Jane Doe
What is small cell lung cancer?
Lung cancer is a cancer that starts in the lungs. To understand lung cancer, it helps to know about the normal structure and function of the lungs.
Your lungs are 2 sponge-like organs in your chest. Your right lung is divided into 3 sections, called lobes. Your left lung has 2 lobes. The left lung is smaller because your heart takes up more room on that side of the body.
Your lungs are 2 sponge-like organs in your chest. Your right lung is divided into 3 sections, called lobes. Your left lung has 2 lobes. The left lung is smaller because your heart takes up more room on that side of the body.
When you breathe in, air enters through your mouth and nose and goes into your lungs through the trachea (windpipe). The trachea divides into tubes called the bronchi (singular, bronchus), which divide into smaller branches called the bronchioles. At the end of the bronchioles are tiny air sacs known as alveoli.
A thin lining called the pleura surrounds the lungs. The pleura protects your lungs and helps them slide back and forth against the chest wall as they expand and contract during breathing.
Below the lungs, a dome-shaped muscle called the diaphragm separates the chest from the abdomen. When you breathe, the diaphragm moves up and down, forcing air in and out of the lungs.
Types of lung cancer
There are 2 major types of lung cancer:
Small cell lung cancer
About 10% to 15% of all lung cancers are small cell lung cancer (SCLC), named for the small cells that make up these cancers. Other names for SCLC are oat cell cancer, oat cell carcinoma, and small cell undifferentiated carcinoma.
SCLC often starts in the bronchi near the center of the chest, and it tends to spread widely through the body fairly early in the course of the disease (usually before it starts to cause symptoms). The cancer cells can multiply quickly and spread to lymph nodes and other organs, such as the bones, brain, adrenal glands, and liver. Sometimes the areas of cancer spread are seen as large tumors on x-rays and other imaging tests, but early on these areas may not be visible (but still there). SCLC spreads early, so removing the tumor in the lung rarely cures the cancer. This is why surgery is rarely used to treat SCLC (and never the only treatment given). On the other hand, chemotherapy, which can reach cancer cells throughout the body, is the main treatment for small cell lung cancers.
- Small cell lung cancer (SCLC)
- Non-small cell lung cancer (NSCLC)
Small cell lung cancer
About 10% to 15% of all lung cancers are small cell lung cancer (SCLC), named for the small cells that make up these cancers. Other names for SCLC are oat cell cancer, oat cell carcinoma, and small cell undifferentiated carcinoma.
SCLC often starts in the bronchi near the center of the chest, and it tends to spread widely through the body fairly early in the course of the disease (usually before it starts to cause symptoms). The cancer cells can multiply quickly and spread to lymph nodes and other organs, such as the bones, brain, adrenal glands, and liver. Sometimes the areas of cancer spread are seen as large tumors on x-rays and other imaging tests, but early on these areas may not be visible (but still there). SCLC spreads early, so removing the tumor in the lung rarely cures the cancer. This is why surgery is rarely used to treat SCLC (and never the only treatment given). On the other hand, chemotherapy, which can reach cancer cells throughout the body, is the main treatment for small cell lung cancers.
Non-small cell lung cancer
About 85% to 90% of lung cancers are non-small cell lung cancer (NSCLC). There are 3 main subtypes of NSCLC:
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
Causes of Lung Cancer
- A person who smokes more than one pack of cigarettes per day has a 20-25 times greater risk of developing lung cancer than someone who has never smoked.
- Once a person quits smoking, his or her risk for lung cancer gradually decreases. About 15 years after quitting, the risk for lung cancer decreases to the level of someone who never smoked.
- Air pollution from motor vehicles, factories, and other sources probably increase the risk for lung cancer, and many experts believe that prolonged exposure to polluted air is similar to prolonged exposure to passive smoking in terms of risk for developing lung cancer.
- Asbestos exposure increases the risk of lung cancer nine times. A combination of asbestos exposure and cigarette smoking raises the risk to as much as 50 times. Another cancer known as mesothelioma (a type of cancer of the lining of the chest cavity called the pleura or of the lining of the abdominal cavity called the peritoneum) is also strongly associated with exposure to asbestos.
- Lung diseases, such as tuberculosis (TB) and chronic obstructive pulmonary disease (COPD), also create a risk for lung cancer. A person with COPD has a four to six times greater risk of lung cancer even when the effect of cigarette smoking is excluded.
- The risk for lung cancer increases with significant long-term exposure to radon, although no one knows the exact risk. An estimated 12% of lung cancer deaths are attributable to radon gas, or about 21,000 lung cancer-related deaths annually in the U.S. Radon gas is the second leading cause of lung cancer in the United States after cigarette smoking. As with asbestos exposure, smoking greatly increases the risk of lung cancer with radon exposure.
- Certain occupations where exposure to arsenic, chromium, nickel, aromatic hydrocarbons, and ethers occurs may increase the risk of lung cancer.
Treatment for Lung Cancer
Small cell lung cancer
Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands) and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer. There is information below about the treatment of small cell lung cancer by stage.
Non small cell lung cancer
Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. There is information below about the treatment of non small cell cancer by stage.
Surgery
A decision to have surgery depends on the size of the tumour and where it is. During the operation, all or part of the tumour and some healthy tissue around the tumour are removed. Surgery is done under general anesthetic (you will be unconscious) and you will stay in the hospital for several days after the surgery.
Surgery is most commonly used for non-small cell cancers that are still small and have not spread. Surgery is not usually done for small cell lung cancer unless tumours are found at a very early stage, before the cancer has started to spread.
Surgery for non–small cell lung cancer can be done in several ways:
Radiation therapy
In external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at the tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. In brachytherapy, or internal radiation therapy, radioactive material is placed directly into or near the tumour.
Radiation side effects are usually mild. Side effects will be different depending on what part of the body receives the radiation. You may feel more tired than usual, have some diarrhea, or notice changes to the skin (it may be red or tender) where the treatment was given.
Chemotherapy
Chemotherapy may be given as pills or by injection. Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells. Although healthy cells can recover over time, you may experience side effects from your treatment like nausea, vomiting, loss of appetite, fatigue, hair loss and an increased risk of infection.
Targeted therapies
Targeted therapies use drugs or other substances to block the growth and spread of cancer cells. These drugs are able to attack specific types of cancer cells. Targeted therapy is sometimes used to treat non–small cell lung cancer that has come back or that does not respond to chemotherapy. Side effects are generally mild. They may include diarrhea, a rash, dry or sore mouth, nausea and tiredness.
Photodynamic therapy
Photodynamic therapy uses a special drug that starts to work when exposed to light. The drug is injected into your bloodstream and absorbed by the cancer cells. When exposed to a high-energy laser light, the drug becomes active and destroys the cancer cells. Photodynamic therapy can be used to treat some cases of early-stage lung cancer. It can also be used to help relieve symptoms of a blocked airway.
Small cell lung cancer is mostly treated with chemotherapy. Surgery is only suitable if there is no sign that the cancer has spread to the lymph glands in the centre of the chest (the mediastinal lymph glands) and this is rare with small cell lung cancer. It has usually spread at the time of diagnosis. So chemotherapy is usually the main treatment. You may also have radiotherapy to treat this type of lung cancer. There is information below about the treatment of small cell lung cancer by stage.
Non small cell lung cancer
Non small cell lung cancer can be treated with surgery, chemotherapy, radiotherapy or a combination of these, depending on the stage when the cancer is diagnosed. There is information below about the treatment of non small cell cancer by stage.
Surgery
A decision to have surgery depends on the size of the tumour and where it is. During the operation, all or part of the tumour and some healthy tissue around the tumour are removed. Surgery is done under general anesthetic (you will be unconscious) and you will stay in the hospital for several days after the surgery.
Surgery is most commonly used for non-small cell cancers that are still small and have not spread. Surgery is not usually done for small cell lung cancer unless tumours are found at a very early stage, before the cancer has started to spread.
Surgery for non–small cell lung cancer can be done in several ways:
- Wedge resection : The surgeon removes the tumour and a small part of the lung.
- Lobectomy : The surgeon removes the lobe of the lung containing the tumour. This is the most common surgery for lung cancer.
- Pneumonectomy : The surgeon removes the entire lung. You will be able to breathe with your remaining lung.
Radiation therapy
In external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at the tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. In brachytherapy, or internal radiation therapy, radioactive material is placed directly into or near the tumour.
Radiation side effects are usually mild. Side effects will be different depending on what part of the body receives the radiation. You may feel more tired than usual, have some diarrhea, or notice changes to the skin (it may be red or tender) where the treatment was given.
Chemotherapy
Chemotherapy may be given as pills or by injection. Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells. Although healthy cells can recover over time, you may experience side effects from your treatment like nausea, vomiting, loss of appetite, fatigue, hair loss and an increased risk of infection.
Targeted therapies
Targeted therapies use drugs or other substances to block the growth and spread of cancer cells. These drugs are able to attack specific types of cancer cells. Targeted therapy is sometimes used to treat non–small cell lung cancer that has come back or that does not respond to chemotherapy. Side effects are generally mild. They may include diarrhea, a rash, dry or sore mouth, nausea and tiredness.
Photodynamic therapy
Photodynamic therapy uses a special drug that starts to work when exposed to light. The drug is injected into your bloodstream and absorbed by the cancer cells. When exposed to a high-energy laser light, the drug becomes active and destroys the cancer cells. Photodynamic therapy can be used to treat some cases of early-stage lung cancer. It can also be used to help relieve symptoms of a blocked airway.
Lifestyle changes after small cell lung cancer
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life – making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Make healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
You can start by working on those things that worry you most. Get help with those that are harder for you. For instance, if you smoke, one of the most important things you can do to improve your chances for treatment success is to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer have better outcomes than those who don't. Quitting can help improve lung function and have a host of other health benefits as well..
Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer treatment. Treatment may change your sense of taste. Nausea can be a problem. You may not feel like eating and lose weight when you don't want to. Or you may have gained weight that you can't seem to lose. All of these things can be very frustrating.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for some other types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
Talk with your health care team before starting anything. Get their opinion about your exercise plans. Then, try to find an exercise buddy so you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
And long term, we know that getting regular physical activity plays a role in helping to lower the risk of some cancers, as well as having other health benefits.
Quitting smoking
Diet and nutrition
Make healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
You can start by working on those things that worry you most. Get help with those that are harder for you. For instance, if you smoke, one of the most important things you can do to improve your chances for treatment success is to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer have better outcomes than those who don't. Quitting can help improve lung function and have a host of other health benefits as well..
Eating better
Eating right can be hard for anyone, but it can get even tougher during and after cancer treatment. Treatment may change your sense of taste. Nausea can be a problem. You may not feel like eating and lose weight when you don't want to. Or you may have gained weight that you can't seem to lose. All of these things can be very frustrating.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for some other types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
Talk with your health care team before starting anything. Get their opinion about your exercise plans. Then, try to find an exercise buddy so you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.
And long term, we know that getting regular physical activity plays a role in helping to lower the risk of some cancers, as well as having other health benefits.
Quitting smoking
If you smoke, quitting is important. It has been shown to help improve outcomes and reduce the risk of recurrence, especially in people with early stage lung cancer. Of course, quitting smoking may have other health benefits as well, including lowering the risk of some other cancers.
Possible links between diet and lung cancer progression or recurrence are much less clear. As noted earlier, some studies have suggested that diets high in fruits and vegetables might help prevent lung cancer from developing in the first place, but this has not been studied in people who already have lung cancer.