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Clinical Description
Lung cancer is the leading cause of cancer death for both men and women in the United States. There will be approximately 220,500 new cases of lung cancer this year and 150,000 deaths from the disease.
There are several types of lung cancer, with two major categories, small cell and non-small cell. Small cell lung cancer makes up 10-15% of all lung cancer. Small cell lung cancer tends to be more aggressive in its clinical picture than non-small cell. For that reason these two types of lung cancers are treated differently.
Symptoms of Small Cell Lung Cancer
· Cough—this symptom can be new or there can be a change in the nature of a chronic cough. Coughing up blood (hemoptysis) can also be a symptom of lung cancer.
· Shortness of breath
· Wheezing
· Chest pain
· Hoarseness
· Weight loss, decreased appetite
· Fatigue or generalized weakness
· Headache associated with swelling of the face, arms or neck
· Arm, shoulder and neck pain can be caused by lung cancer if the tumor is located at the top of the lungs. This can cause weakness in the muscles of the hand, a droopy eyelid and blurred vision.
Risk Factors of Small Cell Lung Cancer
Cigarette smoking is a significant risk factor for the development of lung cancer. It is linked to 85% of all lung cancers. It is very rare for small cell lung cancer to occur in non-smokers. The risk increases as the number of cigarettes and the years smoked increase. The risk of lung cancer stays elevated after quitting and begins to decline 5-10 years after stopping. A smoker’s risk is never as low as a non-smoker’s risk.
Lung cancer increases with age; it can occur in persons younger than 40 years but it is rare. Genetic predispositions for lung cancer do exist. Having a first-degree relative with lung cancer will increase an individual’s risk of developing lung cancer.
Environmental factors have been associated with lung cancer. These include tobacco smoke, arsenic, asbestos, radiation and dust or fumes from metals including nickel and chromium. Radon is an important risk factor that can be found in the home. It is odorless and tasteless, so home testing is important. Diesel exhaust and more globally air pollution both result in an increased risk for development of lung cancer.
A history of previous radiation to the chest also results in an increased risk of lung cancer development.
How Small Cell Lung Cancer is Diagnosed
If an individual has symptoms that suggest lung cancer, the care provider will complete a thorough history and physical and obtain a chest x-ray. If the chest x-ray is abnormal then often a computed tomography (CT) scan is obtained. If the CT scan reveals a suspicious mass then tissue will be needed to confirm the diagnosis. Tissue can be obtained in a variety of ways including, bronchoscopy, CT guided biopsy or even surgery.
There are a variety of other imaging studies that might be used to further evaluate the primary lesion and to look for distant spread. Some of these modalities include magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and bone scan.
Treatment Options for Small Cell Lung Cancer at Tufts Medical Center
Treatment of small cell lung cancer depends on the stage of the disease. Small cell lung cancer is divided into two main stages, limited stage and extensive stage. Limited refers to disease that is confined to one side of the chest and extensive refers to disease on both sides of the chest or disease that has spread outside of the chest.
Options for treatment of limited stage small cell lung cancer include surgery, radiation, chemotherapy and newer more specifically targeted agents. Surgery is rarely used in the treatment of small cell lung cancer. Typically, at diagnosis small cell lung cancer has already spread to lymph nodes. Once the cancer has spread to lymph nodes, surgery is not usually helpful. Chemotherapy and radiation are often used in combination either at the same time or sequentially. The rate of response to treatment is quite high in small cell; however, there is also a high risk of recurrence. Your doctor will explain the different treatment options available.
Patients with extensive stage disease may be offered palliative systemic treatment with chemotherapy and targeted agents. A short course of focused radiation can often help alleviate symptoms such as pain, shortness of breath or swelling caused by the cancer. All of our patients are provided with supportive care for effective pain management, maintenance of good nutrition, and emotional support.
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