Unique Treatment Approaches for Early-Stage and Locally Advanced Lung Cancers

By Jennifer Welsh 

 Medically reviewed by Doru Paul, MD

Being diagnosed with small cell lung cancer can be a shock, especially since this disease tends to develop quickly. In fact, symptoms tend to appear just a few months before diagnosis for many patients. In the whirlwind of a cancer diagnosis and staging process, you may be wondering about treatment options for limited-stage small cell lung cancers. 

Small cell lung cancer (SCLC) is the growth of abnormal cells in the lungs that have the potential to spread to other parts of the body. Growths in the lungs can disrupt your breathing and make it difficult for your lungs and other organs in the chest to function properly. 

Courtney Hale / Getty Images

About 13% of lung cancers diagnosed each year are small cell lung cancers. The American Cancer Society had estimated around 230,000 new cases and 130,000 deaths in the United States in 2022.1 It’s most often caused by tobacco exposure, with 98% of cases linked to smoking.

Small cell lung cancers have a bad reputation. In this case, it’s earned. These cancers grow quickly, spread easily, and are often deadly. SCLC has worse outcomes than non-small cell lung cancers. 

This article will review limited-stage small cell lung cancer and how it can be treated.

What Is Limited Stage SCLC?

Small cell lung cancers are classified as limited-stage if they’re discovered before spreading to other organs. Limited-stage SCLCs are typically large masses in the middle of the lungs. Depending on how long they’ve been growing, they may have spread to the local lymph nodes in the chest. 

Doctors categorize cancers into stages to help compare treatment options and outcomes for people with varying characteristics. Lung cancers are grouped into “limited” or “extensive” stages using an alternative staging system called the Veterans Administration Lung Study Group.

Other cancers use a TNM (tumor, node, metastasis) system for staging. Cancer is ranked from stages 1 to 4, depending on where the cancer is located, how large it is, and how far it has spread.

Limited-stage SCLC includes every stage in which the cancer has not spread (stages 1 through 3). Extensive stage small cell lung cancer would include patients diagnosed with stage 4, also known as metastatic SCLC.

Limited stage small cell lung cancer involves only on one side of the chest and can be treated with a single radiation field. This generally includes cancers that are only in one lung (unless tumors are widespread throughout the lung) and that might also have reached the lymph nodes on the same side of the chest.

Extensive stage small cell lung cancer refers to cancer that have spread widely throughout the lung, to the other lung, to lymph nodes on the other side of the chest, or to other parts of the body (including the bone marrow).

Limited-stage SCLCs make up about one-third of the cases of small cell lung cancer.2 Most SCLC has already spread beyond the lungs and lymph nodes when they’re discovered.

People with SCLCs typically show up to their healthcare provider with respiratory symptoms, like a cough, labored breathing, and coughing up blood. Your oncologist comes to a small cell lung cancer diagnosis and staging by:

• Conducting a thorough personal history

• Performing a physical exam using their hands

• Ordering imaging tests to see how large the tumor is and how far it has spread

• Analyzing samples taken during surgery or a biopsy (sampling the tissue and analyzing it in the lab)

From this information, the healthcare provider assigns cancer a stage. The stage helps them decide on treatment options. 

Limited Stage SCLC Treatment Options

Treatment options for limited-stage small cell lung cancer include surgery, radiation, and chemotherapy. The goal of treatment is to control cancer symptoms and stop cancer from spreading.

Surgery physically removes cancer from the body. Chemotherapy is a medication that kills fast-growing cells, including cancer cells and other cell types in the body. Radiation treatments use high-energy waves to break up cancer cells.

Chemotherapy Side Effects

Chemotherapy side effects include fatigue, anemia (a low number of healthy red blood cells), neutropenia (a low number of infection-fighting white blood cells), nausea, vomiting, loss of appetite, mouth sores, taste changes, hair loss, and skin and fingernail changes.3

Early-stage (stage 1) small cell lung cancers are relatively rare. But when an SCLC is discovered this early, it’s possible to remove the tumor with surgery. Surgery will also remove nearby lymph nodes and test them for cancer.4

After surgery, doctors will often treat small cell lung cancers with radiation and chemotherapy as adjuvant therapies (additional therapies) to stop cancer from spreading and reduce the likelihood of returning. For limited-stage primary cancers, chemotherapy for small cell lung cancer is typically cisplatin–etoposide.

Locally advanced small cell lung cancers are also treated with chemotherapy and radiation, but generally, surgery isn’t an option for these tumors. Doctors will opt to give chemotherapy and twice-daily radiation simultaneously if the patient is healthy enough. 

Concurrent Chemoradiation

Getting radiation and chemotherapy treatments at the same time—called concurrent chemoradiation—is tough on the body. These treatments typically result in more side effects, but the combination is also more effective.4

During radiation treatments, a machine will send high-energy beams into the area of the body with cancer. The goal of radiation therapy is to shrink the tumors to reduce symptoms and improve quality of life. 

Radiation Side Effects

Radiation side effects include fatigue, skin changes, and hair loss at the site of radiation. Radiation can also lead to lung damage and inflammation or scarring of the lungs.5

People whose limited-stage SCLC responds to these treatments may also be offered prophylactic cranial irradiation (PCI) treatment. PCI is radiation treatment of the head, explicitly aimed at preventing the spread of cancer to the brain.

About half of people with small cell lung cancers eventually have tumors spread to the brain.4 PCI significantly reduces the risk of brain metastases and improves survival but may cause side effects.

PCI Side Effects

Neurotoxicity (damage to nerve cells) associated with PCI might cause dementia (decline in memory and thinking ability) and loss of coordination in walking, though some of these may also be the result of cancer itself or other treatments.6

What to Expect During Treatment

Oncologists (doctors who diagnose and treat cancer) will start your treatment for limited-stage small cell lung cancer as soon as possible after your diagnosis. 

During your treatment for SCLC, you will be actively encouraged to stop smoking if you have not quit tobacco. Stopping smoking will decrease complications from treatment and help slow cancer’s spread. It will also help you heal after surgery and reduce the likelihood of infection by strengthening your immune system.

Chemotherapy and radiation will make you feel wiped out. Your ability to fight off infections will decrease, and you’ll feel tired and likely sick to your stomach. Your hair probably will fall out, and you’ll experience gastrointestinal symptoms like nausea, digestive issues, and sores in your mouth. 

Treatment with chemotherapy will likely shrink your tumor, maybe even enough that your oncologist will no longer see it on imaging scans. But, small cell lung cancer is unlikely to be cured. In many people, small bits of cancer will remain, and the disease will return.4

After treatment, you’ll still visit your oncologist regularly, every two to three months. They’ll take scans of your body and blood tests to check if the cancer is coming back.

Longer-term treatment-related side effects include:

• Lung scarring: Called pulmonary fibrosis, this condition may make it hard to breathe.

• Cardiac complications: This may make your heart less effective at pumping blood.

Limited-Stage SCLC Prognosis

Even with treatment, the survival rate for limited-stage small cell lung cancer is not good. Only about half of patients with SCLCs caught in the early stage who undergo a successful surgery to remove the primary tumor are still alive five years later.7

The survival rate for those diagnosed with locally advanced small cell lung cancer is worse. About 30% of patients originally diagnosed in good health are alive five years after diagnosis.7

What If Treatment for SCLC Doesn’t Work?

Small cell lung cancers generally respond well to treatment, but 75% of these cancers come back, often spreading to other organs, leading to low survival rates.7

When treatments stop working, and cancer comes back, it typically spreads to the other lung, the brain, liver, adrenal glands, and bone. When this happens, doctors will opt to treat small cell lung cancer with the chemotherapy drugs Hycampin (topotecan) and Zepzelca (lurbinectedin).

They may also suggest trying immunotherapy drugs, which in some rare cases have led to long-term survival.

Summary 

Even in the limited stage, small cell lung cancer is a deadly disease. Limited-stage means the healthcare provider found the tumor before it spread to other parts of the body.

Doctors treat limited-stage small cell lung cancer using surgery, chemotherapy, and radiation treatments. These treatments improve survival, but many patients still die within a few years of being diagnosed with small cell lung cancer. 

8Sources

American Cancer Society. Lung cancer statistics | How common is lung cancer? 

American Cancer Society. Small cell lung cancer stages.

American Cancer Society. Chemotherapy side effects.

American Cancer Society. Treatment choices for small cell lung cancer, by stage.  

American Cancer Society. Radiation therapy side effects.

Nakahara Y, Takagi Y, Okuma Y, et al. Neurotoxicity due to prophylactic cranial irradiation for small-cell lung cancer: A retrospective analysis. Mol Clin Oncol. 2015;3(5):1048-1052. doi:10.3892/mco.2015.581

Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021;7(1):3. doi:10.1038/s41572-020-00235-0

American Society of Clinical Oncology. Understanding statistics used to guide prognosis and evaluate treatment.

Additional Reading

American Cancer Society. Small Cell Lung Cancer Guide | Understanding SCLC

National Cancer Institute. Small Cell Lung Cancer Treatment (PDQ®)–Patient Version

By Jennifer Welsh
Jennifer Welsh is a Connecticut-based science writer and editor with over ten years of experience under her belt. She’s previously worked and written for WIRED Science, The Scientist, Discover Magazine, LiveScience, and Business Insider.