Small Cell Carcinoma is typically fast and the most fatal of cancers. In the medical world, ‘small-cell carcinoma’ is also referred to as ‘small-cell lung cancer’ (SCLC) due to its size and form. It is generally smaller than a normal cell, just tiny enough to barely attack any cytoplasm. SCLC seriously targets the lung, while some body areas where it can arise includes the prostate, cervix and also the gastrointestinal tract. Compared to other cancer cells, small-cell carcinoma has faster growth fraction, which can double and spread in just a short time.
Small Cell Lung Cancer
Most of lung cancer cases are brought by small-cell lung cancer. According to certain statistics, about 10%-15% of lung cancer patients has founded to have SCLC in their tests which severely triggers their condition. This malignant disease can be compared to other lung cancer as the symptoms can be manifested on the same manner. There is a usual problem with the breathing (dyspnea or shortness of breath), coughing and wheezing as can be observed in some severe cases. Patients can often be found underweight and have excessive sputum production. While some of its late symptoms include hoarseness, difficulty in swallowing, physical weakness, facial swelling, constant fatigue and unceasing fever.
Small-cell lung cancer is highly aggressive & can metastasize quickly. Cells will spread and travel through the bloodstream or lymph nodes until it reaches the liver, bones, adrenals, brain and other body areas. It often starts within the bronchi (near the central chest) ‘till the cell spreads rapidly to these portion of the body. In medical world, SCLC is also identified as ‘oat cell carcinoma’ or ‘oat cell cancer’ and ‘small-cell undifferentiated carcinoma’. But if associated with lung cancer, the common term for SCLC is ‘oat cell carcinoma’ due to its scanty and flat-cell shaped cytoplasm.
Small Cell Cancer
There are two main types of small cell lung cancer.
Each of these 2 types of cancer can develop and vary in some forms & appearance. It also differs in severity, distinction and characteristics. However, both can bring a harmful and lethal effect on the health and one’s own body if not given an immediate diagnosis and medications. The two types of SCC are the following:
Small-cell carcinoma (oat cell cancer)
Oat-cell lung cancer is medically considered as one of the most malignant type of cancer which can spread rapidly in the body. As the name describes, oat-cell cancer structure can be compared to a small grains of oats if viewed under the microscope. This cancer cells greatly affects lungs and other organs such as kidney, bones and other portion of the human internal organs. Oat-cell lung cancer is a type of pulmonary neoplasms that can be accumulated by those persons who frequently smoke or have an excessive smoking habit.
Oat-cell lung cancer is difficult to treat because of its rapid metastasis. A process wherein the cancerous cell invades & establishes at amenable portion of the body, and clinical symptom occurs depending on the extent of spread and severity of the stage. The round-oval structure of oat-cell cancer is a malignant tumor, which appears to grow in groups. However, early stage of oat-cell lung cancer is hard to detect, that is why many-advanced diagnosis is used to identify the particular state of the cancer.
Combined small-cell carcinoma
Combined small-cell carcinoma is typically a form of ‘multiphasic’ lung cancer that occur in various combination of other lung cancer cells (including admixtures of complex malignant tissue). Pathologist diagnoses lung cancer when malignant tumor arise which originates from lung tissue that contains a component of (SCLC). Clinically speaking, when diagnosed with malignant tumor due to different lung cancer form such as adenocarcinoma and squamous-cell carcinoma, a ‘combined small-cell lung cancer carcinoma’ is currently recognized.
Symptoms due to local growth of the tumor include the following:
- Excessive sputum production which leads to coughing up mucus or blood (hemoptysis)
- Weight loss and lack of appetite
- Cough (moderate to severe)
- Dyspnea (shortness or difficulty of breathing)
- Chest pain (painful condition being worsen by deep breathing)
Symptoms occurring from distant spread of cancer cells depending on the proliferation on certain body area:
- Hoarseness or sudden change of voice, which results to nerve compression and supplies the vocal area
- Breathing difficulty resulting to nerve compression which supplies the diaphragm muscles, subsequently leading in inhalation problems or strain. Symptoms also results to stridor (sound that is produced by the turbulent air flow through a narrow portion of the respiratory tracts) which causes trachea (windpipe) compression and bronchi enlargement (lung airways).
- Difficulty in swallowing solid food caused by the compression of esophagus (or food pipe)
- Facial and hand swelling due to the compression of superior ‘vena cava’ (superior vena cava is the vein which is responsible in transporting deoxygenated blood coming from the upper body)
Symptoms that is due to cancer cell spread contingency of the proliferation:
- Rapid spread of the cancer cell can immediately reach to the brain thus causing symptoms such as nausea, blurred vision, headache, fatigue and weakness of the limbs
- Back pain due to the spread of cancer cells in vertebral column
- Paralysis due to the cancer cell spread in the spinal cord
- Bone problems and swelling due to the cancer cell spread in the bone
- Pain in upper abdominal part due to the cancer cell spread in the liver area
Treatment choices by stage for small cell lung cancer
According to ‘How is small-cell lung cancer staged?’ the medical reason for identifying particular phase and stage of SCLC sorts in either extensive or limited. In most cases, small-cell lung cancer doesn’t shows any signs until it severely spreads throughout the body. Symptoms and underlying effect just appear when the body was already infected by the cancer cells even before it is found (even on various diagnosis of early stage). If early detection was immediately found, then initial treatment and proper medical attention can greatly help the chance of survival for the cancer patient.
SCLC is very tough and it attacks patients’ without them noticing it. The illness just show when severity of the stage was already high. If not immediately given a medical attention and right treatment, the probability of surviving the cancer can be very slim. Surgical ways are highly NOT recommended in this case especially when the cancer is already taking over on deteriorating your body. Small-cell lung cancer typically targets those person who are a frequent smokers, and some individuals who are exposed to inert dust-sized particles. In former medical findings, the problem only occurs or is limited to lungs and bronchial tract, but in the latter case, the cancer cells was also found to spread outside the chest and other body area.
The help of multiple-drug combination, radiation therapy, related chemotherapy, medicament administration that can strengthen or stimulate immunity of the patient, and other advanced technology and treating the disease, can do the therapy for SCLC. However, relying on such kind of medical therapies and treatment cannot surely guarantee a positive effect without the patient’s active involvement. Moreover, if ever surgery was opted, the success of the therapy might just depend on the extent of the metastasis or infection therefore not 100% eliminating the proliferation of the cancer cells.
The most effective and general precaution to prevent the occurrence of SCLC is to avoid and stop from smoking. If you are a frequent smoker, then your discipline to quit from smoking is one great way that you can do to save yourself from small-cell lung cancer or else you’re going to put your life into risk and at the brink of death.
Stage I SCLC
If a single and small tumor has been found in your lung yet without any signs of cancer in your lymph nodes or in the other part of your body, then your doctor might recommend a surgery for the removal of tumor. Surgery can be the right option if you are in good health & can be tolerate certain removal of some parts of the lung before the infection get come up on the next stage. Before considering a surgery, you will undergo first to various tests to examine any signs or evidence of cancer cell spread in your lymph nodes using mediastinoscopy or other means of examinations. Only few patients are treated using surgery.
Surgeries are commonly followed with chemotherapy. While radiation therapy (for chest) is typically advised when cancer cells or signs is found in lymph nodes. Chemo and radiation are often given to the patient at the same time. Although this triggers greater side effects, the result is more effective than giving the treatment one after another. Lung condition is highly considered in this therapy, so if you have already acquired a severe lung cancer then you may not be given a radiation therapy to fight the disease.
Half of SCLC patients have higher probability to acquire serious illness due to the spread of cancer in the brain if proper treatment was not given immediately. If these instances occur, you may take a radiation therapy for the head or medically so called PCI (prophylactic cranial radiation) to prevent further downside. PCI is usually given for patients using lower doses than metastases. Patients may experience some side effects that can often cause tolerable pain.
Limited stage SCLC
For patients with limited SCLC stage, surgery can be highly restricted. This is because cancer cells already spread/reach the nearby lymph node, or the tumor is large to undergo for this therapy. If you’re in good health, then standard chemo treatment or chemo-radiation (concurrent chemoradiation) can be the right option for you. Chemo drugs for this procedure are typically etoposide (VP_16) or either carboplatin or cisplatin.
Concurrent chemoradiation is a reliable treatment for limited-stage SCLC patient to make them live longer or have a good chance of curing their cancer. However, the downside of having chemoradiation includes a more serious or unbearable side effects compared to chemo & radiation alone. Whatever treatment it might be, it is still a great way to stop yourself from smoking before you suffer from the toll of having an SCLC. Guided with discipline, you must already avoid smoking if you still want to live a happy and healthy life. However, smoking during your treatment is greatly linked to the worst survival.
Without proper medication and preventive measure, patients with SCLC have greater chance of cancer proliferation to reach their brain. If the cancer has not responded to your initial treatment, then your doctor might give you a PCI therapy to prevent further spread. It commonly comes with a lower dose and same with the ‘radiation section’, this may also trigger some side effects. But on the other hand, most limited-stage SCLC patients who were treated with chemo (without or with radiation) has founded that their tumors significantly shrink using the treatment.
Unfortunately, those patients who had their tumor shrinked after their therapy are still exposed to the possibility of their tumor to come back. To prevent further this possibility, clinical trials using newest chemo drugs & combination are being done to enhance their treatment result. Since cancer are really hard to treat, you can alternatively choose a clinical trial to fight this disease. If you want to take a clinical trial, then you can consult your doctor to know better about the process.
Extensive stage SCLC
If you’re currently having an extensive SCLC and is in good health, then chemotherapy may also help you with your condition. One of today’s common combination for chemo associates etoposide including carboplatin and cisplatin. Some cancer patients who undergo chemo using this combination shows that their tumor had significantly shrink with the aid of chemo and their cancer doesn’t anymore shows on their imaging test.
If the patient’s cancer responds to the chemo, corresponding radiation treatment may be given (to examine their chest). This can be a good help for patients suffering from extensive stage of SCLC to extend their lives and to hopefully survive the illness. Furthermore, radiation for the brain may also be recommended (PCI) to prevent the cancer cells to spread and reach the brain. Same in limited stage, extensive SCLC may also use a clinical trial for new chemotherapy combinations (drug and medications) or if advised by doctors.
Radiation therapy may also be a good option to control & relieve symptoms (bleeding, shortness of breath, etc.) or subsequently shrink the tumor on the infected body part (especially to lung area). Laser surgery may also help for a more severe condition. Radiation therapy is also used to fight or relieve the symptoms caused by the cancer cells that already reached the bones or brain.
However, if you’re health is not on a good state there might be a possibility for you not to withstand certain side effects from the standard chemo. In this case, your doctor may give you lower dose for your chemo or give a supportive care/palliative alone. This treatment may help you to fight certain symptoms of extensive stage such as pain, problems in breathing and other underlying symptoms.
Cancer that progresses or recurs after treatment
If the cancer continually grows despite of the treatment or recur after the treatment, then further medications or action will still depend on the extent of the cancer (affected body area). Another factor to consider is the patient’s health & their desire to take further treatment. It is very important to set the expectation or understand the treatments’ goal before it start (e.g. will it prevent the growth of the cell, is it going to cure the cancer, or is the therapy used to relieve symptoms)- as well as he underlying risks and benefits.
But if the cancer cells continue to grow even during the chemo, another treatment or chemotherapy may be tried to take action on the recurring condition. However, this might be less effective if the cancer doesn’t respond anymore to any of this treatment. Still, if the cancer still comes back after the initial treatment was done, the choice for chemotherapy drugs may still hinge on how long the cancer cell was in remission.
If treatment is no longer working
On the clear perspective, if the treatment does not respond anymore on the standard treatments, then a clinical trial for new lung cancer chemo or treatment may be taken into consideration. Though this may not always be a good option but this may help you to control your illness before it kills your health. Some patients may also benefit from clinical trial as well, if they still have the desire to continue their treatment.
Even the cancer is hard to treat/cure; you must be free from any symptoms if possible. If curative treatments are not recommended, there may also be a proper cancer-medication management aimed for specific body part (affected area) in order to prevent symptoms and lessen the growth of the disease. Generally, those lung cancer patients may experience symptoms such as coughing blood or breathlessness because their airways were already affected by the illness. But this may be prevented and treated using radiation therapy and some palliative treatments as required by the doctor or depending on the severity of the symptoms. Those patients who had already accumulated cancer cells in their bones or brain can be treated using radiation therapy.
Most cancer patients are concerned about the pain brought by the disease. This happen because cancer grows on their nerves resulting to symptoms causing pain, but it can also be relieved using pain medicines. Radiation therapy may also help if recommended by the doctor.
Small Cell Lung Cancer Prognosis and Survival Rates
As what we discuss above, the chances of surviving this disease is slim. Moreover, not all who has SCLC has same prognosis. There is a particular treatment for each stage, however, there’s a wide spectrum for each stage.
In fact, the total survival rate for SCLC is different as reflected in each stage. In present, the survival rate for each stage (average of % year survival) are as follows:
Stage 1- 31%
Stage 2- 19%
Stage 3- 8%
Stage 4- 2%
Small-cell lung cancer- the 5 year survival rate in extensive & limited is only 6 %, and without proper treatment, life expectancy for the extensive stage is only limited on an average of 2-4 months while 6-12 months for those who undertake treatments.