Cancer - lung - small cell

Alternative names
Lung cancer - small cell; Small cell lung cancer

Definition
Lung cancer is a malignant tumor of the lungs. There are many types of lung cancer, but most can be categorized into two basic types, “small cell” and “non-small cell.” Small cell lung cancer is generally faster growing than non-small cell, but more likely to respond to chemotherapy.

Small cell cancer is divided into “limited stage” (generally cancer confined to the chest) and “extensive stage” (cancer that has spread outside the chest).

The traditional staging system, which divides cancer into stages I through IV, is not generally applicable to small cell lung cancer.

Causes, incidence, and risk factors

Most lung cancers are caused by cigarette smoking. The more cigarettes you smoke per day and the earlier you started smoking, the greater the risk of lung cancer.

Second-hand smoke increases the risk. Government surveys show that as many as 3,000 people each year develop lung cancer from second-hand smoke. High levels of pollution, radiation, and asbestos exposure may also increase risk.

Lung cancer begins in cells that line the airways and often invade adjacent tissues or spread elsewhere in the body before symptoms are noticed.

About 20% of all lung cancer cases are small cell lung cancer, meaning about 30,000 patients each year are diagnosed with this disease.

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

Signs and tests

The doctor can sometimes detect fluid that has collected around the lungs from a cancer by listening to your chest with a stethoscope.

Tests that may be performed include:

     
  • Chest X-ray  
  • CAT scan of the chest  
  • Positron Emission Tomography (PET) scan  
  • Bronchoscopy with washings and biopsy for cytology  
  • Cat scan guided needle biopsy  
  • Open lung biopsy

This disease may also alter the results of the following tests:

     
  • PTH  
  • LDH  
  • Serum sodium  
  • CEA

Treatment

The treatment depends upon the stage of the cancer.

For small cell cancer, chemotherapy and radiation are usually used in limited stage disease (when the disease is confined to the chest ). Studies have shown that giving chemotherapy and radiation therapy at the same time is better than giving one after the other. Chemotherapy alone is used for extensive stage disease.

In some cases where a patient with limited stage disease has only one small tumor, the tumor will be surgically removed, followed by chemotherapy. However, very few patients with small cell lung cancer are candidates for surgery.

Some patients with limited stage disease may need radiation to the entire brain after they have completed chemotherapy and radiation to the chest. This is known as prophylactic cranial irradiation (PCI).

Support Groups
For additional information and resources, see cancer support group.

Expectations (prognosis)
The overall survival depends on the stage of the disease. For limited stage small cell cancer, cure rates may be as high as 25%, while cure rates for extensive stage disease are less than 5%.

Complications

     
  • Spread of disease beyond the lung  
  • Side effects of surgery, chemotherapy, or radiation therapy

Calling your health care provider
Call your health care provider if you have risk factors for developing lung cancer, or you develop symptoms of lung cancer (particularly if you smoke).

Prevention

If you smoke, stop smoking. Try to avoid second-hand smoke.

There is no evidence that screening for small cell lung cancer with chest X-rays, CT scans or other means is beneficial for patients at high risk of developing small cell lung cancer, and such screening is not recommended.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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