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Extensive Stage Small Cell Lung Cancer

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Updated May 16, 2014

Small cell lung cancer (unlike non-small cell lung cancer), is divided into only 2 stages -– limited and extensive. Roughly 60% to 70% of people have extensive disease at the time of diagnosis.

Small cell lung cancer is less common than non-small cell, accounting for about 15% of lung cancers. It tends to be more aggressive, growing rapidly and spreading quickly, but often responds well to chemotherapy.

Definition of Extensive Stage Small Cell Lung Cancer

Extensive stage small cell lung cancer is defined as a small cell lung cancer that has spread (metastasized) to other regions of the body such as another lobe of the lung or the brain.

Symptoms

Symptoms can include:

Symptoms related to cancer in the lungs:

Symptoms due to paraneoplastic syndromes, that is symptoms that are due to hormones secreted by a tumor or by the body’s immune response to a tumor rather than the tumor itself. Some of these include:

Symptoms due to spread of the tumor to other regions of the body, for example:

  • Pain in the back, hips, or ribs if the tumor has spread to bone
  • Difficulty swallowing (dysphagia) due to a tumor being near or invading the esophagus
  • Headaches, vision changes, weakness, or seizures if a tumor spreads to the brain
General symptoms related to metastatic cancer such as:

Treatment

Since extensive stage small cell cancer has by definition spread beyond the lung, it is inoperable, that is surgery cannot cure the disease, but it is treatable.

Treatment with a combination of chemotherapy and radiation therapy can extend survival. If the cancer responds to treatment, PCI (prophylactic cranial irradiation) -– preventative radiation therapy to the brain -- is recommended to lower the risk that any cancer cells that have spread to the brain (brain metastases) but aren’t seen on x-rays, will grow and cause symptoms.

Radiation therapy may also be recommended as a palliative therapy -– therapy that is done to control symptoms but does not result in a cure. This can be helpful for some people to control bone pain (due to tumors spreading to bone), bleeding from the lungs, tumors that are obstructing the airways and causing shortness of breath, or brain metastases that are causing significant symptoms, such as headaches or weakness.

Clinical trials are in progress for both stages of small cell lung cancer, evaluating new treatments and treatment combinations for this aggressive cancer.

Prognosis

Survival rates for small cell lung cancer have improved since the addition of radiation therapy to treatment and the use of PCI, but remain low. The overall 5-year survival for small cell lung cancer (limited and extensive) is only about 6%. Without treatment, the average life expectancy with extensive disease is 2 to 4 months, and with treatment is 6 to 12 months. Since small cell lung cancer is rapidly growing, and we have come a long way with other fast-growing cancers such as leukemia, it is hoped that better treatments will be found in the future.

What Can I Do To Help Myself

Studies suggest that learning what you can about your lung cancer can improve your quality of life, and possibly even your outcome. Ask questions. Learn about clinical trials. Consider joining a support group. Many of us hesitate to talk about end-of-life issues, but discussing these with your doctor and your family -– even if all of you are hoping for a cure -– is associated with fewer feelings of loneliness and a better quality of life. Never lose hope, even if you have chosen not to pursue further treatment. Hope for quality time with loved ones, with good control of your symptoms. Hope for the future of your loved ones who will remain, with memories of you in their hearts.

Sources:

Hann, C. and C. Rudin. Management of small-cell lung cancer: incremental changes but hope for the future. Oncology (Williston Park). 2008. 22(13):1486-92.

National Cancer Institute. Small Cell Lung Cancer Treatment (PDQ). 02/13/09. http://www.cancer.gov/CANCERTOPICS/PDQ/TREATMENT/SMALL-CELL-LUNG/PATIENT.

National Institute of Health. Medline Plus. Lambert-Eaton Syndrome. 08/07/06. http://www.nlm.nih.gov/medlineplus/ency/article/000710.htm.

National Institute of Health. Medline Plus. Lung Cancer – Small Cell. 03/03/09. http://www.nlm.nih.gov/medlineplus/ency/article/000122.htm.

Samson, D. et al. Evidence for Management of Small Cell Lung Cancer. AACP Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007. 132(3 Suppl):314S-323S.

Sher, T. et al. Small cell lung cancer. Mayo Clinic Proceedings. 2008. 83(3):355-67.

Sorenson, M. et al. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment, and follow-up. Annals of Oncology. 2009. 20 Suppl 4:71-2.

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