Small cell carcinoma (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.; Varun Kumar, M.B.B.S.

Overview
Small cell carcinoma is a type of histology of carcinoma. It exists in lung cancer, prostate cancer and cervical cancer, etc. And it accounts for approximately 15% of lung cancers. Small cell carcinoma spread to other organs early and quickly. For treatment, surgery is almost never an option. Chemotherapy may be a better decision. Prognosis for almost all small cell carcinoma is poor.

What are the symptoms of Small cell carcinoma?
Other symptoms that may occur with this disease:
 * Bloody sputum (phlegm)
 * Chest pain
 * Cough
 * Loss of appetite
 * Shortness of breath
 * Weight loss
 * Wheezing


 * Facial swelling
 * Fever
 * Hoarseness or changing voice
 * Swallowing difficulty
 * Weakness

What causes Small cell carcinoma?
About 15% of all lung cancer cases are small cell lung cancer. Small cell lung cancer(SCLC) is slightly more common in men than women.

Almost all cases of SCLC are due to cigarette smoking. SCLC is rare in those who have never smoked.

SCLC is the most aggressive form of lung cancer. It usually starts in the breathing tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow very quickly and create large tumors. These tumors often spread rapidly (metastasize) to other parts of the body, including the brain, liver, and bone.

Who is at highest risk?

 * Usually seen in middle aged and elderly
 * History of smoking for many years

When to seek urgent medical care?
Call your health care provider if you have symptoms of lung cancer (particularly if you smoke).

Diagnosis
Your health care provider will perform a physical exam and ask questions about your medical history. You will be asked whether you smoke, and if so, how much and for how long you have smoked.

When listening to your chest with a stethoscope, your health care provider can sometimes hear fluid around the lungs or areas of partial lung collapse. Each of these findings could (but does not always) suggest cancer.

Small cell lung cancer has usually spread to other parts of your body by the time it is diagnosed.

Tests that may be performed include:


 * Bone scan
 * Chest x-ray
 * Complete blood count (CBC)
 * CT scan
 * Liver function tests
 * MRI
 * Positron emission tomography (PET) scan
 * Sputum test (cytology, looking for cancer cells)
 * Thoracentesis (removal of fluid from the chest cavity around the lungs)

In some cases, your health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:


 * Bronchoscopy combined with biopsy
 * CT scan-directed needle biopsy
 * Endoscopic esophageal ultrasound (EUS) with biopsy
 * Mediastinoscopy with biopsy
 * Open lung biopsy
 * Pleural biopsy

Usually, if a biopsy reveals cancer, more imaging tests are done to find out the stage of the cancer. (Stage means how big the tumor is and how far it has spread.) SCLC is classified as either:


 * Limited (cancer is only in the chest and can be treated with radiation therapy)
 * Extensive (cancer has spread outside the chest)

The majority of cases are extensive.

Treatment options
Because SCLC spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Usually, the chemotherapy drug etoposide is combined with either cisplatin or carboplatin.

Combination chemotherapy and radiation treatment is given to people with extensive SCLC. However, the treatment only helps relieve symptoms. It does not cure the disease.

Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells. Radiation therapy can be used with chemotherapy if surgery is not possible. Radiation may be used to:

Treat the cancer, along with chemotherapy if surgery is not possible Help relieve symptoms caused by the cancer such as breathing problems and swelling. Help relieve cancer pain when the cancer has spread to the bones Often, SCLC may have already spread to the brain, even when there are no symptoms or other signs of cancer in the brain. As a result, radiation therapy to the brain may be given to some patients with smaller cancers, or to those who had a good response in the first round of chemotherapy. This method is called prophylactic cranial irradiation (PCI).

Very few patients with SCLC are helped by having surgery because the disease has often spread by the time of diagnosis. Surgery may be done when there is only one tumor that has not spread. If surgery is done, chemotherapy or radiation therapy will still be needed.

Where to find medical care for Small cell carcinoma?
Directions to Hospitals Treating small cell carcinoma

What to expect (Outlook/Prognosis)?
How well you do depends on how much the lung cancer has spread. This type of cancer is very deadly. Only about 6% of people with this type of cancer are still alive 5 years after diagnosis.

Treatment can often prolong life for 6 - 12 months, even when the cancer has spread.

Possible complications

 * Cancer spreads to other parts of the body
 * Side effects of surgery, chemotherapy, or radiation therapy