Lung Cancer- Small Cell

Lung Cancer - Small Cell (SCLC)

The Lungs

When a person breathes, the lungs absorb oxygen from the air and deliver it through the bloodstream to various parts of the body. Cells use this oxygen and release carbon dioxide, which is transported back to the lungs and exhaled during breathing.

The lungs contain different types of cells, including:

• Epithelial cells: Line the airways and produce mucus to protect the lungs.

• Nerve cells and hormone-producing cells.

• Blood cells and supporting cells.

What is Small Cell Lung Cancer (SCLC)?

There are two main types of lung cancer:

1. Small Cell Lung Cancer (SCLC)

2. Non-Small Cell Lung Cancer (NSCLC)

SCLC accounts for 14% of all lung cancers. It starts in neuroendocrine cells, which are either nerve cells or hormone-producing cells. These cells grow uncontrollably, forming tumors.

Statistics

• India records around 72,510 new lung cancer cases annually, making it the 4th most common cancer.

• Mortality Rate: 66,279 deaths occur every year from lung cancer.

• SCLC-specific statistics are not available.

Risk Factors

A risk factor increases the chance of developing cancer but may not directly cause it. Key risk factors for SCLC include:

• Smoking:

• Smoking is the leading cause of SCLC. The chemicals in cigarette smoke damage lung cells, leading to mutations.

• Cigarette smoke contains 7,000 chemicals, with 69 known to cause cancer.

• Even passive smoking (inhaling others’ smoke) can increase the risk.

Prevention

The best way to prevent SCLC is to quit smoking. Even those who quit smoking later in life can significantly reduce their risk of developing lung cancer.

Screening for SCLC

Screening involves testing people without symptoms to detect cancer early.

• Screening goals:

• Identify cancer early for better treatment outcomes.

• Reduce lung cancer mortality.

The low-dose spiral CT scan is used for lung cancer screening. Screening is recommended only for:

• Individuals aged 55 to 74 with a 30 pack-year history of smoking.

• (A pack-year is smoking one pack of cigarettes daily for one year).

• Individuals aged 55 to 74 who quit smoking within the past 15 years.

Symptoms of SCLC

• Fatigue

• Cough

• Shortness of breath

• Chest pain

• Loss of appetite

• Phlegm production

• Coughing up blood

• Hoarseness

• Weight loss

SCLC can spread to other areas, such as lymph nodes, bones, brain, liver, and adrenal glands.

Diagnosis

• CT Scan / PET-CT Scan

• MRI Scan

• Bone Scan: A radioactive tracer detects abnormalities in the bones.

• Biopsy: A small tissue sample from the tumor is analyzed under a microscope to confirm cancer.

• FNAC (Fine Needle Aspiration Cytology): A needle is used to extract lung tissue, guided by imaging tests.

• Bronchoscopy: A thin tube with a light is inserted through the nose or mouth to examine the lungs and collect tissue samples.

• Thoracentesis: Fluid from the pleural space (between the lungs and chest wall) is analyzed for cancer cells.

• Thoracoscopy: A camera is inserted through a small chest incision to inspect the thoracic cavity.

• Mediastinoscopy: Examines the area between the lungs (mediastinum).

• Thoracotomy: Surgery to examine the chest cavity.

Stages of SCLC

1. Limited Stage:

• Cancer is confined to the chest (thorax).

• Around 1/3 of SCLC patients are diagnosed at this stage.

2. Extensive Stage:

• Cancer has spread to other parts of the body.

• Around 2/3 of patients are diagnosed at this stage.

Treatment Options

1. Chemotherapy

• Chemotherapy is the primary treatment for SCLC. It uses drugs to destroy cancer cells.

• It is often given in cycles (schedules) over specific time periods.

• In the limited stage, chemotherapy is combined with radiation therapy.

• In the extensive stage, chemotherapy is combined with immunotherapy.

Common Chemotherapy Regimens:

• Etoposide and cisplatin

• Etoposide and carboplatin

• Irinotecan and cisplatin

• Irinotecan and carboplatin

Side Effects:

• Fatigue, infections, hair loss, nausea, vomiting, loss of appetite, and diarrhea. These side effects typically subside after treatment.

2. Immunotherapy

• Helps the immune system fight cancer.

Medications used include:

• Atezolizumab (Tecentriq)

• Durvalumab (Imfinzi)

3. Radiation Therapy

• High-energy radiation is used to kill cancer cells.

• SBRT (Stereotactic Body Radiation Therapy):

• This technique delivers high-dose radiation to the tumor while minimizing exposure to surrounding tissues. It is used for limited-stage SCLC.

Side Effects of Radiation Therapy:

• Fatigue, loss of appetite, difficulty swallowing, skin irritation, cough, fever, and shortness of breath.

4. Surgery

• Surgery is rarely used to treat SCLC.

• It is only an option in early-stage SCLC with very small tumors.

Follow-up Care for SCLC

Regular follow-up care is essential to:

• Monitor for recurrence of cancer.

• Manage side effects of treatment.

• Ensure timely intervention if cancer returns.
• Physical examinations

• Blood tests

• Imaging tests

Small Cell Lung Cancer (SCLC) is an aggressive type of lung cancer often linked to smoking. Early detection through screening improves treatment outcomes, and quitting smoking can significantly reduce the risk of developing SCLC. Although treatment options like chemotherapy, radiation therapy, and immunotherapy are available, regular follow-up care is essential to ensure better patient outcomes and quality of life.

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