Small cell lung cancer has usually spread into the bloodstream by the time it is diagnosed. However, it is sensitive to both chemotherapy and radiotherapy, which are usually administered as the first line of treatment rather than surgery.
Incidence
There are approximately 9180 cases of lung cancer diagnosed in Australia each year, 9% of all cancers and 19% of cancer deaths. Small cell lung cancer represents approximately 20% of lung cancers.
Screening
No screening test is routinely used.
Symptoms and diagnosis
Patients may present with specific symptoms related to the lung including:
- shortness of breath
- wheezing
- chest pain
- cough which can produce blood stained sputum
or general symptoms which may include:
- weight loss
- lethargy
- loss of appetite
Diagnostic options include a biopsy of the cancer during a bronchoscopy (a tube inserted into the airways) or examination of the sputum for cancer cells.
Staging
Staging is defined as either limited disease (30%), where disease is confined to one side of the chest and is small enough to be all included in a tolerable radiation field, or extensive disease which has spread to both sides of the chest or to organs beyond, usually liver, bones, adrenal glands or the brain. Scans of these organs are taken to determine the stage.
Causes
Cigarette smoking is the major cause.
Prevention
Quitting smoking is a major preventative measure.
Treatment
Limited disease is treated with combination chemotherapy (commonly cisplatin and etoposide). Radiotherapy to the chest is given with the early doses of chemotherapy. Response rates (shrinkage by at least a half) are seen in up to 90% of patients and complete response rates (no visible tumour left) in up to 75% of patients are achieved. Patients who have a complete response can be treated with radiotherapy to the brain to prevent relapse in the brain.
Prognosis
Median survival for limited disease is 18-24 months, with up to 25% of patients alive after five years.
Extensive disease is treated with chemotherapy. Median survival is 12 months, with 10% of patients surviving two years.
For further information, please contact The Cancer Council Helpline on 13 11 20 (cost of a local call within Australia).