Small Cell Lung Cancer Treatment

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Roughly 15 percent of all lung cancers are small cell lung cancers (SCLC). SCLC is an aggressive subtype of lung cancer and typically invades the bronchial mucosal layer (a layer of tissue in the breathing tubes).

Treatment for SCLC depends on the extent of the disease and the overall health of the patient, including whether they have other conditions (comorbidities).1,2

Staging of small cell lung cancer

SCLC may be staged using the TNM system, however, it is more commonly staged using a two-stage system:1,2

  • Limited stage – A limited-stage SCLC is found on only one side of the chest, involving just one part of the lung and/or the lymph nodes on that side. Approximately 30 percent of patients diagnosed with SCLC have limited-stage disease.
  • Extensive stage – An extensive stage SCLC has spread entirely through one lung, into the second lung, to the opposite side of the chest within the lymph nodes, or to distant organs in other parts of the body.

Types of treatment for small cell lung cancer

Chemotherapy is almost always recommended for SCLC, regardless of the stage, as SCLC is very responsive to chemotherapy as compared to other cell types of lung cancer. Chemotherapy can improve the survival of people with SCLC but it is rarely curative. Because of the aggressive nature of SCLC, many patients develop metastases (spread of the cancer to other parts of the body).1-3

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Besides chemotherapy, treatment recommendations are made based on the stage of the disease and may include radiation or surgery. SCLC is highly sensitive to radiation, and radiation therapy can improve survival rates. Surgery is rarely used in SCLC but may be recommended in certain cases where the cancer is considered early stage and is contained to one lung without having spread to other parts of the body. Immunotherapy may also be an option for certain patients with SCLC.1-3

In addition, palliative care, supportive care that aims to improve quality of life and does not treat the cancer itself, is usually done concurrently with other treatment. Some patients with SCLC also find benefit in complementary medicine, practices which are used in combination with traditional medicine, such as dietary supplements, massage, acupuncture, and hypnosis. It is important that patients tell their doctors about any complementary practices they are considering taking part in to ensure that nothing interferes negatively with their treatment.1

Treatment for small cell lung cancer by stage

Treatment for limited-stage SCLC may include surgery, when the tumor is small, only in one lung, and has not yet spread to lymph nodes or other areas. Surgery is not a good option for SCLC that has spread, and surgery is not appropriate for all patients. Chemotherapy may be given following surgery (if surgery is appropriate), and radiation therapy is often recommended for SCLC that has spread to the lymph nodes in patients who can tolerate radiation. These two treatments may be given at the same time, called concurrent chemoradiation. While this concurrent treatment increases the side effects experienced, it appears to be more effective than one treatment at a time. For patients who aren’t able to tolerate concurrent chemoradiation, chemotherapy is often given first and may be followed by radiation.1

Extensive-stage SCLC is generally treated initially with chemotherapy, with the goals of shrinking the cancer and alleviating symptoms. Chemotherapy for SCLC is most often a combination of drugs consisting of etoposide or irinotecan plus either cisplatin or carboplatin. In addition to chemotherapy, patients with extensive stage SCLC may be given radiation therapy. Certain immunotherapies may also be an option for some patients with SCLC as part of first-line combination therapy with chemotherapy.1

Clinical trials as a treatment option

Clinical trials are also a treatment option for people with SCLC. Clinical trials are a type of research in which new treatments are tested, often in comparison to the standard treatment. Patients who meet certain criteria have the opportunity to enroll in clinical trials to gain access to the most current cancer treatment and participate in the research process, which may benefit other patients in the future. Patients in clinical trials receive excellent management of their care and are carefully monitored throughout treatment.

However, there are risks to clinical trials, including possible side effects, the chance that new tests or treatments won’t work, and the potential for additional paperwork and trips to the doctor or hospital.2