Extensive Stage Small Cell Lung Cancer

Small Cell Extensive Stage Definition, Treatments, and Prognosis

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What is extensive stage small cell lung cancer and how is it treated?. Tom Grill/Photographer's Choice RF/Getty Images

Small cell lung cancer is less common than non-small cell lung cancer, accounting for about 15 percent of lung cancers. It tends to be more aggressive, growing rapidly and spreading quickly, but often responds well to chemotherapy.

Small cell lung cancer (unlike non-small cell lung cancer), is divided into only 2 stages -– limited and extensive. Roughly 60 to 70 percent of people have extensive disease at the time of diagnosis.

Definition of Extensive Stage Small Cell Lung Cancer

Extensive stage small cell lung cancer is defined as a small cell lung cancer that has spread (metastasized) to other regions of the body such as another lobe of the lung or the brain.

Symptoms

Symptoms can include:

Symptoms related to cancer in the lungs:

Symptoms due to paraneoplastic syndromes, that is symptoms that are due to hormones secreted by a tumor or by the body’s immune response to a tumor rather than the tumor itself. Some of these include:

  • Muscle weakness in the upper limbs, vision changes, and difficulty swallowing  (Lambert-Eaten myasthenic syndrome)
  • Weakness, fatigue, and a low sodium level in the blood (syndrome of inappropriate antidiuretic hormone secretion (SIADH))
  • Loss of coordination and difficulty speaking (paraneoplastic cerebellar degeneration)

Symptoms due to spread of the tumor to other regions of the body, for example:

  • Pain in the back, hips, or ribs if the tumor has spread to bone
  • Difficulty swallowing (dysphagia) due to a tumor being near or invading the esophagus
  • Headaches, vision changes, weakness, or seizures if a tumor spreads to the brain

    General symptoms related to metastatic cancer such as:

    Treatment

    The treatment of extensive stage disease most commonly includes chemotherapy administered alone. Sometimes radiation may be used to control symptoms (palliative therapy) related to the spread of cancer, such as bone pain, bleeding from the lungs, tumors that are obstructing the airways and causing shortness of breath, or brain metastases that are causing significant symptoms, such as headaches or weakness.

    Clinical trials are in progress for both stages of small cell lung cancer, evaluating new treatments and treatment combinations for this aggressive cancer.

    Prognosis

    Survival rates for small cell lung cancer have improved since the addition of radiation therapy to treatment and the use of PCI, but remain low. Currently, the overall 5-year survival rate for stage 3 small cell lung cancer is 8 percent, and only 2 percent for stage 4 disease.

    Without treatment, the average life expectancy with extensive disease is 2 to 4 months, and with treatment is 6 to 12 months. Since small cell lung cancer is rapidly growing, and we have come a long way with other fast-growing cancers such as leukemia, it is hoped that better treatments will be found in the future.

    What Can I Do To Help Myself

    Studies suggest that learning what you can about your lung cancer can improve your quality of life, and possibly even your outcome. Ask questions. Learn about clinical trials. Consider joining a support group. Many of us hesitate to talk about end-of-life issues, but discussing these with your doctor and your family -– even if all of you are hoping for a cure -– is associated with fewer feelings of loneliness and a better quality of life. Never lose hope, even if you have chosen not to pursue further treatment. Hope for quality time with loved ones, with good control of your symptoms. Hope for the future of your loved ones who will remain, with memories of you in their hearts.

    Sources:

    Hann, C. and C. Rudin. Management of small-cell lung cancer: incremental changes but hope for the future. Oncology (Williston Park). 2008. 22(13):1486-92.

    National Cancer Institute. Small Cell Lung Cancer Treatment (PDQ). 07/07/16. https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq.

    Sorenson, M. et al. Small-cell lung cancer: ESMO Clinical Recommendations for diagnosis, treatment, and follow-up. Annals of Oncology. 2009. 20 Suppl 4:71-2.

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