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Lung Cancer - Small Cell - Introduction

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Small Cell Lung Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

Lung cancer affects more than 200,000 Americans each year. About 10% to 15% of people with lung cancer have a type called small cell lung cancer. Although cigarette smoking is the main cause of lung cancer, anyone can develop the disease. Lung cancer is treatable, no matter the size, location, whether the cancer has spread, and how far it has spread.

Because lung cancer is associated with smoking, patients may feel that they will not receive as much support or help from people around them because they believe that others will think that their behavior caused the disease. The truth is that most smokers do not develop lung cancer, and not all people diagnosed with lung cancer smoke. Lung cancer is a disease that can affect anyone. In fact, most people who get lung cancer today have either stopped smoking years earlier or never smoked.

About the lungs

When a person inhales, the lungs absorb oxygen from the air and bring the oxygen into the bloodstream for delivery to the rest of the body. As the body’s cells use oxygen, they release carbon dioxide. The bloodstream carries carbon dioxide back to the lungs, and the carbon dioxide leaves the body when a person exhales.

The lungs contain many different types of cells. Most cells in the lung are epithelial cells. Epithelial cells line the airways and make mucus, which lubricates and protects the lung. The lung also contains nerve cells, hormone-producing cells, blood cells, and structural or supporting cells.

About small cell lung cancer

There are 2 main classifications of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These 2 types are treated differently. This guide provides information on SCLC. Learn more about NSCLC.

SCLC begins when healthy cells in the lung change and grow out of control, forming a mass called a tumor, a lesion, or a nodule. SCLC begins in the nerve cells or hormone-producing cells of the lung. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope.

A tumor can be cancerous or benign. Once a cancerous lung tumor grows, it may or may not shed cancer cells. These cells can be carried away in blood or float away in the fluid, called lymph, that surrounds lung tissue. Lymph flows through tubes called lymphatic vessels that drain into collecting stations called lymph nodes. Lymph nodes are the tiny, bean-shaped organs that help fight infection. They are located in the lungs, the center of the chest, and elsewhere in the body. The natural flow of lymph out of the lungs is toward the center of the chest, which explains why SCLC often spreads there first. When a cancer cell moves into a lymph node or to a distant part of the body through the bloodstream, it is called metastasis. 

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with SCLC and general survival rates. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Statistics

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find information about the number of people who are diagnosed with SCLC each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Lung cancer makes up about 14% of all new cancer diagnoses. This year, an estimated 228,150 adults (116,440 men and 111,710 women) in the United States will be diagnosed with lung cancer. This includes people diagnosed with SCLC and NSCLC. About 13% of people diagnosed with lung cancer have SCLC. Black men are 15% less likely than white men to develop SCLC, and black women are 30% less likely than white women to develop the disease.

Lung cancer is the second most common cancer and the leading cause of cancer death for men and women. It is estimated that 142,670 (76,650 men and 66,020 women) deaths from this disease will occur this year.

Due to a decrease in smoking, death rates have declined by 48% since 1990 in men and 23% in women since 2002. From 2012 to 2016, the death rates for men with the disease dropped by 4% each year. The death rates for women declined 3% per year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The general 5-year survival rate for people with SCLC is 6%.

It is important to note that survival rates depend on several factors, including the stage of disease. If SCLC is only 1 tumor in the lungs, the 5-year relative survival rate is 31%. If the cancer has spread to nearby tissue or the regional lymph nodes, the 5-year survival ranges from 8% to 19%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 2%.

However, some people with advanced lung cancer can live many years after diagnosis. Sometimes, patients who are told that their lung cancer is curable do not live as long as those who are told that their lung cancer cannot be cured. The important thing to remember is that lung cancer is treatable at any stage, and these treatments have been proven to help people with lung cancer live longer with better quality of life.

It is also important to remember that statistics on the survival rates for people with SCLC are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2019, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by SCLC. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 07/2019

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

The lungs are located under the ribs, and above the liver, the adrenal gland, and the kidneys. The lungs are made up of 2 lobes, a right lobe and left lobe. A hollow tube, the trachea, carries air to the lungs, branching throughout both lobes. Lymph nodes, tiny, bean-shaped organs, are located in the lungs, the center of the chest, and elsewhere in the body. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

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.

Lung Cancer - Small Cell - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find out more about the factors that increase the chance of developing SCLC. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. Most often, SCLC occurs in people who smoke or in those who have smoked in the past. However, people who do not smoke can also develop lung cancer, so it is important for all people to learn about the risk factors and signs and symptoms of SCLC.

The following factor may raise a person’s risk of developing SCLC:

  • Tobacco. Tobacco smoke damages cells in the lungs, causing the cells to grow abnormally. The risk that smoking will lead to cancer is higher for people who smoke heavily and/or for a long time. Regular exposure to smoke from someone else’s cigarettes, cigars, or pipes can increase a person’s risk of SCLC, even if that person does not smoke. This is called environmental or “secondhand” tobacco smoke.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause SCLC, including ways to prevent it. Although there is no proven way to completely prevent the disease, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

The most important way to prevent SCLC is to avoid tobacco smoke. People who never smoke have the lowest risk of SCLC. People who smoke can reduce their risk of SCLC by stopping smoking, but their risk of SCLC will still be higher than people who never smoked.

Attempts to prevent lung cancer with vitamins or other treatments have not worked. For instance, beta-carotene, a drug related to vitamin A, has been tested for the prevention of lung cancer. It did not reduce the risk of cancer. In people who continued to smoke, beta-carotene actually increased the risk of lung cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Screening

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find out more about screening for SCLC. 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 goal of cancer screening is to lower the number of people who die from the disease or eliminate deaths from cancer altogether.

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 NSCLC, and not SCLC. However, sometimes SCLC is found on lung cancer screening scans.

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 instead of screening with a chest x-ray or no screening for people age 55 to 74 who have smoked for 30 pack years or more who are current smokers or who have quit within the past 15 years. A pack year is equal to smoking 20 cigarettes (1 pack) a day each year.

  • 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 United States Preventive Services Task Force recommends that people age 55 to 80 who have smoked for 30 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.

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 body changes or medical problems SCLC can cause. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with SCLC may experience the following symptoms or signs. Sometimes people with SCLC do not have any of these changes, but SCLC often causes these symptoms worsen over weeks or sometimes days. 

  • Fatigue

  • Cough

  • Shortness of breath

  • Chest pain

  • Loss of appetite

  • Unexplained weight loss

  • Coughing up phlegm or mucus

  • Coughing up blood

  • Swelling of the neck or face

The cause of a symptoms may be a different medical condition that is not cancer, but if you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you have been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

For people with SCLC who have no symptoms, the cancer may be noticed on a chest x-ray or CT scan performed for some other reason, such as checking for heart disease. Most people with SCLC are diagnosed when the tumor grows and causes symptoms, takes up space, or begins to cause problems with parts of the body near the lungs. A lung tumor may also cause fluid to build up in the lung or the space around the lung or push the air out of the lungs and cause the lung to collapse. If this happens, you may feel short of breath. This is because enough oxygen is not getting in the body and carbon dioxide is not leaving the body quickly enough.

SCLC can spread anywhere in the body through a process called metastasis. It most commonly spreads to the lymph nodes, other parts of the lungs, bones, brain, liver, and structures near the kidneys called the adrenal glands. Metastases from SCLC can cause:

  • More breathing difficulties

  • Bone pain

  • Abdominal or back pain

  • Headache

  • Weakness

  • Seizures

  • Speech difficulties

  • Rarely, a lung tumor can release hormones that cause problems such as low blood sodium levels or high blood calcium levels.

Symptoms such as fatigue, feeling out-of-sorts or unwell, and loss of appetite are not necessarily caused by metastases. Cancer anywhere in the body can cause a person to feel unwell in a general way. Loss of appetite can cause weight loss. Fatigue and weakness can further worsen a person’s ability to breathe.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Diagnosis

Approved by the Cancer.Net Editorial Board, 07/2019

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 this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread, but they can never be used alone to diagnose SCLC. Imaging tests show pictures of the inside of the body. 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.

This section describes options for diagnosing this type of cancer. Not all tests listed below 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 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 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:

  • Sputum cytology. If lung cancer is suspected, the doctor may ask a person to cough up some phlegm so it can be looked at under a microscope. A pathologist can find cancer cells mixed in with the mucus. However, sputum cytology usually does not provide enough tissue to completely diagnose lung cancer.

  • 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 can insert 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.

  • Bone marrow aspiration and biopsy. This is a test used occasionally for SCLC. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. A pathologist then analyzes the sample(s). A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. Doctors generally give a type of medication called “anesthesia” beforehand to numb the area. Anesthesia is medication that blocks the awareness of pain. Stronger types of anesthesia can also be used to lessen the pain.

  • Blood tests. Doctors do not usually use blood tests to help diagnose SCLC. However, researchers are studying free-floating cancer DNA from blood tests to learn if these tests could help find molecular changes that can be used to plan treatment. These tests are often called circulating tumor DNA tests and may also be referred to as a “liquid biopsy.”

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. 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. 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, it may be helpful to find lung cancer that has spread to the brain.

  • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. 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 all of 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 still called breast cancer. Therefore, 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 extremely 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. He or she 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.

Lung Cancer - Small Cell - Stages

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

In general, a lower number stage of SCLC is linked with a better outcome. However, no doctor can predict how long a patient will live with SCLC based only on the stage of disease because it is different in each person, and treatment works differently for each tumor.

Cancer stage grouping

The most common way doctors stage SCLC is by classifying the disease as limited stage or extensive stage.

  • Limited stage. Limited stage means that the cancer is only in 1 part of the chest and radiation therapy could be a treatment option. About 1 out of 3 people with SCLC have limited stage disease when first diagnosed.

  • Extensive stage. Extensive stage is used to describe SCLC that has spread to parts of the body such as the other lung, bone, brain, or bone marrow. Many doctors consider SCLC that has spread to the fluid around the lung to be extensive stage as well. About 2 out of 3 people with SCLC have extensive disease when the cancer is first found.

SCLC is often staged in this way because it helps doctors decide if a patient might benefit from more aggressive treatments. Learn more about treatment options for SCLC.

There is another, more formal system to describe the stage of lung cancer, but SCLC is almost always staged as limited or extensive stage as described above. The other, less commonly used staging system gives a number, 0 through 4, based on whether the tumor can be completely removed by a surgeon. Less than 5% of people have early-stage lung cancer (stage 0 to stage 2). About 25% of people have stage 3 (III) disease when first diagnosed. Stage 0 to stage 3 are called limited stage. Most patients with SCLC have extensive or stage 4 (IV) disease when first diagnosed.

Stage 0

This is called in situ disease, meaning the cancer is “in place” and has not grown into nearby tissues and spread outside the lung.

Stage I

A stage I lung cancer is a small tumor that has not spread to any lymph nodes, making it possible for a surgeon to completely remove it. Stage I is divided into 2 substages based on the size of the tumor:

  • Stage IA tumors are 3 centimeters (cm) or less in size. Stage IA tumors may be further divided into IA1, IA2, or IA3 based on the size of the tumor.

  • Stage IB tumors are more than 3 cm but 4 cm or less in size.

Stage II

Stage II lung cancer is divided into 2 substages:

  • A stage IIA cancer describes a tumor larger than 4 cm but 5 cm or less in size that has not spread to the nearby lymph nodes.

  • Stage IIB lung cancer describes a tumor that is 5 cm or less in size that has spread to the lymph nodes. Or a stage IIB cancer can be a tumor more than 5 cm wide that has not spread to the lymph nodes.

Stage III

Stage III lung cancers are classified as either stage IIIA, IIIB, or IIIC. The stage is based on the size of the tumor and which lymph nodes the cancer has spread to. Stage III cancers have not spread to other distant parts of the body.

Stage IV

Stage IV means the lung cancer has spread to more than 1 area in the other lung, the fluid surrounding the lung or the heart, or distant parts of the body through the bloodstream. Once cancer cells get into the blood, the cancer can spread anywhere in the body. Stage IV is divided into 2 substages:

  • Stage IVA cancer has spread within the chest and/or has spread to 1 area outside of the chest.

  • Stage IVB has spread outside of the chest to more than 1 place in 1 organ or to more than 1 organ.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Prognosis

The stage of SCLC and the patient’s overall health influence prognosis. Although SCLC is treatable at any stage, only some people with certain stages of SCLC can be cured.

Doctors measure a patient’s general strength and health using an index known as performance status. Patients who are strong enough to go about their daily activities without assistance and work outside the home can safely receive chemotherapy, radiation therapy, and/or surgery. Treatment may not be as effective for patients with SCLC that has spread to the bones or liver, excessive weight loss, ongoing cigarette use, or pre-existing medical conditions, such as heart disease or emphysema.

It is important to note that a patient’s age has never been useful in predicting whether a patient will benefit from treatment. The average age of patients with SCLC in the United States is 71. A patient’s age should never be used as the only reason for deciding what treatment is best, especially for older patients who are otherwise physically fit and have no medical problems besides SCLC.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Lung Cancer - Small Cell - Types of Treatment

Approved by the Cancer.Net Editorial Board, 07/2019

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

This section explains the types of treatments that are the standard of care for SCLC. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the 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 to consider for treatment and care 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.

Treatment overview

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, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment for SCLC often starts with a combination of chemotherapy and immunotherapy. Treatment may also include radiation therapy and/or surgery. Descriptions of the common types of treatments used for SCLC are listed 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.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

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.

Chemotherapy

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.

Chemotherapy is the primary treatment for SCLC because it spreads quickly. The most commonly used chemotherapy regimen is etoposide (available as a generic drug) or irinotecan (Camptosar) plus a platinum-based drug such as cisplatin (available as a generic drug) or carboplatin (available as a generic drug).

For people with limited stage SCLC, chemotherapy plus radiation therapy (see below) to the chest is given daily over several weeks. People with extensive stage cancer initially receive chemotherapy for 3 to 4 months. Or they may receive chemotherapy in combination with immunotherapy (see below).

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.

Learn more about the basics of chemotherapy.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. 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 immunotherapy may be used for SCLC:

  • Atezolizumab (Tecentriq)

  • Ipilimumab (Yervoy)

  • Nivolumab (Opdivo)

  • Pembrolizumab (Keytruda)

Different types of immunotherapy 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.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles 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 several weeks.

For people with limited stage SCLC, radiation therapy directed to the chest is combined with chemotherapy (see above). Radiation therapy is best when given during the first or second month of chemotherapy.

In people whose cancer has shrunk after chemotherapy, radiation therapy to the head 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.

People with extensive stage SCLC may sometimes receive radiation therapy to treat residual disease in the chest if systemic therapy using medication has worked to shrink the cancer.

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.

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.

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 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:

  • A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy.

  • During 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.

Treatment options by stage

For limited stage cancer, treatment may include chemotherapy combined with radiation therapy to try to cure the cancer. For extensive stage, chemotherapy alone is likely a better option. Learn more about recommendations for the treatment of SCLC on a separate ASCO website.

Metastatic lung cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Most patients who develop metastatic 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 a combination of surgery, chemotherapy, and 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 metastatic cancer is very stressful and, at times, difficult to bear. 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.

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 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.

If treatment does not work

Recovery from cancer 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.

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.

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ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with SCLC. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of SCLC. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These studies evaluate new drugs and methods of treatment, new approaches to treatments, and new prevention methods.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating SCLC. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with SCLC.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor will:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for SCLC, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for small cell lung cancer. Use the menu to choose a different section to read in this guide.

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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 biopsy to diagnose the cancer may not 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 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. 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 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 additional information about the latest areas of research regarding SCLC, explore these related items that take you outside of this guide:

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.

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care” or “supportive care.” It is an important part of your treatment plan, regardless of your age or the stage of disease. 

Coping with physical side effects

Common physical side effects from each treatment option for SCLC are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with SCLC. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Attending appointments to help listen and take notes

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide. 

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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. 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 originally diagnosed and the types of treatment given.

People who develop lung cancer are at higher risk for developing a second lung cancer. Your doctor will recommend scans to watch for a recurrence, so any new cancer can be found as early as possible.

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

Managing long-term and late side effects

Most people expect to experience 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 afterwards. 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 the type of cancer, 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 further increase these risks. Even for those who don’t smoke, healthy lifestyle choices after cancer are important for overall well-being.

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 family 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 him or her 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.

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ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

Nothing helps recovery more than stopping smoking. There are many tools and approaches available. Be sure to get help from your family, friends, nurses, and doctors—it is difficult to stop on your own.

People recovering from SCLC are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Recovering patients, even those using oxygen, are encouraged to walk for 15 to 30 minutes each day to improve their heart and lung function. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical 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 and productive as possible.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide. 

Lung Cancer - Small Cell - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 07/2019

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, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. 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?

  • Should I see other doctors to assist in my care, such as a radiation oncologist, medical oncologist, and/or pulmonologist? What is the role of each doctor?

  • Who will be leading my overall treatment?

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

  • What treatment plan do you recommend? Why?

  • Do I need additional scans or biopsies in order to plan my treatment?

  • 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?

  • In addition to treating my cancer, what can be done to treat my symptoms?

  • 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?

  • If I’m participating in a clinical trial, what are the costs I need to pay? What is covered by my health insurance?

  • 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 are the names of the drugs, and how will they be given?

  • What are the possible side effects of each medication? What side effects or problems should I watch for?

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

  • What can be done to lessen these side effects?

  • How often will I need to visit the doctor to receive treatment, and how long will each visit take?

  • 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 radiation therapy

  • How will my treatment be planned? What types of scans will be used?

  • 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?

  • Is it possible for me to receive chemotherapy with my 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?

Questions to ask about clinical trials

  • What are my options for standard treatment?

  • What other treatments through clinical trials are available to me?

  • How will my experience differ if I enroll in this clinical trial, as opposed to standard treatment? For example, are there different risks, extra tests, a different time commitment, schedule, or costs?

  • 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 I need them?

  • 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 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 some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide. 

Lung Cancer - Small Cell - Additional Resources

Approved by the Cancer.Net Editorial Board, 07/2019

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Small Cell Lung Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net: 

This is the end of Cancer.Net’s Guide to Small Cell Lung Cancer. Use the menu to choose a different section to read in this guide.