20th January 2022

Understanding Small Cell Lung Cancer

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Getting diagnosed with small cell lung cancer is terrifying and overwhelming. There is a lot to process and lots of information to take in. You are also trying to understand what your diagnosis means and are, understandably, scared and fearful for the future.  

In this article, we aim to help you understand your diagnosis better, the types of tests you may need and what treatments may be available. 

What is Small Cell Lung Cancer?  

Small cell lung cancer is one of the two main sub-types of lung cancer that can be identified through testing.  

In the UK for every 100 people diagnosed with lung cancer, 10 – 15 will have small cell. It is called this because when you look at the cancer cells through a microscope, they look small and almost filled with the cell’s nucleus, the core. 

Small cell lung cancer is typically caused by smoking and exposure to tobacco smoke. If you smoke at the time of diagnosis, then you will be encouraged to try and stop smoking with support. Although this may be difficult, it is important as this may improve your health and fitness for treatment. 

In July 2021, a Russian-based study found that lung cancer patients who quit smoking when they are diagnosed can extend a person’s life for up to two years, compared to those who continue to smoke. 

How your Small Cell Lung Cancer will be diagnosed 

Small cell lung cancer CT scan

When you are diagnosed with small cell lung cancer, your doctor will need to do further tests to understand the type of cancer, stage and treatment. 

There are several tests your doctor will run to identify your small cell lung cancer. This will identify the type of cancer it is, its stage and the best treatment that can be offered.  

A CT-scan may be arranged, if one has not yet taken place and a biopsy taken so the doctors can assess what is happening. Additional tests such as a PET, or MRI scan may be organised as well as a physical assessment. 

Small Cell Lung Cancer Staging  

When diagnosed with lung cancer, your doctors will use a TNM system that will identify the stage of your cancer. This is based on the size, location and extent of the tumour.  

The doctors will assess the Tumour size, and whether it has spread into the surrounding area, the number and location of Nodes affected and whether there is evidence of Metastasis, the spread of cancer from one part of the body to another. 

In small cell lung cancer, a simplified 3 stage description may be used to help with treatment planning. This may be: 

Early Stage:  

The cancer is in one lung and perhaps one lymph node. In this situation the cancer may be contained within one lobe of the lung and surgery may be possible. Sadly, it is uncommon for small cell lung cancer to be found this early. 

Limited Stage:  

The cancer is larger but within one lung. It may have spread to surrounding lymph nodes. 

Extensive Stage:  

The cancer has spread outside the lung, perhaps to the other lung, brain or bones. 

Treatment options for Small Cell Lung Cancer 

Small cell lung cancer treatment analysis

Once your small cell lung cancer has been diagnosed and stage, your treatment options will be based on your fitness, general health and the extent of your lung cancer.  

Because small cell lung cancer spreads rapidly the doctors may recommend starting treatment quickly. You or your loved one, may have decisions to make about treatment but you have time to make the right decision for yourself. If you are worried or unsure of the recommended treatment, talk through your concerns with your doctor. Don’t be afraid to ask questions if you are unsure about the treatment, the effects and what the treatment is aiming to achieve.  

For many people with small cell lung cancer, their first kind of treatment will be chemotherapy. This is a systemic treatment that can reach all parts of the body through the bloodstream. This means it can be effective when a cancer is in more than one location. The treatment is usually given in cycles via an injection regularly during outpatient appointments. It may reduce symptoms such as cough and breathlessness. 

Radiotherapy can be used with chemotherapy or as a follow-on treatment. It may be targeted at the tumour or will sometimes be used on the head to treat or reduce the risk of cancer cells spreading to the brain. 

If someone has extensive small cell lung cancer they may have the option of a first treatment with an immunotherapy drug, sometimes in combination with chemotherapy treatment. The doctor will discuss if this is an appropriate treatment depending on staging, general fitness and other medical conditions. 

There may be the option for further treatment or a different course of treatment via Clinical Trials, do ask your doctor if there are any open and relevant to your small cell lung cancer treatment.  

Managing your Treatment 

Sometimes your treatment for your small cell lung cancer will be adjusted, postponed or stopped depending on whether there is evidence of the following: 

  • – The cancer is shrinking 
  • – Slowing its growth 
  • – Your body is coping with the treatment 
  • – Side effects  

If you have any concerns about your treatment don’t be scared to talk to your doctor or nurse and get advice. It is important not to struggle with ongoing side effects or health problems. If you are on chemotherapy or immunotherapy, you may be given an emergency contact number and told about reactions to watch for that need to be reported urgently. 

Looking after yourself is important. You can do this by:  

  • – Eating a healthy diet 
  • – Maintaining activity when you can 
  • – Taking a rest and relaxing regularly 

Some people struggle emotionally with cancer and treatment. It is normal and expected that your moods may change, and you may find it difficult to cope emotionally. Support and help are available, so do talk to your GP if you are worried, low or finding it hard to cope. We also offer a range of support, including:  

Our services are free to access and can help with information, advice and support throughout your lung cancer journey. 

Looking ahead 

Understanding your small cell lung cancer booklet image

After treatment, a follow up plan will be arranged, and you will be advised on how best to adjust and manage your health.  

You can find out more information on small cell lung cancer and its treatment in our booklet which can be accessed here or you can request a copy by calling 0333 323 7200.  

We also have an online community that you can join, which has experienced members who live well with small cell lung cancer. You can join for free and be a source to reach out to others, ask questions about treatment and side effects and share your experience with others. 

If you have any questions, you can also contact our Ask the Nurse service on 0800 358 7200 or email lungcancerhelp@roycastle.org.