As mentioned in "How is small cell lung cancer staged?" for practical reasons this type of cancer is usually staged as either limited or extensive. Studies have shown that small cell lung cancer (SCLC) has usually spread by the time it is found (even if that spread is not seen on x-rays and other imaging tests), so it usually cannot be treated by surgery alone. If you are healthy enough, you will probably get chemotherapy, regardless of the stage of your disease.

If you smoke, one of the most important things you can do to be ready for treatment is to try to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer tend to have better outcomes than those who don't.

Limited stage SCLC

If you only have a single nodule in your lung and no evidence of cancer elsewhere and are in fairly good health, your doctors may recommend surgery to remove the tumor and the nearby lymph nodes. This would be followed by chemotherapy, with or without radiation (see the "Chemotherapy" section for more details on commonly used drugs). Radiation to the chest is usually advised if cancer is found in the lymph nodes that were removed. The radiation is often given at the same time as the chemotherapy. Although this increases the side effects of treatment (see the "Radiation therapy" section), it appears to be more effective than giving one treatment after the other. You may not be given radiation therapy if you already have severe lung disease (in addition to your cancer) or other serious health problems.

If the cancer is considered to be limited stage but is larger, is in several places in the lung, or is in the lymph nodes, surgery is not usually an option. If you are in good health, the standard treatment is chemotherapy plus radiation (given at the same time). If you have lung problems or other major health problems, chemotherapy may be given alone.

If no preventive measures are taken, about half of people with SCLC will have spread (metastasis) to their brain. For this reason, if your cancer has responded well to initial treatment, you may be given radiation therapy to the head (prophylactic cranial irradiation, or PCI) to try to prevent spread to the brain. The radiation is usually given in lower doses than that for treatment of known metastases. Still, some patients given PCI may suffer side effects, such as those described in the "Radiation therapy" section above.

Most people treated with chemotherapy (with or without radiation) for their limited stage SCLC will have their tumors shrink significantly. In about half of these people, the cancer will shrink to the point where it can no longer be seen on imaging tests. Unfortunately, the cancer will still return at some point in most people.

Clinical trials of new chemotherapy drugs and combinations, as well as other new treatments, are being done to improve on current treatment results. These may be a good option for some people. If you think you might be interested in taking part in a clinical trial, talk to your doctor.

Extensive stage SCLC

If you have extensive SCLC and are in fairly good health, chemotherapy can often treat your symptoms and also help you to live longer. (See the "Chemotherapy" section for more details on commonly used drugs.) About 3 out of 4 people will have their cancer shrink significantly with chemotherapy. Unfortunately, the cancer will still return at some point in almost all people with extensive stage SCLC.

Clinical trials of new chemotherapy drugs and combinations, as well as other new treatments, may be a good option for some people. If you think you might be interested in taking part in a clinical trial, talk to your doctor.

Radiation therapy is sometimes used to help control symptoms in a specific part of the body, such as if cancer growth within the lungs is causing shortness or breath or bleeding. Other types of treatment, such as laser surgery, can also sometimes be helpful in these situations. Radiation therapy can also be used to relieve symptoms if the cancer has spread to the bones or brain.

If your general health is poor, you may not be able to withstand the side effects of chemotherapy or benefit from it. In this case, your doctor may select a treatment plan based on your individual medical situation. If you are too ill to have chemotherapy, the best plan may be to have supportive care. This would include treatment of any pain, breathing problems, or other symptoms you might have.

Cancer that progresses or recurs after treatment

If the cancer continues to grow during treatment or comes back, any further treatment will depend on the extent of the cancer, what treatments have been used, and a person's health and desire for further treatment. It is always important to understand the goal of any further treatment before it starts -- if it is to try to cure the cancer, to slow its growth, or to help relieve symptoms -- as well as the likelihood of benefits and risks.

If a cancer continues to grow during chemotherapy, another type of chemotherapy may be tried, although it may be less likely to be effective. For cancers that come back after initial treatment is finished, the choice of chemotherapy drugs may depend on how long the cancer was in remission (see the "Chemotherapy" section).

At some point, it may become clear that standard treatments are no longer controlling the cancer. If you want to continue anti-cancer treatment, you might think about taking part in a clinical trial of newer lung cancer treatments. Although these are not always the best option for every person, they may benefit you as well as future patients.

Even if you have incurable lung cancer you should be as free of symptoms as possible. If curative treatment is not an option, treatment aimed at specific sites can often relieve symptoms and may even slow the spread of the disease. Symptoms caused by cancer in the lung airways -- such as shortness of breath or coughing up blood -- can often be treated effectively with radiation therapy, laser therapy, or other local treatments if needed. Radiation therapy can be used to help control cancer spread in the brain or relieve pain if cancer has spread to the bones.

Many people with lung cancer are concerned about pain. As the cancer grows near certain nerves it can sometimes cause pain, but this can almost always be treated effectively with pain medicines. Sometimes radiation therapy will help as well. It is important that you talk to your doctor and take advantage of these treatments.

Deciding on the right time to stop treatment aimed at curing the cancer and focus on care that relieves symptoms is never easy. Good communication with doctors, nurses, family, friends, and clergy can often help people facing this situation.

Last Medical Review: 10/13/2009
Last Revised: 10/13/2009