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Small-Cell Lung Cancer: Symptoms, Causes, Tests, Treatment, And More - WebMD
When cells of the lung start growing rapidly in an uncontrolled way, the condition is called lung cancer This disease can affect any part of the lung, and it's the leading cause of cancer deaths in both women and men in the United States, Canada, and China.
There are two main types of lung cancer. Small-cell lung cancer (SCLC), sometimes called small-cell carcinoma, causes about 10%-15% of all lung cancer. Non-small-cell lung cancer (NSCLC) causes the rest.
There are two main types:
Both include many types of cells that grow and spread in different ways. They're named according to what the cells look like under a microscope.
Small-cell lung cancer differs from non-small-cell lung cancer in some key ways. Small-cell lung cancer:
The main cause of both small-cell lung cancer and non-small-cell lung cancer is tobacco smoking. But small-cell lung cancer is more strongly linked to smoking than non-small-cell.
Even secondhand tobacco smoke can make you more likely to get lung cancer. If you live with a smoker, your chances of getting NSCLC go up by about 30%, and your odds of getting SCLC rise by about 60%. That's compared to people who aren't exposed to secondhand smoke.
All types of lung cancer develop more often in people who mine uranium, but small-cell lung cancer is most common. The prevalence goes up even more in uranium miners who smoke.
Exposure to radon -- an inert gas that develops from the decay of uranium -- has been reported to cause small-cell lung cancer.
Exposure to asbestos greatly increases the risk of lung cancer. A combination of asbestos exposure and cigarette smoking increases the risk even further.
People with small-cell lung cancer typically have symptoms for about 2 to 3 months before they visit their doctor.
The symptoms can result from local growth of the tumor (meaning growth in the lung where it started), spread to nearby areas, distant spread, paraneoplastic syndromes, or a combination of some of these.
Some symptoms due to local growth of the tumor are:
Some symptoms due to the spread of the cancer to nearby areas are:
Symptoms due to the distant cancer spread depend on where it spreads. Here are some examples:
Some symptoms due to paraneoplastic syndromes are:
Call your doctor right away if you have any of these symptoms:
Call 911 if you have any of these symptoms:
If your doctor thinks you might have lung cancer, they'll give you a physical exam. They'll also ask about your health history, your work, any surgeries you've had, and whether you smoke or have in the past.
They may also give you exams and tests like these:
If your doctor diagnoses you with lung cancer, they'll recommend you get other exams and tests to find out whether the cancer has spread (metastasized) to other organs. These tests help determine the stage of the cancer.
Staging is important because lung cancer treatment is based on the stage of the cancer. Tests used to detect the spread of cancer may include:
Staging
Staging of the cancer provides important information about the outlook of your condition and helps your doctor plan the best treatment. Small-cell lung cancer has two stages: limited and extensive. That makes it different from other cancers, which go from stage I to stage IV.
Limited stage SCLC. In this stage, the tumor is confined to one side of the chest, the tissues between the lungs, and nearby lymph nodes only.
About 1 in 3 people with SCLC have limited stage cancer when they first get diagnosed.
If that's you, your doctor might recommend aggressive treatments -- meaning more intense than usual – to try to cure your cancer. For example, they might give you chemotherapy combined with radiation.
Extensive stage SCLC. In this stage, cancer has spread from the lung to other parts of the body. About 2 in 3 people with SCLC have extensive disease when they first get diagnosed.
Treatment can't cure the disease, but it could ease your symptoms and help you live longer.
Some of the most commonly used combinations of medications used for SCLC are carboplatin (Paraplatin), cisplatin (Platinol- AQ), cyclophosphamide (Cytoxan), docetaxel (Taxotere), doxorubicin (Adriamycin, Rubex), etoposide (Vepesid), irinotecan (Camptosar), lurbinectedin (Zepzelca), paclitaxel (Onxol, Taxol), topotecan (Hycamtin), and vincristine (Oncovin).
Treatment of limited-stage SCLC
Standard treatment of small-cell lung cancer involves combination chemotherapy with a regimen that includes cisplatin. Treatment cycles are typically repeated every 3 weeks. People receive treatment for four to six cycles.
Radiation therapy to the chest may be started as early as possible, or it may be given later in the course of treatment. This depends on things like the stage of your cancer and your overall health.
Radiation and chemotherapy: Some people get radiation followed by chemotherapy. But studies show that the earlier the radiation is started along with chemotherapy (as early as the first cycle of chemotherapy), the better the outcome.
If you have limited disease and you've had a very good response to chemotherapy, your doctor may recommend radiation therapy to your brain to lower the chances of small-cell lung cancer spreading there.
This is called prophylactic cranial irradiation (PCI). It is usually given after you've completed the full chemotherapy and radiation therapy to the chest. Short-term side effects include fatigue, skin changes, and hair loss. Long-term side effects include possible radiation necrosis where some healthy brain cells may be killed due to radiation effects.
Treatment of extensive-stage small-cell lung cancer
People with extensive-stage small-cell lung cancer are treated with combination chemotherapy. The combination of etoposide plus either cisplatin or carboplatin is the most widely used regimen.
Radiation therapy may be used for relief of the following symptoms:
For people newly diagnosed with extensive small-cell lung cancer, doctors recommend adding either atezolizumab(Tecentriq) or durvalumab (Imfinzi) to be given along with immunotherapy.
Treatment of relapse of small-cell lung cancer
A relapse is when your cancer or the signs of it come back after improving for a while.
If the disease doesn't respond to treatment or gets worse after your initial treatment (called "refractory disease"), your doctor has other ways to ease your symptoms and help you live somewhat longer. They may recommend immunotherapy. If you're not considered a candidate for immunotherapy, doctors typically use chemotherapy with topotecan (Hycamtin).
People whose cancer doesn't get worse for more than 3 months may be given more chemotherapy, including another treatment with their original chemotherapy regimen.
People 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.
Your doctor can give you medicines to prevent and treat side effects of radiation, chemotherapy, or symptoms of the cancer itself, such as nausea or vomiting. Pain medications are also important to relieve any pain due to cancer or its treatment.
Surgery
Surgery plays little, if any, role in the treatment 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%) who get diagnosed at a very early stage of the disease, when the cancer is confined to the lung without any spread to the lymph nodes. But surgery alone is not considered a possible cure, so they also get chemotherapy. Sometimes they also need radiation therapy if the cancer has 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 (meaning it reduces the risk of cancer spreading to the area to which it is given), or palliative (helps ease pain and other symptoms).
Follow-up
Palliative and terminal care
Because small-cell lung cancer is diagnosed in most people when it is not curable, palliative care becomes important. The goal of palliative and terminal care is to manage pain and discomfort and enhance the quality of life.
Palliative care not only focuses on comfort but also addresses the concerns of the patient's family and loved ones. Caregivers may include family and friends in addition to doctors, nurses, and other health care professionals.
Palliative and terminal care is often given in a hospital, hospice, or nursing home; however, it can also be provided at home.
Lung cancer is linked to several known risk factors for the disease. The main cause of lung cancer is tobacco smoking. So the most important way to help prevent lung cancer is to quit smoking.
Products that are available to help quit smoking include nicotine gum, medicated nicotine sprays or inhalers, nicotine patches, and oral drugs. Group therapy and behavioral training can also help you kick the habit.
For information about how to quit smoking, visit Smokefree.Gov.
Other risk factors for lung cancer include exposure to secondhand tobacco smoke, and workplace carcinogens such as asbestos, radon, and uranium. Take precautions to avoid being exposed to these harmful substances.
The success of treatment depends on the stage of small-cell lung cancer.
Unfortunately, in most people with small-cell lung cancer, the disease has already spread to other organs of the body by the time it is diagnosed. That shortens life expectancy.
The 5-year survival rate is between about 3% and 30%. That's the percentage of people who are alive 5 years after they were diagnosed with or started treatment for a disease.
There's no cure for advanced-stage small-cell lung cancer, but doctors have lots of ways to improve your quality of life and ease any symptoms of the cancer or its treatment.
Support groups and counseling can help you feel less alone and can improve your ability to deal with the uncertainties and challenges that cancer brings.
Cancer support groups provide a forum where patients with cancer, survivors of cancer, or both, can discuss the challenges that accompany the illness, as well as guide you in dealing with your concerns.
Support groups provide an opportunity to exchange information about the disease, give and take advice about managing side effects, and share feelings with others who are in a similar situation.
Support groups also help your family and friends deal with the stress of cancer.
Many organizations offer support groups for people with cancer and their loved ones. You can get information about such groups from your doctor, nurse, or hospital social worker.
The following organizations can help you with support and counseling:
Stage 3 Lung Cancer: Types, Symptoms, Diagnosis, Treatments, & Prognosis - WebMD
Doctors use stages to describe how much cancer you have and where it is in your body. People with stage III lung cancer can be a very mixed group. Their tumors can differ in size, location, and how distant they are from where the cancer started.
But almost always, stage III cancer is in just one lung. It's also limited to the lymph nodes, organs, and other tissue near that organ. The cancer has not spread, or metastasized, beyond that. That's why this stage is also called locally advanced or locoregional disease.
The next stage, stage IV, is the last and most serious stage of lung cancer.
Nearly 9 out of 10 people with lung cancer have non-small-cell lung cancer (NSCLC). A rarer and more aggressive type is called small-cell lung cancer. But the numbered stages are used mainly for the more common NSCLC.
Staging uses three key criteria called TNM:
Doctors split stage III non-small-cell lung cancer into three main subtypes. It helps them get a more detailed picture of your cancer and decide on the best treatments.
Stage IIIA. You have one or more tumors in one lung. The cancer is in nearby lymph nodes. The cancer may be in certain nearby tissues, but it hasn't reached distant organs.
Stage IIIB. You have one or more tumors in the same lung. Your cancer may have spread to lymph nodes above your collarbone and may be in lymph nodes on the opposite side of your chest. The cancer may be in certain nearby tissues but not in distant organs.
Stage IIIC. This is the most advanced stage within stage III. You have one or more tumors in the same lung. Your cancer has spread to lymph nodes above your collarbone or to lymph nodes on the opposite side of your chest. The cancer may be in the chest wall, heart, breastbone, and other nearby tissues but hasn't spread to distant organs.
Most non-small-cell lung cancer is found after it's become advanced. That's partly because the disease worsens quickly and often doesn't have signs in the early stages. But symptoms may include:
If your stage III lung cancer has spread beyond your lungs, it can cause other symptoms. For example, you may have bone pain if it has spread to your bones.
Your doctor probably found your lung cancer after checking your symptoms. Most people aren't routinely checked for the disease unless they smoke or otherwise face a higher risk.
If you have symptoms of lung cancer, your doctor will likely order a chest X-ray to learn more. (Photo Credit: Stockbyte/Getty Images)
A chest X-ray is often the first image test. If it suggests you have cancer, you'll have follow-up tests, such as:
CT scan. Your doctor may order a "contrast-enhanced" version of this scan, which can take more detailed images.
Your doctor may run other tests to check the extent of your cancer. They might include:
Biopsy. A doctor will examine a sample of your tissue under a microscope to confirm that it's cancer.
Your doctors have several ways to treat you based on the size, location, and other characteristics of your cancer, including:
Stage III lung cancer surgery
If possible, your doctor may opt for an operation to remove all the tumors from your lungs. If your lung cancer has spread into your lymph nodes, they may not be able to remove all of it. Some surgical options include:
Adjuvant therapy
After you have a primary treatment for your lung cancer, such as surgery, chemotherapy, or radiation, your health care team may recommend adjuvant therapy, or treatments that try to keep your cancer from coming back. Adjuvant therapy may include additional chemotherapy, targeted drug therapy, or immunotherapy. You may receive adjuvant therapy for a few weeks or up to 10 years, depending on your overall health and how likely it is for your cancer to come back.
Talk with your doctor to understand your treatment plan.
More people in the U.S. Die of lung cancer than of breast, colon, and prostate cancers combined. About 1 in 3 people diagnosed with stage IIIA lung cancer live for at least 5 years after their diagnosis. For stage IIIB, the average 5-year survival rate is 26%. For stage IIIC, it's 13%.
Your long-term outlook may be better if you:
Any serious illness can bring worry, uncertainty, and other challenges to you and your loved ones. Try to:
Manage your pain. You may feel pain not only from your cancer but also from treatments as well. Work with your doctors to control your pain as well as you can. That also may help lower your chances of depression.
Ease other symptoms. Weight loss is common when you have cancer. Eat well to help keep up your strength and to prevent infections. For constant coughs, you might find relief with:
Pulmonary rehab may also improve your symptoms and quality of life. It may help you breathe easier and stay more active.
Quit smoking. It's never too late to stop. People who give up smoking before their cancer treatments tend to respond better. If it's hard for you to quit, a smoking cessation program may help.
Connect with others. There is no such thing as too much support. It may help to talk to a medical social worker, mental health counselor, or other professionals. Join a cancer support group, either in person or online. Find out if any local groups offer free rides to appointments and other help. The American Cancer Society has a searchable directory of programs.
If you've smoked heavily in the past, your doctor may recommend you get screened for lung cancer each year. Using a low-dose CT scan (LDCT), a type of noninvasive X-ray, your doctor can check for early signs of lung cancer before you even have symptoms.
You may be a candidate for yearly lung cancer screening if you:
LDCT scans expose you to a small amount of radiation, which can increase your risk of cancer, but this test uses less radiation than a standard CT scan. The benefits of the scan typically outweigh its risks, as earlier stages of lung cancer are easier to treat if your doctor sees any early signs of cancer.
Stage III lung cancer is when you have cancer in one or more lobes, or sections, of one lung. Depending on how progressed it is, cancer at this stage may have also spread to nearby lymph nodes and tissue. The diagnosis is serious, but treatments for stage III lung cancer, including chemotherapy,radiation, and surgery, may be able to improve your outlook. If you smoke now or have smoked heavily in the last 15 years, talk with your doctor to see if you're a good candidate for yearly lung cancer screening.
Is stage III lung cancer terminal?
No. Everyone's cancer and response to treatment are different. However, therapies for stage III lung cancer are improving, and survival rates have gotten better in recent years.
How long can you live with stage III lung cancer?
Everyone's outlook is different, but on average, 15 in 100 people with stage III cancer will live 5 years after they've been diagnosed.
What is the most aggressive form of lung cancer?
Small cell lung cancer is the most aggressive form of the illness. It usually begins in the airways and can quickly spread to other parts of the body.
Non-Small Cell Lung Cancer Prognosis: Survival Rates - Health
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, accounting for 80-85% of all cases. It develops when abnormal lung cells grow uncontrollably, forming a tumor.
There are three main subtypes of NSCLC: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Each subtype starts in different lung cells, but treatment and prognosis for each are similar. Prognosis refers to the expected trajectory and outcome of a disease.
The prognosis of non-small cell lung cancer varies depending on the specific subtype and the stage of cancer at diagnosis. Early-stage NSCLC—when the cancer is confined to one or two lungs— generally has a better prognosis than more advanced stages, when the cancer has metastasized (spread) to nearby lymph nodes or distant organs. Additionally, certain subtypes of NSCLC tend to grow more rapidly than others, which can influence prognosis.
The prognosis of non-small cell lung cancer depends on several factors, including the stage of the cancer at diagnosis. Staging provides a comprehensive picture of the extent of cancer. To determine the cancer stage, healthcare providers use a staging system called TNM. TNM focuses on three key aspects: (T) Tumor size and location: The size of the primary tumor and whether it has grown into nearby tissues or organs (N) Lymph node involvement: Whether cancer has spread to lymph nodes in the chest near the lungs (M) Metastasis: Whether the cancer has spread beyond the lungs to distant organs or body areas, such as the liver, brain, or bones; metastasis is common in more advanced stages Staging helps inform treatment decisions and can determine potential outcomes. Early-Stage Prognosis In the early stages of NSCLC, the primary tumor is small and has not spread to distant organs. Detecting lung cancer early offers the best chance for successful treatment and a positive prognosis. Here's a look at the prognosis for each early stage of NSCLC: Stage 0: Cancer cells are limited to only the top layer of cells in the airways and have not spread to other lung tissues. Stage 0 NSCLC is curable with treatment, which usually involves surgical removal of the cancer cells and the affected part of the lung, laser therapy, or brachytherapy (internal radiation). Stage 1: The primary tumor is no larger than 3 or 4 centimeters and has not spread to any lymph nodes in the chest or other body areas. Treatment may include surgery, chemotherapy, or radiation therapy. Stage 2: The cancer has not spread to other organs or body areas but may have spread within the lungs or to nearby lymph nodes in the chest. Treatment typically involves surgery, chemotherapy, immunotherapy, and/or targeted therapy. Advanced-Stage Prognosis Advanced NSCLC, including stage 3 and stage 4, means cancer has spread beyond the lungs to nearby or distant lymph nodes or other organs in the body, such as the brain, liver, or bones. While the prognosis for advanced stages of NSCLC is poorer than that of earlier stages, advancements in treatment options have improved outcomes in recent years. In some cases, treatment for advanced NSCLC focuses on managing the disease and improving quality of life rather than achieving a cure. The prognosis for stage 3 NSCLC varies widely, depending on which lymph nodes the cancer has spread to, such as those in the chest or neck. Treatment typically includes a combination of chemotherapy, radiation therapy, immunotherapy, and/or surgery. Stage 4 is the most advanced form, with cancer having spread to distant organs. Stage 4 cancers can be challenging to treat and cure. Treatment options depend on how far the cancer has spread and your overall health and may include chemotherapy, surgery, and radiation therapy. If your tumor has specific gene mutations (changes), targeted therapies or immunotherapies may help you feel better, even if they do not cure the cancer. Survival rates for non-small cell lung cancer represent the percentage of people still alive for a specific period after diagnosis. The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program collects data on various cancers, including NSCLC. The program categorizes NSCLC stages based on the extent to which cancer has spread. While the SEER system is similar to the TNM staging system, SEER uses a broader grouping: Localized: There is no evidence of cancer spread beyond the lung Regional: The cancer has spread to nearby lymph nodes Distant: The cancer has spread to distant organs beyond the lungs Here's a breakdown of the five-year survival rate for NSCLC from 2012-2018: Localized: 65% Regional: 37% Distant: 9% All SEER stages combined: 28% It's important to remember that survival rates represent averages from years past and do not predict a specific person's outcome. While lung cancer is the leading cause of cancer-related deaths in the United States, thanks to advancements in treatment options, survival rates and the prognosis for NSCLC continue to improve. Several factors influence your prognosis with non-small cell lung cancer. Healthcare providers consider each of these factors to assess the likely course and outcome of the disease: Stage: This is the most critical factor in determining prognosis. Detection and diagnosis of NSCLC in earlier stages offer a better chance of successful treatment than in advanced stages. Subtype: Some subtypes of NSCLC, such as large cell carcinoma, grow and spread more quickly than others and can be more difficult to treat. Age: Younger people generally have a better prognosis than older adults. This may be due to a combination of factors. For example, younger people generally have fewer comorbidities and a greater ability to tolerate chemotherapy and other treatments. Sex: Women have a slightly better prognosis than men. Performance status: This is a measurement of how well you can perform daily activities while living with cancer. Generally, the higher your performance status, the better your prognosis. Smoking history: People who currently or used to smoke have a poorer prognosis than people who never smoked. Research shows that current smokers have a 68% higher mortality, and former smokers have a 26% higher mortality compared to people who never smoked. Underlying conditions: People with NSCLC who have underlying conditions like chronic obstructive pulmonary disease (COPD), heart disease, or diabetes generally have a poorer prognosis than those who are otherwise in good health. Gene mutations: NSCLC cancer cells with changes in specific genes may be more responsive to targeted therapies, which can improve prognosis. A diagnosis of non-small cell lung cancer, discussions about prognosis, and learning to live with lung cancer can be overwhelming and emotionally challenging. Finding ways to cope with these challenges and leaning on support can help you navigate your NSCLC journey. Practicing Emotional and Psychological Coping Strategies Coming to terms with a lung cancer diagnosis and how it will impact your life can take some time. You might experience a rollercoaster of emotions, including fear, anxiety, anger, sadness, or frustration. Here are some tips for managing the emotional and psychological aspects of an NSCLC diagnosis: Acknowledge your feelings: Allow yourself to feel what you're feeling and express your emotions. There is no right or wrong way to do this, but the important thing is not to bottle up your feelings. Consider journaling, talking to a trusted friend or family member, or seeking professional counseling. Talk to your healthcare team: Open communication with your cancer care team is crucial. Don't hesitate to ask questions about your prognosis, treatment options, and potential side effects. The more informed you are, the more empowered you feel to manage your care. Relaxation techniques: Practices such as mindfulness meditation, deep breathing exercises, guided imagery, and yoga can help manage stress and positively impact emotional well-being. Join a support group: Connecting with others who understand what you're going through can be helpful. Online and in-person NSCLC support groups can provide a safe space to share your experiences, ask questions, and gain emotional support from others facing similar challenges. Caring For Your Physical Well-Being Taking care of your physical health can support your overall health and give your body the strength required to get through treatment. You can care for your physical well-being while living with NSCLC through: Exercise: Regular physical activity, including gentle exercise like walking, can help improve your mood, energy levels, and overall strength. Talk to your healthcare provider to discuss which exercises and how much physical activity they recommend. Diet: Eating a balanced and nutritious diet with plenty of fruits, vegetables, healthy fats, lean proteins, and whole grains can help ensure your body gets the nutrients it needs to maintain your strength and support your immune system before, during, and after treatment. Sleep: Getting enough quality sleep is essential for your physical and mental health. Aim for seven to eight hours of good-quality sleep every night. Sleep problems are common in people with cancer, so talk to your healthcare provider if you have trouble falling asleep or staying asleep. Supportive care: Supportive care therapies, such as massage therapy and acupuncture, can help reduce pain and improve sleep and quality of life in people with cancer. Finding Additional Support A diagnosis of NSCLC can be overwhelming, but you do not have to navigate your cancer journey along. Many organizations provide resources and support for people living with NSCLC. These organizations offer information about the disease, treatment options, financial aid, and emotional support. Here are some reputable sources: The National Cancer Institute: Provides comprehensive cancer information, supports research, and offers resources for patients and caregivers The American Cancer Society: Offers patient support, advocacy, and funding for cancer research The Lung Cancer Foundation: Provides comprehensive support, including a HelpLine, support groups, educational materials, clinical trial information, and guidance on financial resources CancerCare: Offers free professional support services, including counseling, support groups, and workshops, for people living with cancer and their loved ones National Lung Cancer Partnership: Provides resources and support for people with lung cancer, including information about clinical trials, financial assistance for treatment, and research updates Non-small cell lung cancer (NSCLC) is the most common form of lung cancer, accounting for up to 85% of all lung cancer diagnoses. After an NSCLC diagnosis, it's natural to wonder about your prognosis, meaning the outcome of the disease and treatment. Your healthcare provider will consider several factors when determining your prognosis, including the subtype and stage of cancer, your age, sex, and overall health. It's important to remember that the prognosis is just your healthcare provider's best guess. With advancements in treatment options, the prognosis for people with NSCLC continues to improve. Living with NSCLC comes with challenges, but you don't have to face this journey alone. There are many resources available to help you cope with the emotional and physical challenges of lung cancer. With proper support and treatment, it is possible to live well with NSCLC.Thanks for your feedback!
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