Many cancers have four stages, but small cell lung cancer (SCLC) is generally divided into two stages — limited stage and extended stage.
Knowing the stage gives you some idea about the general outlook and what to expect from treatment. When deciding on the next steps, the stage isn’t the only consideration. Your doctor will also factor in your age, overall health, and personal preferences regarding your quality of life.
Read on to learn more about what it means to have extensive stage SCLC.
Extensive stage SCLC has spread far from the original tumor. Your doctor will diagnose extensive stage SCLC when the cancer:
- is widespread throughout one lung
- has spread to the other lung
- has invaded the area between the lungs
- has reached lymph nodes on the other side of the chest
- has reached bone marrow or distant sites such as the brain, adrenal glands, or liver
Because there often are no early symptoms, about 2 in 3 people with SCLC have extensive stage disease at the time of diagnosis.
Recurrent SCLC is cancer that has returned after treatment has been completed.
Because the cancer has spread, the main treatment for extensive stage SCLC is chemotherapy. Chemotherapy is a type of systemic therapy. It doesn’t target a specific tumor or area of the body. It seeks out and attacks cancer cells no matter where they are. It can shrink tumors and slow progression.
Some of the more common chemo drugs used for SCLC are:
Usually, two drugs are used in combination.
Immunotherapy drugs like atezolizumab can be used in combination with chemotherapy, as a maintenance therapy, or when chemotherapy is no longer working.
In extensive stage SCLC, radiation to the chest is usually only done if you have a good response to chemotherapy.
Radiation therapy can be used to target specific areas of the body where cancer has spread. This can help shrink tumors to improve symptoms and potentially prolong your life.
Even if the cancer hasn’t spread to your brain, your doctor may recommend radiation to the brain (prophylactic cranial irradiation). This can prevent the cancer from spreading there.
Cancer in the lungs can lead to bleeding and trouble breathing. When that happens, radiation therapy or laser surgery may be used. The goal isn’t to cure it, but to improve your symptoms and overall quality of life.
SCLC is difficult to treat. You might want to consider clinical trials of new chemotherapy agents, immunotherapies, or other treatments that aren’t otherwise available. If you’re interested in learning more, your doctor can find out what trials might be a good match for you.
In addition, you may need supportive (palliative) care to address specific symptoms. For example:
- bronchodilators to widen the airways of your lungs
- oxygen therapy
- pain relievers
- gastrointestinal medications
You can also work with a dietician for nutritional support.
Chemotherapy can be effective at shrinking SCLC. Many people will experience some symptom relief.
Even if the cancer shrinks to the point where imaging tests can no longer locate it, your doctor will likely suggest maintenance therapy. That’s because SCLC is an aggressive disease that almost always returns.
While there is no cure for extensive stage SCLC, treatment can help slow progression and improve your quality of life.
There are many standard treatments for extensive SCLC, and many things to consider. In addition to the stage, your doctor will recommend treatment based on:
- where the cancer has spread (metastasized) and what organs are affected
- severity of symptoms
- your age
- personal preferences
Chemotherapy and radiation can lead to significant side effects, even in the healthiest of people. Your overall health will guide decisions about chemotherapy drugs and dosing.
Set aside time to have an in-depth discussion with your oncologist. It may help to involve family members or other loved ones. Get a good idea of each type of treatment, what you should reasonably expect of them, and likely side effects.
Ask about the logistics of treatment and how it will impact your life on a day-to-day basis. Your quality of life matters. What you want matters. Encourage your doctor to speak plainly so you can make good decisions.
If chemotherapy or clinical trials aren’t a good fit for you, you can still continue to receive supportive care. Rather than try to cure the cancer or slow progression, supportive care focuses on symptom management and maintaining the best quality of life possible for as long as possible.
Living with extensive stage SCLC can be overwhelming. But there are ways to cope with the disease and live your life to the fullest.
Some people find it helpful to see a therapist to help sort out their emotions. This can also be beneficial for loved ones who are having difficulty.
Many people find comfort in support groups, whether they’re online or in-person meetings. Your doctor can refer you to groups in your area, or you can get more information from these organizations:
Getting treatment is important, but it’s not the only thing to consider. Treat yourself to activities that are meaningful to you. You deserve it and it will contribute to your quality of life.
Whether or not you choose chemotherapy, you’ll probably need supportive care, also known as palliative care.
Palliative care does not treat the cancer itself but strives to help you maintain the best quality of life possible. This can include pain relief, breathing assistance, and stress relief. Your palliative care team may include:
- social workers
If your airways are restricted, you can have:
- Photodynamic therapy. This therapy uses a drug called a photosensitizer and exposure to light at certain wavelengths. You’ll be sedated as an instrument called a bronchoscope is passed down your throat and into your lung. The procedure can help open your airway.
- Laser therapy. Using a laser on the end of a bronchoscope, a doctor can burn parts of the tumor away. You’ll need to be under general anesthesia.
- Stent. A doctor can place a tube called a stent into your airway to help you breathe.
Pleural effusion is when you have a buildup of fluid around your lung. It can be treated with a procedure called thoracentesis. In this procedure, a hollow needle is placed in the space between the ribs to drain the fluid.
There are also several procedures to keep the fluid from building up again:
- Chemical pleurodesis. A doctor inserts a hollow tube into the chest wall to drain fluid. Then a chemical is introduced to cause the lining of the lung and the chest wall to stick together and prevent future buildup of fluids.
- Surgical pleurodesis. During surgery, a medicine such as a talc mixture is blown into the area around the lungs. The medicine causes scar tissue to form, which makes the lung stick to the chest. This helps close up the space where fluid can collect.
- Catheter. A doctor places a catheter in the chest and leaves it outside the body. Fluid is regularly drained into a bottle.
If fluid is building up around your heart, these procedures can help:
- Pericardiocentesis. Guided by an echocardiogram, a doctor places a needle into the space around the heart to drain fluid.
- Pericardial window. During the procedure, a surgeon removes a part of the sac around the heart. This allows fluid to drain into the chest or abdomen.
For tumors that grow outside of the lungs, radiation therapy can help shrink them to relieve symptoms.
Extensive stage SCLC means your cancer has spread far from the tumor. There is no cure for this type of cancer, but treatment is available to help manage symptoms and prolong your life. Your doctor will recommend a treatment plan based on your diagnosis and overall health.