Lung cancer - small cell Health Article

Definition

Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It spreads much more quickly than non-small cell lung cancer.

There are three different types of small cell lung cancer:

• Small cell carcinoma (oat cell cancer)
• Mixed small cell/large cell carcinoma
• Combined small cell carcinoma

Most small cell lung cancers are the oat cell type.

Alternative Names

Cancer - lung - small cell; Small cell lung cancer; SCLC

Causes, incidence, and risk factors

About 15% of all lung cancer cases are small cell lung cancer. Small cell lung cancer is slightly more common in men than women.

Almost all cases of SCLC are due to cigarette smoking. SCLC is rare in those who have never smoked.

SCLC is the most aggressive form of lung cancer. It usually starts in the breathing tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow very quickly and create large tumors. These tumors often spread rapidly (metastasize) to other parts of the body, including the brain, liver, and bone.

Symptoms

• Bloody sputum (phlegm)
• Chest pain
• Cough
• Loss of appetite
• Shortness of breath
• Weight loss
• Wheezing

Other symptoms that may occur with this disease:

• Facial swelling
• Fever
• Hoarseness or changing voice
• Swallowing difficulty
• Weakness

Signs and tests

Your health care provider will perform a physical exam and ask questions about your medical history. You will be asked whether you smoke, and if so, how much and for how long you have smoked.

When listening to your chest with a stethoscope, your health care provider can sometimes hear fluid around the lungs or areas of partial lung collapse. Each of these findings could (but does not always) suggest cancer.

Small cell lung cancer has usually spread to other parts of your body by the time it is diagnosed.

Tests that may be performed include:

• Bone scan
• Chest x-ray
• Complete blood count (CBC)
• CT scan
• Liver function tests
• MRI
• Positron emission tomography (PET) scan
• Sputum test (cytology, looking for cancer cells)
• Thoracentesis (removal of fluid from the chest cavity around the lungs)

In some cases, your health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

• Bronchoscopy combined with biopsy
• CT scan-directed needle biopsy
• Endoscopic esophageal ultrasound (EUS) with biopsy
• Mediastinoscopy with biopsy
• Open lung biopsy
• Pleural biopsy

Usually, if a biopsy reveals cancer, more imaging tests are done to find out the stage of the cancer. (Stage means how big the tumor is and how far it has spread.) However, the traditional staging system, which uses numbers to tell how advanced the cancer is, is usually not used for patients with SCLC. Instead, SCLC is classified as either:

• Limited (cancer is only in the chest and can be treated with radiation therapy)
• Extensive (cancer has spread outside the chest)

The majority of cases are extensive.