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Small-Cell Lung Cancer

Small-Cell Lung Cancer Treatment continued...

Treatment of relapse of small-cell lung cancer

  • Persons who have a relapse of small-cell lung cancer have an extremely poor prognosis. 
  • If the disease does not respond to treatment or progresses after initial treatment (called "refractory disease") or if the disease relapses within six months of completion of therapy, the person has little chance of responding to additional chemotherapy. The most common drug used in this setting is topotecan.
  • Persons whose cancer does not progress for more than six months may be given additional chemotherapy, including re-treatment with their original chemotherapy regimen.
  • Persons with relapsed or refractory small-cell lung cancer may enroll in a clinical trial. For information about ongoing clinical trials, visit the National Cancer Institute's Clinical Trials.

Other drugs may be given to prevent and treat adverse effects of radiation, chemotherapy, or the cancer itself, such as nausea or vomiting. Pain medications are also important to relieve pain due to cancer or its treatment.

Surgery

Surgery plays little, if any, role in the management of small-cell lung cancer because almost all cancers have spread by the time they are discovered.

The exceptions are the relatively small number of people (less than 15%) whose cancer is discovered at a very early stage of the disease, when the cancer is confined to the lung without any spread to the lymph nodes. However, surgery alone is not considered curative, so chemotherapy is also given. Sometimes radiation therapy will also be needed if the cancer had spread to the nearby lymph nodes.

Other Therapy

Radiation therapy

Radiation therapy is the use of high-dose X-rays or other high-energy rays to kill cancer cells. Radiation can be given from outside the body using a machine (external radiation therapy), or it can be given with the help of radiation-producing materials that are implanted inside the body (brachytherapy).

Radiation therapy can be curative (kills all cancer cells), prophylactic (reduces the risk of cancer spreading to the area to which it is given), or palliative (helps reduce suffering).

Next Steps

Follow-up 

  • Patients who are receiving chemotherapy require close monitoring for side effects and response to therapy.
  • A blood workup, including CBC (complete blood count), is needed prior to each cycle of chemotherapy to ensure that the bone marrow has recovered before the next dose of chemotherapy is given. 
  • Kidney function is monitored, especially if the patient is taking cisplatin, as it can damage the kidneys. Also, carboplatin's dosage is based upon kidney function.
  • The patient will undergo a CT scan to assess their response to treatment
  • Other tests are performed to monitor liver function and electrolytes -- especially sodium and magnesium levels -- due to the effects of the cancer and its treatment.

Palliative and terminal care

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