From the Guidelines
Small cell carcinoma (SCC) is a highly aggressive and poorly differentiated neuroendocrine carcinoma that primarily affects the lungs, accounting for approximately 15% of all lung cancers, with a strong association with smoking, as noted in the most recent guideline by 1.
Definition and Characteristics
- Small cell carcinoma is characterized by small, round cells that multiply rapidly and spread early to other parts of the body, as described in 1.
- It is usually staged using the Veterans Administration Lung Study Group staging system, which defines limited-stage (LS-SCLC) as disease confined to one hemithorax within a tolerable radiation field, and extensive-stage (ES-SCLC) as disease extending beyond LS-SCLC, including malignant pleural effusion, contralateral lung involvement, and hematogenous metastases, as outlined in 1.
- Symptoms typically include persistent cough, chest pain, shortness of breath, coughing up blood, and systemic symptoms like weight loss and fatigue.
Diagnosis and Treatment
- Diagnosis is usually made through imaging tests (CT scans), followed by biopsy procedures to confirm the diagnosis, as mentioned in 1.
- Treatment generally involves a combination of chemotherapy (commonly etoposide with cisplatin or carboplatin) and radiation therapy, as surgery is rarely an option due to how quickly this cancer spreads, as noted in 1.
- For limited-stage disease confined to one side of the chest, concurrent chemoradiation is the standard approach, while extensive-stage disease requires systemic chemotherapy, with immunotherapy now often added, as recommended in 1.
Prognosis and Outcomes
- Despite initial responsiveness to treatment, small cell carcinoma frequently recurs, and the overall prognosis remains poor, with five-year survival rates of up to 34% for limited-stage disease and less than 5% for extensive-stage disease, as reported in 1.
- Early detection and prompt treatment are crucial for improving outcomes, and smoking cessation is strongly recommended to decrease the risk of developing lung cancer and to improve the outcomes of people already diagnosed with lung cancer, as emphasized in 1.
From the Research
Definition and Characteristics of Small Cell Carcinoma (SCC)
- Small cell lung cancer (SCLC) is an aggressive malignancy characterized by rapid proliferation, early dissemination, acquired therapy resistance, and poor prognosis 2.
- SCLC has high metastatic potential, resulting in a clinically poor prognosis 3.
- It is an aggressive disease with distinct pathological, clinical, and molecular characteristics from non-small-cell lung cancer 3.
Diagnosis and Treatment Options
- Early diagnosis of SCLC is crucial since most patients present with advanced/metastatic disease, limiting the potential for curative treatment 2.
- Early concurrent chemo-radiation is the standard of care for limited-stage SCLC (LS-SCLC) 3.
- A combination of etoposide and cisplatin or carboplatin remains the mainstay of first-line treatment for extensive-stage SCLC (ES-SCLC) 3, 4.
- Topotecan and amrubicin (in Japan) remain the primary chemotherapy options for relapsed SCLC 3.
- Immunotherapy, including nivolumab with or without ipilimumab, is now available for refractory disease 3.