Most people with small cell lung cancer will have a recurrence. While several factors affect life expectancy, the outlook is typically less favorable. Treatment for recurrent small cell lung cancer is typically palliative.

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Lung cancer is the second most common type of cancer and the leading cause of cancer death in both men and women in the United States. The American Cancer Society estimates that in the United States, in 2024, there will be 234,580 new diagnoses of lung cancer.

Small cell lung cancer (SCLC) makes up roughly 15% of lung cancer diagnoses and is more aggressive than other types of lung cancer. That means it’s more likely to grow and spread quickly and can come back (recur) after treatment.

To learn more about recurrent SCLC and its outlook, please continue reading.

Learn more about small cell lung cancer.

Recurrent SCLC is cancer that comes back after treatment. It happens when a small number of cancer cells survive treatment. These cells may not show up on follow-up testing but can eventually grow to form a new, detectable tumor.

According to the National Cancer Institute, most cancers will recur within 5 years. However, according to a 2020 study, over 90% of SCLCs recurred within 2 years.

SCLC can recur in different ways:

  • Locally: Cancer recurrence is close to the area of your original cancer
  • Regionally: Cancer recurrence is close to the original site of your cancer but has spread into nearby tissues or lymph nodes
  • Distantly: Cancer recurrence has occurred in more distant tissues

The life expectancy of recurrent SCLC can vary based on its stage. The table below shows the five-year survival rates of each stage of SCLC between the years 2012 and 2018.

Life expectancy for each stage of SCLC

StageFive-year survival rate
Local30%
Regional18%
Distant3%
Overall7%

Doctors can also use a two-stage system for recurrent SCLC:

  • Limited: Cancer recurrence is typically only in one lung and may have spread to some nearby lymph nodes on the same side of the chest
  • Extensive: Cancer has recurred and spread more widely in the lungs, chest, or body

A 2018 review notes that the median overall survival is 20 months for limited-stage SCLC and 8–12 months for extensive-stage SCLC.

Age can also play a role in the outlook for SCLC. Generally speaking, people ages 65 years and older can have a negative effect on their outlook because of their age.

One 2021 study of individuals with SCLC suggests that the average age at diagnosis was 66 years. Most people in the study experienced a recurrence of their SCLC.

The table below shows the median survival time and the one- and three-year survival rates based on age, according to a 2022 study in people with SCLC.

Survival times for SCLC

Age groupMedian survival (months)1-year survival rate3-year survival rate
18–49 years1249.9%15.7%
50–69 years10.844.9%14.3%
70 years and older8.534.9%9.7%
all ages10.141.8%12.8%

SCLC is often very aggressive and challenging to treat. Because of this, it is very unlikely to cure recurrent SLCC.

A 2018 commentary notes that doctors consider recurrent SCLC to be incurable and that they prescribe the treatment with palliative intent.

Palliative therapy is treatment aimed at improving quality of life and reducing symptoms. It may shrink or slow the growth of the cancer, but it cannot cure it.

The long-term outlook of SCLC is less favorable. This is because SCLC is aggressive, meaning that it grows and spreads quickly.

A 2020 study on recurrent lung cancer says that most people who developed recurrent SCLC had a distant recurrence. The most common site was the central nervous system. Other common sites were liver, bones, and adrenal glands.

Response to treatment also plays a role. While a 2023 review notes that many people with SCLC respond well to first-line treatment, which includes platinum-based chemotherapy (chemo), this often isn’t the case with recurrent SCLC.

The review points out that recurrent SCLC is often resistant to treatment with platinum-based chemo. This reduces treatment options, making the treatment of recurrent SCLC more challenging and the outlook less favorable.

Doctors determine the stage of your recurrent cancer in the same way as staging at your initial SCLC diagnosis. Your doctor will use imaging and laboratory tests to determine the extent of your recurrent SCLC.

Your doctor will then develop a treatment plan for your recurrent SCLC. This depends on several factors, including:

  • the extent and location(s) of your recurrent SCLC
  • the treatments you’ve had in the past
  • your age and overall health
  • your personal preference

Several factors can affect survival and outlook for recurrent SCLC. These include:

  • the extent of cancer
  • the location(s) of the cancer
  • how the cancer responds to the recommended treatment
  • your performance status, a measure of your well-being and ability to do daily activities
  • whether or not you’ve experienced significant (more than 10%) weight loss
  • your age and overall health

It’s important to remember that each person with cancer is different. Your care team can consider all of the factors above to give you a better idea of your outlook and what to expect.

How do you treat recurrent small cell lung cancer?

Doctors treat recurrent SCLC with chemo with or without immunotherapy. The specific type of chemo they use depends on which chemo drugs that cancer is sensitive to. They may also use radiation therapy as a palliative treatment.

It’s also possible that your care team may recommend that you participate in a clinical trial testing new or updated ways to treat recurrent SCLC.

Can you prevent small cell lung cancer from coming back?

There’s no surefire way to prevent SCLC from coming back. Most SCLCs will recur.

If surgery was part of your initial treatment, you may have adjuvant therapy to destroy the remaining cancer cells and help prevent the cancer from coming back. You can also improve your overall health after treatment by making lifestyle changes like:

Is recurrent small cell lung cancer terminal?

SCLC is typically terminal. A cancer is terminal when it cannot be managed or cured using treatment and will eventually lead to death.

Is small cell lung cancer the worst kind of lung cancer?

There are two general types of lung cancer, SCLC and non-small cell lung cancer (NSCLC). SCLC is more aggressive and has a less favorable outlook than NSCLC.

SCLC is an aggressive type of lung cancer. Many people who have this type of lung cancer will experience a recurrence, typically within 2 years of diagnosis.

Because it’s aggressive and often resistant to first-line treatments, recurrent SCLC has an unfavorable outlook. The treatment that you receive for recurrent SCLC is typically palliative.

The extent of SCLC and age are two important factors affecting your outlook. Other factors affecting recurrent SCLC outlook include how the cancer responds to treatment, your performance status, and your overall health.

If you receive a diagnosis of recurrent SCLC, have an open discussion with your care team about your outlook. They can give you a better idea of what to expect.