ON THIS PAGE: You will find a drawing of the main body parts affected by small cell lung cancer (SCLC). Use the menu to see other pages.

The next section in this guide is Risk Factors and Prevention. It explains the factors that may increase the chance of developing SCLC. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for small cell lung cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease.

Learn more about the basics of cancer screening.

Screening information for lung cancer

Several groups, including ASCO, have recommendations for lung cancer screening using a test called a low-dose helical or spiral computed tomography (CT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors.

CT scanning is not recommended for every person who smokes. The current recommendations are discussed below, and such screening for lung cancer is approved by Medicare. It is also important to receive screening at an approved and experienced center.

It is important to note that lung cancer screening was intended to find non-small cell lung cancer (NSCLC), and not small cell lung cancer (SCLC). However, sometimes SCLC is found on lung cancer screening scans.

ASCO's recommendations are based on a person's age and how much they smoke. This number, called a "pack year," is equivalent to smoking 20 cigarettes or 1 pack each day for a year. ASCO recommends the following lung cancer screening schedules for people who currently smoke or who have quit smoking:

• Yearly screening with a low-dose CT scan is recommended for people age 55 to 74 who have smoked for 30 pack years or more. It is also recommended for those age 55 to 74 who have quit within the past 15 years.

• CT screening is not recommended for people who have smoked for less than 30 pack years, are younger than 55 or older than 74, have quit smoking more than 15 years ago, or have a serious condition that could affect cancer treatment or shorten a person's life.

The U.S. Preventive Services Task Force recommends that people age 50 to 80 who have smoked for 20 pack years or more or who have quit within the past 15 years receive screening for lung cancer with low-dose CT scans each year. Screening can stop after a person has not smoked for 15 years or develops a health problem that would shorten their life or prevent them from being able to have surgery for lung cancer.

Always discuss whether you are eligible for regular screening with your primary care doctor.

Listen to a Cancer.Net Podcast on Understanding Lung Cancer Screening and find more information about lung cancer screening on the website of the National Cancer Institute.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems SCLC can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How small cell lung cancer is diagnosed

There are many tests used for diagnosing this type of cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• Size, location, and type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose and stage small cell lung cancer (SCLC):

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If cancer cells are found, the pathologist will determine if it is SCLC or non-small cell lung cancer (NSCLC), based on what it looks like when seen through a microscope.

More procedures that doctors use to collect tissue for the diagnosis and staging of SCLC are listed below:

• Bronchoscopy. In a bronchoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the main windpipe, and into the breathing passages of the lungs. A surgeon or a pulmonologist may perform this procedure. A pulmonologist is a medical doctor who specializes in the diagnosis and treatment of lung disease. The tube lets the doctor see inside the lungs. Tiny tools inside the tube can take samples of fluid or tissue so the pathologist can examine them. Patients are given mild anesthesia during a bronchoscopy. Anesthesia is medication to block the awareness of pain.

• Fine needle aspiration/core biopsy. After numbing the skin, a special type of radiologist, called an interventional radiologist, removes a sample of the lung tumor for testing. A fine needle aspiration uses a thin needle to remove a small sample of cells. A core biopsy is done with a wider needle. The type of needle used depends on how large of a sample is needed. Often, the radiologist uses a chest CT scan or special x-ray machine called a fluoroscope to guide the needle. In general, a core biopsy provides a larger amount of tissue than a fine needle aspiration. Doctors have learned that more tissue is needed to diagnose SCLC.

• Thoracentesis. After numbing the skin on the chest, a needle is inserted through the chest wall and into the space between the lung and the wall of the chest where abnormal amounts of fluid can collect. The fluid is removed and checked for cancer cells by the pathologist.

• Thoracoscopy. Through a small cut in the skin of the chest wall, a surgeon inserts a special instrument and a small video camera to assist in the examination of the inside of the chest. Patients need general anesthesia for this procedure, but recovery time may be shorter with a thoracoscopy because of the smaller incisions that are used. This procedure may be referred to as video-assisted thoracoscopic surgery or VATS.

• Mediastinoscopy. A surgeon examines and takes a sample of the lymph nodes in the center of the chest underneath the breastbone by making a small incision at the top of the breastbone. This procedure also requires general anesthesia and is done in an operating room.

• Thoracotomy. This procedure is performed in an operating room, and the patient receives general anesthesia. A surgeon then makes an incision in the chest, examines the lung directly, and takes tissue samples for testing. A thoracotomy is the procedure surgeons most often use to completely remove a lung tumor.

Imaging tests

In addition to biopsies and surgical procedures, imaging scans are very important in the care of people with SCLC. However, no test is perfect, and no scan can diagnose SCLC. Only a biopsy can do that. Imaging tests show pictures of the inside of the body. Chest x-ray and scan results must be combined with a person’s medical history, a physical examination, blood tests, and information from the biopsy to form a complete story about where the cancer began and whether or where it has spread.

• CT scan. A CT scan produces images that allow doctors to see the size and location of a lung tumor and/or lung cancer metastases. This test takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Positron emission tomography (PET) scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

• Magnetic resonance imaging (MRI) scan. An MRI also produces images that allow doctors to see the location of a lung tumor and/or lung cancer metastases and measure the tumor’s size. An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. MRI scanning does not work well to take pictures of parts of the body that are moving, like your lungs, which move with each breath you take. For that reason, MRI is rarely used to look at the lungs. However, an MRI of the brain is recommended after the initial diagnosis of SCLC. This is because SCLC often spreads to the brain.

• Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image. PET scans (see above) have been replacing bone scans to find lung cancer that has spread to the bones.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

Finding out where the cancer started

Lung cancer starts in the lungs. Many other types of cancer start elsewhere in the body and spread to the lungs when they metastasize. For example, breast cancer that has spread to the lungs is called metastatic breast cancer, not lung cancer. That's why it is important for doctors to know if the cancer started in the lungs or elsewhere.

To find where the cancer started, your doctor will take into account your symptoms and medical history, physical examination, how the tumor looks on x-rays and scans, and your risk factors for cancer. A pathologist can perform tests on the biopsy sample to help find out where the cancer began. Your doctor may recommend other tests to rule out specific types of cancer. If, after these considerations, the doctor is still not sure where the cancer started, you may be diagnosed with metastatic “cancer of unknown primary.” Most treatments for metastatic cancer of unknown primary that are first found in the chest are the same as those for metastatic SCLC.

Coping with a lung cancer diagnosis

For most patients, a diagnosis of SCLC is very stressful. Some patients with SCLC develop anxiety and, less commonly, depression. You and your family should not be afraid to express how you feel to doctors, nurses, and social workers. Your health care team is there to help and has special training and experience that can make things easier for you and your family.

In addition to emotional support and education, your doctor may prescribe anti-anxiety medication and occasionally, an antidepressant if it is needed. They may also refer you to a counselor, psychologist, social worker, or psychiatrist. There are also resources available in the community to help you and your family.

Some patients feel comfortable discussing their disease and experiences throughout treatment with their doctor, nurse, family, friends, or other patients through a support group. These patients may also join a support group or advocacy group in order to increase awareness about lung cancer and to help fellow patients who are living with this disease.

A SCLC diagnosis is serious. However, patients can be hopeful that their doctors can offer them effective treatment. They may also be able to take some comfort knowing that the advances being made in the diagnosis and treatment of lung cancer will provide more and more patients with a chance for cure.

Learn more about the counseling, finding a support group, and being a cancer advocate.

Stopping smoking

If you smoke, it is still beneficial to quit cigarette smoking even after SCLC is diagnosed. People who stop smoking have an easier time with all treatments, feel better, live longer, and have a lower risk of developing a second lung cancer or other health problems. Stopping smoking is never easy and even harder when facing a lung cancer diagnosis. People who smoke should seek help from family, friends, programs for quitting smoking, and health care professionals. None of the products available to quit smoking interfere with cancer treatment. Learn more about stopping tobacco use after a cancer diagnosis.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with small cell lung cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for small cell lung cancer (SCLC). “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How small cell lung cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Chemotherapy is the primary treatment for SCLC. Additional treatment depends on whether or not it is limited stage SCLC or extensive stage SCLC (see Stages). For limited stage SCLC, chemotherapy is often combined with radiation therapy to the chest. For extensive stage SCLC, chemotherapy is often combined with immunotherapy. Radiation therapy can also be an option for people with extensive stage SCLC that could spread to the brain or has already spread to the brain. Surgery is not usually an option for people with SCLC, except for in a small number of people with very limited stage SCLC. These treatments are described below, followed by an outline of treatment options by stage. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for SCLC because there are different treatment options. Learn more about making treatment decisions.

The common types of treatment used for SCLC are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

• Chemotherapy

• Immunotherapy

• Radiation therapy

• Surgery

• Physical, social, and emotional effects of cancer

• Treatment options by stage of SCLC

• Remission and the chance of recurrence

• If treatment does not work

Therapies using medication (updated 10/2023)

The treatment plan may include medications to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of systemic therapies used for SCLC include:

• Chemotherapy

• Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes radiation therapy and/or surgery.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

The information in this section is based in part on the joint guideline from the American Society of Clinical Oncology (ASCO) and Ontario Health, “Systemic Therapy for SCLC.” Please note that this link takes you to a different ASCO website. 

Chemotherapy

Chemotherapy is the primary treatment for SCLC because of how quickly the disease can spread. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.

Treatment can depend on if the disease is considered limited stage SCLC or extensive stage SCLC. For people with limited stage SCLC, chemotherapy plus radiation therapy (see Radiation Therapy section, below) to the chest is given daily over several weeks. For certain patients who may have difficulty managing combined chemotherapy and radiation therapy, the radiation therapy may be delayed or removed from the treatment plan. People with extensive stage SCLC initially receive a combination of chemotherapy and immunotherapy for 3 to 4 months, then remain on maintenance immunotherapy (see Immunotherapy section, below). Some people may have difficulty coping with the combined treatments recommended for extensive stage SCLC. If so, a single chemotherapy drug may be recommended instead.

Usually, SCLC is treated with a combination of chemotherapy drugs, which may include:

• Cisplatin (available as a generic drug)

• Carboplatin (available as a generic drug)

• Etoposide (available as a generic drug)

• Irinotecan (Camptosar)

For people with SCLC that has come back and spread after receiving previous platinum-based chemotherapy treatment, the treatment may depend on the timing of the recurrence, also called a relapse. If more than 90 days have passed since they last received chemotherapy, a repeat course of platinum-based chemotherapy or single-drug regimen may be recommended, such as lurbinectedin (Zepzelca) or topotecan (Hycamtin). If less than 90 days have passed since they last received chemotherapy, a single-drug chemotherapy, such as lurbinectedin or topotecan, may be recommended in this situation.

Sometimes, non-small cell lung cancer with a mutation in the EGFR gene that is treated with targeted therapy may transform into SCLC. If this happens, the cancer should be treated with chemotherapy, either carboplatin or cisplatin plus etoposide. In some cases, the targeted therapy may be continued along with the chemotherapy for SCLC.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, diarrhea, and hair loss. Nausea and vomiting are often avoidable. Learn more about preventing nausea and vomiting caused by cancer treatment. These side effects usually go away after treatment is finished.

Chemotherapy may also cause a side effect called bone marrow suppression, which lowers the number of blood cells in the body. This is called myelosuppression. People with SCLC who are receiving chemotherapy, chemotherapy plus immunotherapy, or chemotherapy plus radiation therapy may receive treatment with trilaciclib (Cosela) or G-CSF (granulocyte colony-stimulating factor) to prevent myelosuppression.

Learn more about the basics of chemotherapy.

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells. For example, the PD-1 pathway may be very important in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of SCLC for some patients. The following types of immunotherapies may be used for SCLC:

• Atezolizumab (Tecentriq)

• Durvalumab (Imfinzi)

Different types of immunotherapies can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Radiation therapy

Radiation therapy is the use of high energy x-rays to destroy cancer cells. A radiation oncologist is a doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to 6 or more weeks.

Radiation therapy can be used to treat SCLC, prevent the spread of SCLC to the brain, and it can be used to relieve symptoms. For people with limited stage SCLC, radiation therapy directed to the cancer in the chest is recommended. For people who are receiving radiation therapy combined with chemotherapy (see above), radiation therapy to the chest should begin with the first or second cycle of chemotherapy. Radiation treatments may be given once or twice a day.

Radiation therapy may also be recommended after surgery for patients who have residual disease or whose lymph nodes are involved with cancer. If chemotherapy shrank the cancer, then the remaining tumors and lymph nodes affected by cancer should receive additional treatment with radiation therapy.

For people who have limited stage SCLC that has not spread to the lymph nodes and who cannot be treated with surgery, radiation therapy is recommended. A specific type of radiation therapy called stereotactic body radiation therapy (SBRT) may be an option. In SBRT, a large, precise radiation therapy dose is delivered to a small tumor area. For certain patients, SBRT may be followed by chemotherapy.

People with extensive stage SCLC may receive radiation therapy to treat remaining disease in the chest if chemotherapy has worked to shrink the cancer in other areas of the body. The radiation therapy should be given after chemotherapy treatment has finished. If extensive stage SCLC is being effectively treated with chemotherapy plus immunotherapy, radiation therapy may be given after chemotherapy is done but before maintenance immunotherapy starts.

In people whose cancer has shrunk during treatment, radiation therapy to the brain lessens the risk that the cancer will spread to the brain. This is called prophylactic cranial irradiation (PCI), and it has been shown to lengthen the lives of some patients. If the cancer responds to initial treatment, a repeat brain MRI scan after completion of chemotherapy is recommended (see Diagnosis). This will help guide decisions around whether PCI should be included in the treatment plan moving forward.

PCI may be a part of the treatment plan and the risks and benefits of the treatment should be discussed with the health care team.

This information is based on an ASCO guideline endorsement of an American Society of Radiation Oncology (ASTRO) clinical practice guideline, “Radiation Therapy for Small Cell Lung Cancer.” Please note that this link takes you to another website.

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Side effects of radiation therapy

People with SCLC who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (Rayos) and extra oxygen to help them breath. Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation (see above).

Learn more about the basics of radiation therapy.

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Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery.

Surgery is rarely used for patients with SCLC and is only considered for people with very early-stage disease, such as cancer in a small lung nodule. In those situations, chemotherapy, with or without radiation therapy, is given after surgery (see above).

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

The following treatments may be given to help relieve the symptoms of SCLC:

• Radiation therapy can be used to shrink a tumor in the chest that is bleeding or blocking the lung passages.

• Using a bronchoscopy (See Diagnosis), lung passages blocked by cancer can be opened to improve breathing.

• A surgeon can use a laser to burn away a tumor or place a stent to prop open an airway.

• Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer. Learn more about managing cancer pain.

• Medications can be used to suppress cough, open closed airways, or reduce bronchial secretions.

• Prednisone or methylprednisolone (multiple brand names) can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.

• Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to pull oxygen from the air.

• Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases.

• Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Treatment options by stage of SCLC

For limited stage SCLC, treatment may include chemotherapy combined with radiation therapy to try to cure the cancer. For extensive stage, using only systemic medications (see above) is likely a better option. Learn more about recommendations for the treatment of SCLC on a separate ASCO website.

Extensive stage SCLC

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. SCLC that has spread to other parts of the body is called "extensive stage" (see Stages). Most patients who develop extensive stage SCLC need to start treatment right away. Talk with your doctor about the available treatment options, including clinical trials, so you are comfortable with the treatment plan.

Your treatment plan may include surgery, chemotherapy, immunotherapy, and/or radiation therapy. Chemotherapy is not as effective as radiation therapy or surgery to treat lung cancer that has spread to the brain. For this reason, lung cancer that has spread to the brain is usually treated with radiation therapy. Most people with brain metastases from lung cancer receive radiation therapy to the entire brain. This can cause side effects such as hair loss, fatigue, and redness of the scalp.

Palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

For most people, a diagnosis of extensive stage SCLC is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called relapsed cancer or recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When there is a recurrence, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as chemotherapy and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Treatment for recurrent SCLC may not work well for very long. If treatment does stop working, it is important to talk with your doctor about the next steps and the goals of further treatment.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from SCLC is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about SCLC, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Personalized therapy. Researchers are looking at the features of lung tumors that can predict whether a specific treatment may be effective. To collect this information, patients are increasingly being asked to have additional analyses of the tumor samples taken when the disease is first diagnosed. The amount of tumor tissue removed during the original biopsy to diagnose the cancer may not be enough for these additional studies. If this is the case, patients may be asked to have another biopsy to help plan treatment and, if part of a clinical trial, to help researchers find better ways to treat lung cancer. Learn more about personalized therapy.

• Targeted therapy. Targeted therapy is a type of systemic treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. The targeted therapy rovalpituzumab is being studied for SCLC. It is a drug combined with an antibody that attaches to a protein called DLL3 found on SCLC cells.

• Immunotherapy. The PD-1 pathway may be very important in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of lung cancer for some patients. Research into new immunotherapies and new ways to use these treatments is ongoing. Learn more about immunotherapy and lung cancer.

• Better techniques for radiation therapy. Doctors are finding ways to improve the effectiveness of radiation therapy while reducing the side effects. For example, some studies are looking at stereotactic radiation therapy, which is used to focus radiation more directly on the cancer and avoid healthy tissue.

• Improved screening/early detection. SCLC is more successfully treated in its early stages, which has raised interest in screening more people for lung cancer before it causes signs and symptoms.

• Stopping tobacco use. Even with the best methods for the early detection and treatment of lung cancer, the best way to save lives from lung cancer in general and SCLC specifically is through programs to encourage people to never begin smoking and, if they have, quit smoking. For most people, lung cancer is a highly preventable disease. Even for people with lung cancer, stopping smoking lets them live longer, lowers side effects, and lessens the chance of getting a second lung cancer. Quitting smoking is hard at any time, and even more so during cancer treatment. Your health care team can help make it easier to quit smoking with nicotine replacement and other techniques. Research continues into new ways to help people stop smoking.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current lung cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in SCLC, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases.

• Visit the Cancer.Net Blog to review research announced in August 2022 during the ASCO Plenary Series and at the 2020 ASCO Annual Meeting.

• Visit the website of Conquer Cancer, the ASCO Foundation, to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. During this period, tell your doctor or nurse about any new problem that lasts for more than 2 weeks.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence or second cancer

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer first diagnosed and the types of treatment given.

People who develop lung cancer are also at higher risk for developing a second lung cancer. Your doctor will recommend scans to watch for both a recurrence and any new lung cancer.

Different organizations, including ASCO, have developed different follow-up care recommendations for SCLC in the United States. ASCO recommends that most people who were successfully treated for stage I to stage III (limited stage) SCLC receive imaging scans every 6 months for the first 2 years after treatment to watch for a recurrence. The preferred test is a chest CT scan (see Diagnosis). After the first 2 years, people should receive a low-dose chest CT scan once a year. Those who did not receive radiation therapy to the brain, also known as prophylactic cranial irradiation or PCI (see Types of Treatment), should receive a brain MRI every 3 months for the first year after treatment and then once every 6 months during the second year after treatment. Periodic brain MRIs may also be recommended for people who did receive PCI. ASCO does not recommend using PET-CT scans with fluorodeoxyglucose (FDG) or blood tests as routine tests to watch for cancer recurrence.

This information is based on ASCO recommendations for Lung Cancer Surveillance After Definitive Curative-Intent Therapy. (Please note that this link takes you to a separate ASCO website.)

Another organization called the National Comprehensive Cancer Network recommends imaging scans every 3 months for the first 2 years after treatment for limited stage SCLC, then every 6 months for the third year, then annually after that.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Common post-treatment problems include pain, fatigue, and shortness of breath. Your doctor, nurse, and social worker can help you develop a plan to manage any problems that persist after treatment.

Survivors of SCLC who have smoked cigarettes in the past also have a high risk of heart disease, stroke, emphysema, and chronic bronchitis. Certain cancer treatments can also increase these risks. Even for those who don’t smoke, healthy lifestyle choices after cancer are important for overall well-being. This should be a regular part of your survivorship care discussions with your health care team.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What is the stage of my lung cancer? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having chemotherapy or immunotherapy

• What type of treatment is recommended?

• What is the goal of this treatment

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about radiation therapy

• Do you recommend radiation therapy?

• Where will I receive radiation therapy?

• How often will I receive radiation therapy?

• How much time will each treatment take?

• How much of the healthy lung will be included in the radiation field?

• Will I receive chemotherapy along with radiation therapy? If so, what are the added side effects of giving the chemotherapy at the same time, compared with one after another?

• Who should I contact about any side effects I experience? And how soon?

• Will I be able to go to and return from this treatment on my own, or should I arrange to have assistance?

Questions to ask about having surgery

• Do I need to have surgery? If so, what type of surgery will I have?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this surgery?

Questions to ask about clinical trials

• What are my options for standard treatment?

• What other treatment options through clinical trials are available to me?

• How will my experience differ if I enroll in this clinical trial, compared to standard treatment? For example, are there different risks, testing schedule, time commitment, schedule, or costs to consider?

• What is the goal of this clinical trial? Is this a phase I, II, or III clinical trial? What does this mean?

• Where will I receive the clinical trial treatment?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• Is there anything more I can do to reduce the chance that my cancer will return?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What tests will I have during my follow-up visit?

• What survivorship support services are available to me? To my family?

Questions to ask for patients who smoke

• What are the benefits of me quitting smoking?

• How can you help me to quit smoking?

The next section in this guide is Additional Resources. It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.