Small Cell Lung Cancer Treatments by Stage

There are many different ways to treat small cell lung cancer, or SCLC. The type of treatment or treatments you get depends on many things, such as:

  • The type of lung cancer
  • Your stage (how big the tumor is, if the cancer has spread, and where it has spread)
  • Where the tumor is in your lung
  • Your general health
  • Your preferences

Most people get more than one type of treatment. For instance, you might get chemo and then get radiation. And if one type of treatment stops working, there’s often another kind that you can get.

As with any condition, your treatment is an ongoing discussion with your medical team. Your doctors can make recommendations, but it’s up to you to decide how much or what kind of treatment you want. As your treatments go along, be sure you tell your doctor about any side effects you’re having, any pain you have, and how you’re doing emotionally. Always feel free to ask questions, whether it’s about changes you’ve noticed, nutrition or other lifestyle topics, or anything else that’s on your mind.

Your medical team cares about your whole self, not just your cancer. A medical specialty called palliative care can help treat your pain and symptoms and give you emotional and spiritual support. You can get palliative care along with your cancer treatments.

SCLC Treatment Glossary

Before you get into the treatments for your stage, you’ll need to know which treatments are most often used for small cell lung cancer:

Chemotherapy (chemo) medicines kill cancer cells or slow their growth. The drugs kill any cells that are growing quickly, like cancer cells. Many times, chemo drugs are used in combinations. Chemo is usually part of SCLC treatment because this cancer has almost always spread beyond the lung before it’s diagnosed.

Clinical trials may be a good option. SCLC is often hard to treat. In a trial, you can get the best treatment available now and may also get treatments that are thought to be even better. Talk to your doctor if you’d like to learn more about trials that you might qualify for and what’s involved.

Continued

PCI stands for prophylactic cranial (brain) irradiation. This is a type of radiation therapy. If your cancer responds well to the first treatment, your doctor may talk to you about PCI. SCLC tends to spread to the brain. PCI uses low doses of radiation to treat the whole brain before the cancer spreads there -- and makes it less likely that the cancer will go to the brain.

Radiation uses high-energy rays (like X-rays) to kill cancer cells. The rays come from a large machine that aims them at the tumor through your skin.

Surgery is rarely part of SCLC treatment. But it may be an option if you have one small tumor that’s only in your lung. A surgeon might remove the tumor, the part (lobe) of your lung with the tumor in it, or your entire lung. Nearby lymph nodes are taken out, too, so they can be checked for signs of cancer.

Limited or Extensive?

Most doctors use two stages when talking about SCLC treatment. You may have been told you have limited or extensive stage cancer. These two groups are used more often than numbering the stages I, II, III, or IV.

Limited stage means the cancer is in only one area and can be treated with radiation. It usually includes stage I, II, and some stage III cancers.

Extensive stage includes stage III cancers that are too big to be treated with radiation and those that have spread throughout the lung. It also includes all stage IV SCLCs.

You’ll get scans and tests throughout SCLC treatment. These are needed to see if treatment is working. If the cancer grows or spreads during one kind of treatment, you’ll get a different treatment.

Treatment for 'Limited' Small Cell Lung Cancer

First (initial) treatment

If there’s only one tumor in your lung and it hasn’t spread to any lymph nodes, you’ll get surgery to take out the part of your lung with the tumor. The surgeon will take out nearby lymph nodes to test them for cancer.

Continued

If there’s no cancer in your lymph nodes, you’ll get chemo. If cancer is found in your nodes, you’ll get chemo and radiation. They can be given at the same time, or the chemo may be completed and then you get the radiation.

If your overall health is good, but all of the cancer can’t be removed with surgery, you’ll get chemo and radiation together.

If you’re not in good health due to the SCLC, you can get chemo and radiation at the same time, or the radiation can be given after the chemo.

If you have other health problems that make you unable to get standard cancer treatment, treatment will be based on what you can tolerate and what helps you feel better.

Next (subsequent) treatment

After your first treatment, you’ll get scans and tests to see how the cancer responded.

If the tumor is smaller or can’t be found, you’ll get PCI. Then you’ll see your doctor often to watch for signs that the cancer has come back.

If the tumor is the same size (stable), you’ll see your doctor often to watch for signs that it has started to grow.

Treatment for relapse or progression

If your limited stage SCLC didn’t respond to your first treatment, comes back (relapses), or starts to grow (progresses), treatment will depend on your overall health.

No matter how well you are, treatment will be done to manage any problems the cancer is causing. For instance, radiation may be used to shrink a tumor that’s pressing on your airway and making it hard to breathe.

If you’re in fairly good health and able to tolerate treatment, you’ll get chemo. Doctors can use different drugs if the ones you’re taking stop working. This will continue as long as you’re OK with the treatment and the cancer stays under control.

'Extensive' Small Cell Lung Cancer Treatment

First (Initial) treatment

If the cancer hasn’t spread to your brain, the tumors aren’t causing problems, or your problems are caused by the tumors (like shortness of breath or bleeding) and you’re well enough for treatment, you’ll get chemo, along with other treatments as needed to help you feel better.

Continued

If you’re not well enough for standard treatment due to other health problems, cancer treatment will be given based on what you can tolerate; for instance, lower doses of chemo might be used. You’ll also get treatment that helps you feel better.

If the tumors are causing problems, like blocking part of your lung or causing bone pain from cancer that has spread there, you’ll get chemo along with radiation to the tumors that are causing your problems. For instance, radiation to cancer that has spread to your bone can help ease the pain it’s causing in that bone.

If the cancer has spread to and weakened the bones of your spine (called spinal cord compression), you’ll get radiation to those sites to help keep your spinal cord from being damaged. Chemo will be given after the radiation.

If the cancer has spread to your brain, treatment depends on whether it’s causing problems. If you aren’t having any problems from it, you’ll get chemo and then radiation to your whole brain. If you’re having problems, you’ll get radiation to your whole brain first, and then chemo.

Next (subsequent) treatment

After your first treatment, you’ll get scans and tests to see how the cancer responded.

If the tumor is smaller or can’t be found, you might get PCI, chest radiation, or both. This helps lower the chance of cancer coming back to or spreading throughout these areas. Then you’ll see your doctor often to watch for signs that the cancer has come back.

If the tumor is the same size (stable), you’ll see your doctor often to watch for signs that it has started to grow.

Treatment for relapse or progression

If your extensive SCLC didn’t respond to your first treatment, comes back (relapses), or starts to grow (progresses), treatment will depend on your overall health.

No matter how well you are, treatment will be done to manage any problems the cancer is causing. For instance, radiation may be used to shrink a tumor that’s pressing on your airway and making it hard to breathe.

If you’re in fairly good health and able to tolerate treatment, you’ll get chemo. Different drugs can be used if the ones you’re taking stop working. This will continue as long as you’re OK with the treatment and the cancer is staying under control.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on April 17, 2018

Sources

SOURCES:

American Society of Clinical Oncology: “Lung Cancer - Small Cell: Treatment Options.”

American Cancer Society: “Treating Small Cell Lung Cancer,” “Treatment Choices by Stage of Small Cell Lung Cancer,” “Small Cell Lung Cancer Stages.”

National Cancer Institute: Small Cell Lung Cancer Treatment (PDQ) -- Patient Version: “Treatment Option Overview,” “Treatment Options by Stage.”

National Comprehensive Cancer Network: “Clinical Practice Guidelines in Oncology (NCCN Guidelines), Small Cell Lung Cancer, Version 2.2018 -- January 17, 2018.”

© 2018 WebMD, LLC. All rights reserved.

Pagination