Small Cell Lung Cancer: Contending With the Facts

Small cell lung cancer (SCLC) is an aggressive form of cancer that is found in 15% of people with lung cancer. The other 85% of people have non-small cell lung cancer. The difference is how the cancer behaves and its appearance under a microscope.

This article will discuss small cell lung cancer prognosis, treatment, and survival. It will also cover how to manage the symptoms and treatment side effects.

Receiving a Small Cell Lung Cancer Diagnosis

The events that lead up to a small cell lung cancer diagnosis look different for each person. You may have had respiratory symptoms like a worsening cough, coughing up blood, or wheezing that brought you into a healthcare provider's office. For others, who are at a high risk for lung cancer, their diagnosis could have been preceded by a lung cancer screening CT (computed tomography) scan.

Receiving a small cell lung cancer diagnosis can be a confusing and emotional event. There will be endless questions and concerns as you process the information.

One of the best ways to keep yourself focused on the information is to keep a record of the information you receive from healthcare providers. This could be on your phone, in a notebook, or anywhere that is easily accessible.

Write down any information from your healthcare provider like:

• Diagnosis
• Lab results
• Treatment schedule
• Medications
• Doctor referrals
• Future radiation or chemotherapy treatments

You need to be your best advocate. Keep a separate list of questions to ask your healthcare provider. There will be so much information given to you when you get your diagnosis. Do not be afraid to repeat questions or ask for clarification if you do not understand.

Small cell lung cancer grows rapidly. Therefore, it is crucial for those with symptoms to contact their healthcare provider for an evaluation and diagnosis. This will allow for prompt treatment.

Small Cell Lung Cancer Progression

Small cell lung cancer is an aggressive form of cancer that increases in size quickly. One of the measures of how quickly cancer grows is its doubling time. Doubling time is the amount of time it takes for a cell or tumor to double in size. Small cell lung cancer's doubling time can be as short as 25 to 30 days.

Another way small cell lung cancer's progression is measured is through a two-stage system listed as limited stage and extensive stage.

• Limited stage is when the cancer is located in just one lung and it may or may not be in the lymph nodes on the same side of the chest.
• Extensive stage is when the cancer has spread to both lungs, is found in lymph nodes on both sides of the chest, is in distant organs, or is in the fluid around the lungs.

Only about 1 in 3 people who have small cell lung cancer are diagnosed in the limited stage. A common site of spread of SCLC is to the brain, which occurs in about half of small cell lung cancer cases.

Managing Symptoms of Small Cell Lung Cancer

SCLC will cause a variety of symptoms that will be based on how far the cancer has spread.

Symptoms can include:

• Dyspnea (difficulty breathing)
• Coughing
• Chest pain that worsens with coughing, laughing, or deep breathing
• Loss of appetite
• Weight loss
• Wheezing
• Tiredness

Managing these symptoms can be difficult. As the cancer spreads and grows symptoms will worsen.

One of the most uncomfortable symptoms, difficulty breathing, can be managed with help from a healthcare provider. They will treat the cause, whether it's fluid around the lungs, an infection, or resulting from a growing tumor. Certain medications that treat difficulty breathing include:

• Bronchodilators
• Steroids
• Antianxiety medications
• Pain medications
  

How Treatable Is Small Cell Lung Cancer?

For most people, small cell lung cancer treatment does not cure them. Treatment will improve their quality of life and prolong it. Treatment will be based on the extent of the condition.

Limited Stage

People with limited stage small cell lung cancer may be treated with:

• Radiation
• Chemotherapy (usually etoposide plus either cisplatin or carboplatin)
• Surgery

With treatment, limited stage small cell lung cancer is curable in 20% to 25% of cases. People with limited stage small cell lung cancer greatly benefit from chemotherapy to both improve their quality of life and increase the chance of survival. When given along with radiation, tumor shrinkage is seen in 80% to 100% of cases.

Radiation therapy may be given to the chest to address the site of the tumor. Radiation is also often given to the head (prophylactic cranial irradiation) to prevent spread to the brain.

Extensive Stage

Those with extensive stage small lung cancer may be treated with:

• Chemotherapy
• Immunotherapy: This is often given with chemotherapy. The most common combination is Tecentriq (atezolizumab) or Imfinzi (durvalumab) immunotherapy with the chemotherapy agents etoposide and a platinum drug (cisplatin or carboplatin).
• Radiation: This is given if the cancer has responded well to chemotherapy and/or chemotherapy plus immunotherapy. It may include radiation to the chest and to the brain.

The goals in people with extensive stage small cell lung cancer are to improve symptoms, prolong their survival, and improve their quality of life. Chemotherapy plus immunotherapy has a positive response, with 60% to 80% achieving tumor shrinkage.

Relapse or Recurrence

Unfortunately, the recurrence of small cell lung cancer is high. Most people will relapse in one to two years after treatment. What treatment is recommended with recurrence will depend on your individual case, treatment history, the extent of the cancer, and your wishes.

Facing Small Cell Lung Cancer Treatment

SCLC treatment can be daunting to think about. There will be major changes in almost every aspect of your life. Finding a support system will be crucial in navigating all the changes. Here are some tips to help you face cancer treatment:

• Let family and friends help.
• Designate someone as a spokesperson to pass on your status to others.
• Try to maintain a healthy lifestyle.
• Talk to other people who have had cancer.
• Prepare for physical changes.
• Understand how treatment may impact finances.

Small Cell Lung Cancer Treatment Side Effects

Cancer treatment causes undesired side effects by affecting normal cells in addition to cancer cells.

Chemotherapy causes certain blood counts to drop. This can increase a person's chance of infections which can become very serious. Other chemotherapy side effects:

• Nausea
• Vomiting
• Hair loss
• Diarrhea
• Fatigue
• Mouth sores
• Loss of appetite
• Decreased kidney function

Immunotherapy is a treatment that prompts the body to use its own immune system to treat cancer. The side effects of this treatment include:

• Fatigue
• Fever
• Rash
• Diarrhea
• Shortness of breath
• Liver and kidney dysfunction

Radiation is a common treatment for SCLC. Its side effects include tiredness, reddened skin, and painful swallowing.

Support for Advanced Small Cell Lung Cancer

People with advanced small cell lung cancer will have different goals and needs than others. They may want to try a clinical trial or enter palliative care or hospice. Whatever they choose, the support of healthcare providers, family, and friends will be necessary.

Palliative care is used to improve the quality of life for someone with a terminal condition. It treats or prevents the symptoms and side effects of the condition. The person can continue their standard treatment (chemotherapy or radiation) along with palliative care.

Hospice is when treatment to cure cancer is stopped, although palliative care continues. The goal is to maintain quality of life.

Summary

Receiving a small cell lung cancer diagnosis is challenging. It will produce endless emotions and concerns. Treatment options are available depending on the stage of the cancer. If treatment is no longer working, shifting towards supportive treatment is an option.