lung cancer cells.

Treatment may cure SCLC that’s caught before it spreads outside of your lung. And newer treatments are helping people live longer with small cell lung cancer that has spread to other parts of the body.

Symptoms of small cell lung cancer

A small tumor that hasn’t spread outside of your lung rarely causes symptoms. A large tumor or one that’s spread may cause symptoms, including:

• Coughing up blood
• Difficulty breathing or wheezing
• Fatigue
• Chest pain or discomfort
• Chronic cough that doesn’t go away or worsens
• Hoarseness
• Loss of appetite
• Unexplained weight loss

You may have other symptoms if SCLC causes complications. For example, you may have facial swelling or swollen neck veins if SCLC leads to superior vena cava syndrome.

Having one or more of these symptoms doesn’t mean that you have small cell lung cancer. That said, talk to a healthcare provider if you have any of these symptoms and you smoke or used to smoke tobacco.

Small cell lung cancer causes

A genetic change that happens during your lifetime causes SCLC. The change affects genes that manage cell growth. With small cell lung cancer, cells multiply uncontrollably to form tumors in your lungs.

While anyone can get lung cancer, your risk increases if you smoke, used to smoke or are exposed to secondhand smoke. Other risk factors are:

• Exposure to radiation from previous cancer treatments
• Exposure to radon gas, which is a colorless radioactive gas that may seep into homes and other buildings
• Exposure to workplace hazards, like asbestos, arsenic, nickel, tar or toxic chemicals

Complications of small cell lung cancer

Without treatment, this disease may spread to your:

• Brain
• Lymph nodes
• Bones
• Liver
• Adrenal glands, which are near your kidneys.

Other potential complications include:

• Pleural effusion: This is when fluid builds up in your lungs or in the space around your lungs. The fluid can push air out of your lung, so it collapses.
• Superior vena cava syndrome: You may develop this issue if the tumor presses on a big vein in your chest called the superior vena cava.

How doctors diagnose small cell lung cancer

A healthcare provider will ask about your symptoms and do a physical exam. They’ll do a chest-X-ray to check your lungs. If an X-ray shows suspicious spots, your provider may do more tests, including:

• Imaging scans: CT scans are the primary way to diagnose lung cancer. PET scans may also detect tumors in your lungs.
• Bronchoscopy: Your provider uses a bronchoscope to look inside your airways. They may take tissue samples to examine under a microscope.
• Biopsy: Your provider may do a needle biopsy to get a small sample of tissue from your lungs.

A medical pathologist will check tissue samples under a microscope. They may do tests to check for the genetic changes that cause SCLC.

Stages of SCLC

Your provider will use the test results to set a cancer stage. SCLC stages are:

• Limited-stage SCLC: You have cancer in one lung only or in nearby lymph nodes.
• Extensive-stage SCLC: Cancer has spread to more distant areas of your body.

How is small cell lung cancer treated?

Treatment varies depending on the cancer stage. Treatment for a tumor that hasn’t spread outside your lung may involve:

• Radiation therapy that targets the tumor in your lung
• Chemotherapy
• Chemoradiation, which combines chemotherapy and radiation
• Immunotherapy, including checkpoint inhibitors

You may have radiation therapy to prevent metastatic brain cancer. Very rarely, you may have surgery to remove a single small tumor in your lung.

Treatment for a tumor that’s spread may include:

• Chemotherapy
• Immunotherapy
• Bispecific T-cell engager (BiTE) therapy

You may have radiation therapy to ease issues that cancer may cause if it spreads from your lungs to your brain, or to places like your bones and spine.

Researchers are studying new ways to treat SCLC. Clinical trials are research studies that check whether new medications or combinations of medications are safe and effective. If you’re interested, talk to your cancer care team about participating in a trial.

Living with an incurable disease like extensive-stage SCLC may feel like an emotional balancing act. Your feelings may swing from anger, sadness or uncertainty to acceptance. It may help to talk to a mental health professional.

When should I see my healthcare provider?

Talk to your cancer care team for support in managing treatment side effects.

Is small cell lung cancer curable?

Treatment may cure limited-stage small cell lung cancer. But the condition may come back after treatment. There’s no cure for extensive-stage SCLC.

What’s the life expectancy for someone with small cell lung cancer?

How long you’ll live with the disease depends on factors like the cancer stage, how your body responds to treatment and your health. SCLC survival rate estimates are based on clinical trials involving different treatments. According to recent research, the five-year survival rates by stage are:

• Limited-stage SCLC: 16% to 30%
• Extensive-stage SCLC: 12%

Researchers continue to study new ways to treat this condition.

What is the difference between non-small cell lung cancer and small cell lung cancer?

Small cell lung cancer usually starts in one type of lung cell. Non-small cell lung cancer can begin in three different types of lung cells and may develop in different parts of your lungs. Small cell lung cancer also tends to spread more quickly than non-small cell lung cancer.