Small Cell Lung Cancer Treatment Options

1. Chemotherapy

Chemotherapy is often the primary treatment for small cell lung cancer. SCLC tends to spread throughout the body rather quickly, which means it is usually spread past the lungs by the time it is discovered. Chemo is given because it reaches cancer cells throughout the body. 

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the lung cancer being treated.

For people with limited-stage small cell lung cancer, chemotherapy is usually given with radiation in a treatment called chemoradiation. However, for people with extensive-stage small cell lung cancer, chemotherapy with or without immunotherapy may be given.

2. Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. 

There are two types of radiation therapy: 

1. External radiation therapy uses a machine outside the body to send radiation toward cancer. 
2. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. 

The way the radiation therapy is given depends on the type and stage of the lung cancer being treated. 

A more recent approach to delivering radiotherapy is called hypofractionated radiation therapy, where the same overall dose of radiation is given in a shorter time period. Instead of getting radiation therapy for 6-8 weeks, the same results can be achieved in 4-5 weeks by giving a higher dose of radiation at each treatment. The shorter radiation treatments are made possible through advanced technology that precisely aims radiation, allowing the cancerous cells to be treated with a higher dose while sparing nearby organs and tissues. The final number of treatments depends on the specific cancer diagnosis. 

Radiation therapy may be used for small-cell lung cancer in the following ways: 

• To treat tumors or lymph nodes in the chest, and may be given at the same time as chemotherapy.
• Following a chemotherapy treatment. Sometimes chemotherapy and radiation are given to patients with advanced small cell lung cancer, but they can also be given to patients with limited-stage cancer who can’t tolerate having radiation and chemotherapy treatments at the same time.
• To reduce the chances of cancer spreading to the brain. This treatment is called prophylactic cranial irradiation and is usually used in limited-stage small-cell lung cancer. 
• To shrink tumors in order to relieve some of the symptoms associated with them, such as pain, bleeding, or shortness of breath. 

3. Surgery and Surgical Resection for Lung Cancer

Surgery may be used if the cancer is found in one lung and in nearby lymph nodes only. Because this type of lung cancer is usually found in both lungs, surgery alone is not often used to treat SCLC.

If your doctor believes you may be a good candidate for surgery, then the following will take place:

• A pulmonary test will be given to ensure that you would be left with enough functioning lung tissue following the surgery
• Your heart and other vital organs will be tested to make sure that they are healthy enough for you to have surgery
• Your doctor will check to see if cancer has spread to the lymph nodes located between your lungs

Even if the doctor removes all cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery to lower the risk that your lung cancer will come back is called adjuvant therapy.

4. Immunotherapy 

Immunotherapy is essentially a cancer treatment that uses your own immune system to help fight cancer. Substances produced by your body or made in a laboratory are used to jumpstart your body’s natural defense against disease. 

Lung cancer immunotherapy belongs to a class called checkpoint inhibitors. These “checkpoints” — proteins on immune cells that need to be turned on (or off) to start an immune response — are what the immune system uses to keep itself from attacking your normal cells. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. However, drugs that target these checkpoints can be used in the treatment plan for people with advanced small-cell lung cancer, and this is called immune checkpoint inhibitor therapy. 

The following types of immunotherapy may be used for SCLC:

• Nivolumab (Opdivo)
• Atezolizumab (Tecentriq)
• Ipilimumab (Yervoy)

5. Endoscopic Stent Placement

An endoscope is a thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may be used to place a stent in a body structure to keep the structure open. Endoscopic stent placement can be used to open an airway blocked by abnormal tissue.

6. Laser Therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells. It is often used alongside other forms of small-cell lung cancer treatment. It is sometimes used when a tumor is blocking off the airway and making it difficult for you to breathe properly.