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National Cancer Institute

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Small cell lung cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is small cell lung cancer?
STAGE EXPLANATION
Stages of small cell lung cancer
Limited stage
Extensive stage
Recurrent stage
TREATMENT OPTION OVERVIEW
How small cell lung cancer is treated
Treatment by stage
LIMITED STAGE SMALL CELL LUNG CANCER
EXTENSIVE STAGE SMALL CELL LUNG CANCER
RECURRENT SMALL CELL LUNG CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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. If a patient has non-small cell lung cancer, see the PDQ patient information summary on non-small cell lung cancer.

Small cell lung cancer is usually found in people who smoke or who used to smoke cigarettes. A doctor should be seen if there are any of the following symptoms: 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.

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.


STAGE EXPLANATION


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 OPTION OVERVIEW


How small cell lung cancer is treated

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

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:

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

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 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. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about small cell lung cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklets about lung cancer may be helpful:

What You Need To Know About Lung Cancer
Research Report: Cancer of the Lung

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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