Small cell lung cancer treatment

This page was reviewed under our medical and editorial policy by

Peter Baik, DO, Thoracic Surgeon

This page was reviewed on January 8, 2023.

Determining an appropriate treatment for small cell lung cancer depends on the stage of the cancer, how aggressive it is and other factors. Small cell lung cancer, or SCLC, is usually divided into two stages: limited and extensive.

  • Limited small cell lung cancer means the cancer is only on (or “limited” to) one side of the chest, such as in one lung, or in one lung and the lymph nodes on the same side of the body.
  • Extensive stage small cell lung cancer means the cancer has spread (thus “extended”) throughout the lung, both lungs or to other parts of the body.

According to the American Cancer Society (ACS), two out of three patients have extensive small cell lung cancer at the time of diagnosis.

Most treatments for small cell lung cancer do not lead to complete disappearance of the tumor on imaging, but they may contribute to an improved length and quality of life.

Surgery for SCLC

For those with small cell lung cancer in the limited stages, meaning it only shows up as a single tumor and hasn’t spread elsewhere, surgery may be an appropriate treatment option. That said, according to the ACS, this option is less common, since fewer than one in 20 patients is found to have a single lung tumor that hasn’t spread at the time of diagnosis. When surgery is performed, it’s often followed by chemotherapy.

Small cell lung cancer surgery is performed under a general anesthetic and involves removing a portion of a lung (known as a lobe) or a portion of a lobe via incisions between the ribs. Nearby lymph nodes are also removed during surgery to ensure that there is no lymph node involvement.

The type and size of the tumor, along with the overall health of the lungs, will determine which type of surgery will be recommended. However, surgeries for small cell lung cancer are extensive and often require a five- to seven-day hospital stay, followed by a lengthy recovery period at home.

As with nearly all medical procedures, side effects are possible. Side effects and risks of surgery may include:

  • Prolonged air leak
  • Pneumonia
  • Bleeding
  • Blood clots in the lungs or legs
  • Reactions to general anesthesia
  • Arrhythmia

Chemotherapy for SCLC

Chemotherapy is a treatment that administers medication into the body, usually directly into the bloodstream through an IV, to kill cancer cells. Sometimes it’s taken as a pill. It’s used for both limited and extensive-stage small cell lung cancer.

For patients with limited stage small cell lung cancer, chemotherapy is often given with radiation therapy in a treatment regimen called chemoradiation. Those with extensive-stage small cell lung cancer may undergo chemotherapy alone or in combination with immunotherapy and radiation therapy.

Small cell lung cancer chemotherapy is delivered in cycles, with rest periods in between, and it often involves using a combination of two or more types of chemotherapy drugs, given via an injection or through an infusion, with infusions given over a longer period of time.

The exact chemotherapy drugs used and the length of treatment vary, so talk to your care team about details specific to your situation.

Chemotherapy often causes side effects, although everyone reacts differently. Small cell lung cancer chemotherapy side effects may include:

Some small cell lung cancer chemotherapy drugs may also damage the body’s nerve endings or cause kidney damage. Your care team will advise you if you’re at risk of these side effects.

Radiation therapy for SCLC

Radiation therapy for small cell lung cancer is used to treat both limited and extensive stage small cell lung cancer patients and involves using targeted, high-energy X-rays to destroy cancer cells.

Limited small cell lung cancer patients typically undergo radiation therapy in combination with chemotherapy, and radiation may also be used to reduce the chances of cancer spreading into the brain.

Many patients with extensive small cell lung cancer, meanwhile, undergo radiation therapy after chemotherapy. It’s also used to reduce the size of tumors that have spread to other parts of the body or to ease symptoms caused by tumors in the lungs (such as coughing or breathing problems).

External beam radiation therapy (EBRT) is used most often for small cell lung cancer. This treatment uses an external machine to specifically target the radiation site, and it’s given in courses of several weeks, requiring daily or twice daily treatments.

While radiation is designed to only target the tumor and reduce damage to healthy cells, risks of side effects remain, including:

  • Fatigue
  • Hair loss near the radiation site
  • Weight loss and loss of appetite
  • Vomiting and nausea
  • Skin redness, irritation or peeling near the radiation site
  • Sore throat (when radiation is given near the middle of the chest)

Immunotherapy for SCLC

Immunotherapy for small cell lung cancer is designed to help the immune system target and kill cancer cells. Immunotherapy is used for some advanced-stage cancers, sometimes in combination with chemotherapy.

This treatment is given intravenously, every few weeks, and it works by turning on or off proteins, called checkpoints, which may trigger an immune response. This helps the body target cancer cells without harming healthy cells.

Side effects of immunotherapy may include:

  • Skin rash
  • Joint pain
  • Diarrhea or constipation
  • Feeling nauseous
  • Coughing
  • Reduced appetite
  • Allergic reactions to the infusion

Occasionally, a severe autoimmune reaction may occur, causing the body to attack healthy parts of the body, such as the lungs, intestines or organs. Your care team will closely monitor you for serious reactions like these and may have to stop your immunotherapy if they occur.

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