The process used to find out if cancer has spread within the chest or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.
In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.
There are different types of treatment for patients with small cell lung cancer.
Different types of treatment are available for patients with small cell lung cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Three types of standard treatment are used:
Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used. Occasionally, surgery may be used to help determine the patient’s exact type of lung cancer. During surgery, the doctor will also remove lymph nodes to see if they contain cancer. Laser therapy (the use of an intensely powerful beam of light to kill cancer cells) may be used.
Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Video (Dr. David Harpole, a Professor of Thoracic Surgery at Duke University Medical Center, explains how researchers at Duke have developed the first genomic test which can predict which patients with lung cancer would require chemotherapy.)
Video (Dr. Kemp Kernstine, Director of the Lung Cancer Program in City of Hope, also discusses an article where a test can determine if chemotherapy would benefit a lung cancer patient.)
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Prophylactic cranial irradiation (radiation therapy to the brain to reduce the risk that cancer will spread to the brain) may also be given. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Treatment Options by Stage
Limited-Stage Small Cell Lung Cancer
Treatment of limited-stage small cell lung cancer may include the following:
- Combination chemotherapy and radiation therapy to the chest, with or without radiation therapy to the brain.
- Combination chemotherapy with or without radiation therapy to the brain in patients with complete response.
- Combination chemotherapy with or without radiation therapy to the chest.
- Surgery followed by chemotherapy or chemotherapy plus radiation therapy to the chest, with or without radiation therapy to the brain.
- Clinical trials of new chemotherapy, surgery, and radiation treatments.
Extensive-Stage Small Cell Lung Cancer
Treatment of extensive-stage small cell lung cancer may include the following:
- Combination chemotherapy.
- Combination chemotherapy with or without radiation therapy to the brain for patients with complete response.
- Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life.
- Clinical trials of new chemotherapy treatments.
Recurrent Small Cell Lung Cancer
Recurrent small cell lung cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the chest, central nervous system, or in other parts of the body.
Treatment of recurrent small cell lung cancer may include the following:
- Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
- Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
- Laser therapy, surgical placement of devices to keep the airways open, and/or internal radiation therapy, as palliative therapy to relieve symptoms and improve quality of life.
- Clinical trials of chemotherapy.