Small Cell Lung Cancer Treatment (PDQ®)
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General Information About Small Cell Lung CancerKey Points:
Small cell lung cancer is a disease in which malignant (cancer)
cells form in the tissues of the lung.
The lungs are a pair of cone-shaped breathing organs that are found
in the chest. The lungs bring oxygen into the body when you breathe in and
take out carbon dioxide when you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right
lung, which is slightly larger, has three. A thin membrane called the
pleura surrounds the lungs. Two
tubes called bronchi lead from the
trachea (windpipe) to the right and
left lungs. The bronchi are sometimes also affected by lung
cancer. Small tubes called bronchioles and tiny air sacs called
alveoli make up the inside of the
Respiratory anatomy; drawing shows right lung with upper, middle, and lower lobes; left lung with upper and lower lobes; and the trachea, bronchi, lymph nodes, and diaphragm. Inset shows bronchioles, alveoli, artery, and vein.
There are two types of lung cancer:
small cell lung cancer and
non-small cell lung cancer.
summary is about small cell lung cancer and its treatment. See the following PDQ summaries for more information about lung cancer:
- Non-Small Cell Lung Cancer
- Unusual Cancers of Childhood
- Lung Cancer Prevention
- Lung Cancer Screening
There are two main types of small cell lung cancer.
These two types include many different types of
cells. The cancer cells of each type
grow and spread in different ways. The types of small cell lung cancer are
named for the kinds of cells found in the cancer and how the cells look when
viewed under a microscope:
- Small cell carcinoma (oat cell
- Combined small cell carcinoma.
Smoking tobacco is the major risk factor for developing small
cell lung cancer.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk. Cigarette smoking is the most common cause of lung cancer.
Risk factors for small cell lung
Possible signs of small cell lung cancer include coughing,
chest pain, and shortness of breath.
These and other symptoms may be caused by small cell lung cancer. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following
- Chest discomfort or pain.
- A cough that doesn’t go away or gets worse over time.
- Trouble breathing.
- Blood in sputum (mucus coughed up from the lungs).
- Trouble swallowing.
- Loss of appetite.
- Weight loss for no known reason.
- Feeling very tired.
- Swelling in the face and/or veins in the neck.
Tests and procedures that examine the lungs are used to detect
(find), diagnose, and stage small cell lung cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, including smoking, and past jobs, illnesses, and treatments will also be taken.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Chest x-ray; drawing shows the patient standing with her back to the x-ray machine. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
- CT scan (CAT scan) of the brain, chest, and abdomen: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Sputum cytology: A
microscope is used to check for cancer cells in the sputum (mucus coughed up
from the lungs).
aspiration (FNA) biopsy of the lung: The removal of tissue or fluid from the lung, using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to find the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.
Lung biopsy; drawing shows a patient lying on a table that slides through the computed tomography (CT) machine with an x-ray picture of a cross-section of the lung on a monitor above the patient. Drawing also shows a doctor using the x-ray picture to help place the biopsy needle through the chest wall and into the area of abnormal lung tissue. Inset shows a side view of the chest cavity and lungs with the biopsy needle inserted into the area of abnormal tissue.
- Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Bronchoscopy; drawing shows a bronchoscope inserted through the mouth, trachea, and bronchus into the lung; lymph nodes along trachea and bronchi; and cancer in one lung. Inset shows patient lying on a table having a bronchoscopy.
- Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs, and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung. If certain tissues, organs, or lymph nodes can’t be reached, a thoracotomy may be done. In this procedure, a larger incision is made between the ribs and the chest is opened.
The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
- Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
- Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
Certain factors affect prognosis (chance of recovery) and
The prognosis (chance of
recovery) and treatment options depend on the following:
- The stage of the cancer (whether it is in the chest
cavity only or has spread to other places in the body).
- The patient’s age, gender,
and general health.
For certain patients, prognosis also depends on whether the patient is treated with both chemotherapy and radiation.
For most patients with small cell lung cancer, current
treatments do not cure the cancer.
If lung cancer is found, patients should think about taking part in one of the many
clinical trials being done to
improve treatment. Clinical trials are taking place in
most parts of the country for patients with all stages of small cell lung
cancer. Information about ongoing clinical trials is available from the
site.[Back to top]
Stages of Small Cell Lung CancerKey Points:
After small cell lung cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the chest or to other parts of
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. Some of the tests used to diagnosesmall cell lung cancer are also used to stage the disease. (See the General Information section.) Other tests and procedures that may be used in the staging process include the following:
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for small cell lung cancer:
Limited-Stage Small Cell Lung Cancer
cancer is in the lung where it started and may have spread to the area between the lungs or to the lymph nodes above the collarbone.
Extensive-Stage Small Cell Lung Cancer
cancer has spread beyond the lung or the area between the lungs or the lymph nodes above the collarbone to other places in the body.[Back to top]
Recurrent Small Cell Lung Cancer
Recurrentsmall 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.[Back to top]
Treatment Option OverviewKey Points:
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. 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. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five 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. During surgery, the
doctor will also remove lymph nodes to find out if they have cancer in them. Sometimes, surgery may be used
to remove a sample of lung tissue to find out the exact type of lung cancer.
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 lower the risk that the cancer will come back, is called adjuvant
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them 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 cerebrospinal fluid, 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.
See Drugs Approved for Small Cell Lung Cancer for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 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.
Laser therapy is a
cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Endoscopic stent placement
An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. An endoscopic stent can be used to open an airway blocked by abnormal tissue.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.[Back to top]
Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.[Back to top]
Limited-Stage Small Cell Lung Cancer
Treatment of limited-stage small cell
lung cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with limited stage small cell lung cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Extensive-Stage Small Cell Lung Cancer
Treatment of extensive-stage small cell
lung cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with extensive stage small cell lung cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
Treatment Options for Recurrent Small Cell Lung Cancer
Treatment of recurrentsmall cell lung cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent small cell lung cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.[Back to top]
To Learn More About Small Cell Lung Cancer
For more information from the National Cancer Institute about small cell lung cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:[Back to top]
Changes to This Summary (03/22/2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.