Palliative Procedures for Small Cell Lung Cancer
Palliative, or supportive care, is aimed at relieving symptoms and improving a person’s quality of life.
People with small cell lung cancer (SCLC) often benefit from procedures to help with problems caused by the cancer. For example, people with advanced lung cancer can be short of breath. This can be caused by many things, including fluid around the lung or an airway that is blocked by a tumor. Although treating the cancer with chemotherapy or other drugs may help with this over time, other treatments may be needed as well.
Treating an airway blocked by a tumor
Tumors can sometimes grow into the lung airways, blocking them and causing problems such as pneumonia or shortness of breath. Sometimes this is treated with radiation therapy (described in Radiation Therapy for Small Cell Lung Cancer), but other techniques can also be used.
Photodynamic therapy (PDT)
Photodynamic therapy is sometimes used to help open up airways blocked by tumors to help people breathe better.
For this technique, a light-activated drug called porfimer sodium (Photofrin) is injected into a vein. This drug collects more in cancer cells than in normal cells. After a couple of days (to give the drug time to build up in the cancer cells), a bronchoscope is passed down the throat and into the lung. This can be done with either local anesthesia (numbing the throat) and sedation, or with general anesthesia (which puts you in a deep sleep). A special laser light on the end of the bronchoscope is aimed at the tumor, which activates the drug and kills the cells. The dead cells are then removed a few days later during a bronchoscopy. This process can be repeated if needed.
PDT can cause swelling in the airway for a few days, which may lead to some shortness of breath, as well as coughing up blood or thick mucus. Some of this drug also collects in normal cells in the body, such as skin and eye cells. This can make you very sensitive to sunlight or strong indoor lights. Too much exposure can cause serious skin reactions (like a severe sunburn), so doctors recommend staying out of any strong light for several weeks after the injection.
For more information on PDT, see Photodynamic Therapy.
Lasers can sometimes be used to help open up airways blocked by tumors to help people breathe better.
You are usually asleep (under general anesthesia) for this type of treatment. The laser is on the end of a bronchoscope, which is passed down the throat and next to the tumor. The doctor then aims the laser beam at the tumor to burn it away. This treatment can usually be repeated, if needed.
If a lung tumor has grown into an airway and is causing problems, sometimes a bronchoscope is used to put a hard silicone or metal tube called a stent in the airway to help keep it open. This is often done after other treatments such as PDT or laser therapy.
Treating fluid buildup in the area around the lung
Sometimes fluid can build up in the chest outside of the lungs. This is called a pleural effusion. It can press on the lungs and cause trouble breathing.
This is done to drain the fluid. For this procedure, the doctor will numb an area in the chest, and then place a hollow needle into the space between the lungs and the ribs to drain the fluid. This is often done using ultrasound to guide the needle into the fluid.
This procedure might be done to remove the fluid and keep it from coming back.
One way to do this is to make a small cut in the skin of chest wall, and place a hollow tube (called a chest tube) into the chest to remove the fluid. Then a substance is instilled into the chest through the tube that causes the linings of the lung (visceral pleura) and chest wall (parietal pleura) to stick together, sealing the space and limiting further fluid buildup. A number of substances can be used for this, such as talc, the antibiotic doxycycline, or a chemotherapy drug like bleomycin. The tube is often left in for a couple of days to drain any new fluid that might collect.
Another way to do this is to blow talc into the space around the lungs during an operation. This is done through a small incision using thoracoscopy
This is another way to control the buildup of fluid. One end of the catheter (a thin, flexible tube) is placed in the chest through a small cut in the skin, and the other end is left outside the body. This is done in a doctor’s office or hospital. Once in place, the catheter can be attached to a special bottle or other device to allow the fluid to drain out on a regular basis.
Treating fluid buildup around the heart
Lung cancer can sometimes spread to the area around the heart. This can lead to fluid buildup inside the sac around the heart (called a pericardial effusion), which can press on the heart and affect how well it works.
In this procedure, the fluid is drained with a needle placed into the space around the heart. This is usually done using an echocardiogram (an ultrasound of the heart) to guide the needle.
Creating a pericardial window
This procedure can be done to keep the fluid from building up again. During surgery, a piece of the sac around the heart (the pericardium) is removed to allow the fluid to drain into the chest or belly.
Last Medical Review: February 22, 2016 Last Revised: May 16, 2016