What Is Limited-Stage Small Cell Lung Cancer?

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Limited-stage small cell lung cancer (SCLC) is the early stage of the disease in which the cancer is in one lung and possibly the lymph nodes on the same side of the chest. This is one of only two stages of SCLC, the other being the extensive stage (indicating further spread). Symptoms of limited-stage small cell lung cancer can include coughing, hemoptysis (coughing blood), shortness of breath, and more.

A biopsy can confirm the type and stag of lung cancer. Because it's usually aggressive, limited-stage SCLC is treated with chemotherapy and radiation without delay.

Staging

Staging for SCLC is used to direct management. It also provides insight into the prognosis of the disease.

All of the following criteria must be met for SCLC to be classified as limited-stage:

  • The cancer must be is present in only one lung.
  • It may have grown within the tissue directly adjacent to the lungs.
  • It may have invaded nearby lymph nodes.
  • It must be confined to a small enough area that radiation therapy can be applied with a single radiation field.

If SCLC is found to have metastasized (spread) to the other lung or to distant regions of the body, it will be defined as extensive stage.

Roughly 30% to 40% of those with small cell lung cancer are diagnosed when their tumors are considered limited-stage, whereas 60% to 70% are designated as having extensive-stage SCLC at the time of diagnosis.

Sometimes SCLC is also classified according to the TNM staging criteria, which is the system used to stage non-small cell lung cancer (NSCLC), the more common type of lung cancer. Using this system, T represents the size of the tumor, N indicates the extent of lymph node involvement, and M describes the degree of metastasis, with each of these factors given a numerical value between 0 and 4.

Limited-Stage Symptoms

At this early stage, SCLC might not cause any symptoms. However, because it starts in the bronchi (airways), it can cause breathing problems even if it hasn't spread beyond one area of the lung.

If limited-stage SCLC enlarges within one lung, respiratory effects can be more prominent. And lymph node involvement can cause additional symptoms.

Symptoms of limited-stage SCLC can include:

  • Persistent cough
  • Coughing up blood (hemoptysis)
  • Shortness of breath
  • Chest pain or soreness
  • Pain with breathing
  • Recurrent respiratory infections such as pneumonia or bronchitis
  • Hoarse voice
  • Clubbing: An oxygen deprivation-induced deformity of the fingers in which the ends of the fingers takes on the appearance of a flipped-over teaspoon
  • Enlargement or tenderness of the arm due to lymph node involvement
  • Wheezing
  • Swelling in the face and/or neck due to vein obstruction

The specific effects caused by your limited-stage SCLC cancer depend on the exact position and size of the tumor in your lung and, if applicable, your lymph nodes.

Paraneoplastic Symptoms

Sometimes SCLC can also produce paraneoplastic syndromes, which may be the earliest noticeable effects of the tumor. These syndromes occur when the cancer cells produce antibodies (a type of immune protein) or hormones that overstimulate distant cells in the body such as in the brain.

Paraneoplastic effects associated with SCLC include:

  • Muscle weakness in the upper limbs, vision changes, and difficulty swallowing due to Lambert-Eaton myasthenic syndrome
  • Weakness, fatigue, and a low sodium level in the blood with the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  • A round, full face and weight gain, increased thirst, excessive hair growth, and weakness associated with Cushing's syndrome
  • Loss of coordination and difficulty speaking resulting from paraneoplastic cerebellar degeneration

Causes

Generally, SCLC is caused by smoking, exposure to radon or asbestos, or secondhand exposure to cigarette smoke. These substances contain toxins that may harm your lungs. This type of lung damage can lead to cancer-inducing mutations, or changes, in the DNA (genes) of your lung cells.

Diagnosis

Limited-stage SCLC may appear on an imaging study such as a chest X-ray, chest computerized tomography (CT) scan, or a lymph node CT scan. You might have these tests as part of routine lung cancer screening or for an unrelated reason (like a pre-surgical evaluation).

You may also have imaging done in response to your symptoms. When SCLC produces paraneoplastic effects and lung inflammation, it can produce more noticeable effects. This can prompt people to seek medical attention sooner, leading to earlier diagnostic testing that identifies cancer while it's still in the limited stage.

Lung Cancer Screening

Lung cancer may be diagnosed with a yearly screening CT scan.

You meet the criteria for screening if you have all of the following apply:

  • You are a current smoker or smoked within the past 15 years
  • You are between 55 and 74 years old
  • You have at least a 30 pack-year smoking history

Screening is only considered appropriate if you would agree to have treatment if diagnosed and if your health is good enough that you could tolerate it.

Biopsy

Often, a lung biopsy or a lymph node biopsy is needed to get a definitive diagnosis of the type of cancer. Your lesion would be sampled with a fine needle aspiration, a bronchoscopy procedure, or an open surgery.

Your biopsy sample would then be examined under a microscope.

What Is Oat-Cell Lung Cancer?

Small cells in lung cancer have an appearance that's often described as an "oat cell," which is distinctive from that of non-small cells in lung cancer. Small-cell lung cancer, therefore, is sometimes referred to as oat-cell lung cancer.

Staging Process

If your cancer is identified, further tests may be needed to verify the staging. For example, brain magnetic resonance imaging (MRI), ultrasound of the liver, or positron emission tomography (PET) of the adrenal glands can help your doctors determine whether or not you have metastasis.

Your condition might be defined as limited-stage at the time of your diagnosis if you haven't had lung cancer long enough for it to spread.

If metastases are found, however, it would mean that you have extensive-stage SCLC rather than limited-stage SCLC, which changes the treatment plan.

Interestingly, when the SCLC begins peripherally (further out in the lungs), it may not grow or metastasize as quickly as SCLC that is located centrally in the lungs (which is more common). It isn't clear why this pattern occurs, but it can lead to a better outcome.

Treatment

Since SCLC tends to grow rapidly, it's usually recommended that treatment is started as soon as possible after diagnosis. And with the better outcomes of limited-stage SCLC, there is a greater anticipated benefit of prompt treatment if it is started at this stage.

Generally, SCLC is treated with a combination of chemotherapy and radiation therapy. Surgery is not expected to cure SCLC, but it can offer symptom relief.

Chemotherapy and Immunotherapy

Chemotherapy is used to destroy cancer cells and prevent the growth and spread of cancer. Chemotherapy for SCLC usually includes a combination of a platinum drug, such as cisplatin or carboplatin, and an alkaloid drug, such as etoposide or irinotecan delivered in a series of four to six cycles. These different chemotherapeutics destroy cancer cells using different mechanisms that complement one another.

Depending on the specific medication used, a cycle may include one or more infusions, with each infusion lasting between a few minutes to several hours. A chemotherapy cycle may take three or four weeks.

Immunotherapy is a type of treatment that uses the body's immune system to fight diseases, including cancer. Specifically, a group of drugs described as immune checkpoint inhibitors, which prompt your immune system to fight cancer cells, are used for treating SCLC.

Immunotherapy treatments used in SCLC include:

  • The CTLA-4 inhibitor Yervoy (ipilimumab)
  • The PD-1 inhibitors Opdivo (nivolumab) and Keytruda (pembrolizumab)

These medications may be used along with chemotherapy or for the treatment of recurrent SCLC that has already been treated with chemotherapy and radiation. They are also being investigated as possible first-line agents in the treatment of SCLC.

Radiation Therapy

Radiation is used to shrink the tumor and small cancer cells that can't be seen with imaging tests. Limited-stage SCLC is encompassed within a standard radiation field.

Generally, radiation to the lungs and nearby lymph nodes is scheduled in the same weeks as chemotherapy and immunotherapy.

Prophylactic Cranial Irradiation

If you experience a complete or partial response to chemotherapy and radiation, you might be a candidate for prophylactic cranial irradiation (PCI). This radiation therapy to the brain is sometimes recommended to reduce the risk that undetectable cancer cells in the brain would grow and cause symptoms.

While PCI improves survival, it can have cognitive complications such as memory loss. Consider this option carefully and discuss the pros and cons with your doctor, as well as loved ones who would take care of you if you experience these side effects.

Surgery

Surgery is rarely used as a treatment for SCLC because the condition is usually considered inoperable. This type of cancer is considered highly aggressive and can recur after treatment—even in the limited stage.

Even surgery for removal of lesions in the lung and lymph nodes might not be curative if there are microscopic metastases elsewhere in the body that can't be detected with imaging tests.

For SCLC, surgery is typically considered for symptomatic relief only. If the tumor is obstructing an airway, it might be resected to help you breathe, for example. Surgery could also reduce neck or face swelling due to superior vena cava syndrome.

That said, surgery is occasionally considered if a tumor is present in only one lung and nearby lymph nodes. Adjuvant chemotherapy (chemotherapy after surgery) is usually recommended to decrease the risk of cancer recurrence.

Clinical Trials

Clinical trials are in progress for both stages of SCLC, evaluating new therapies and treatment combinations for this aggressive cancer. The National Cancer Institute (NCI) recommends that anyone with small cell lung cancer consider participating in a clinical trial.

You can find NCI-supported clinical trials by using their searchable online database.

Prognosis

The survival of limited-stage SCLC is better than the overall survival of SCLC. With optimal treatment, one study showed a 1-year survival rate of approximately 78.9%, a 2-year survival rate of 58.6%, and a 5-year survival rate of 27.6%.

This is similar to another study in which those with limited-stage SCLC who received standard of care treatment with chemotherapy and radiation had a 5-year survival rate of 30% to 35%.

In contrast, the overall 5-year survival of SCLC (all stages combined) is about 6.5%.

A Word From Verywell

Living with SCLC can be challenging. This type of cancer can't improve without treatment, but you can have a good outcome. Be sure to ask your medical team all of your questions and to seek treatment for your symptoms. Consider learning about clinical trials that might be a good fit for you. Connecting with a support group or leaning on your loved ones may help you on your journey with cancer, both emotionally and physically.

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  1. American Cancer Society. If You Have Small Cell Lung Cancer. Updated October 1, 2019.

  2. National Cancer Institute. Small cell lung cancer treatment patient version. Updated May 21, 2020.

  3. Zhong L, Suo J, Wang Y, et al. Prognosis of limited-stage small cell lung cancer with comprehensive treatment including radical resection. World J Surg Oncol. 2020;18(1):27.doi:10.1186/s12957-020-1807-1

  4. American Cancer Society. Small cell lung cancer stages. Updated October 1, 2019.

  5. Dora D, Rivard C, Yu H, et al. Neuroendocrine subtypes of small cell lung cancer differ in terms of immune microenvironment and checkpoint molecule distribution [published online ahead of print, 2020 Jun 7]Mol Oncol. 2020;10.1002/1878-0261.12741. doi:10.1002/1878-0261.12741

  6. Pavan A, Attili I, Pasello G, Guarneri V, Conte PF, Bonanno L. Immunotherapy in small-cell lung cancer: from molecular promises to clinical challenges. J Immunother Cancer. 2019;7(1):205.doi:10.1186/s40425-019-0690-1

  7. American Cancer Society. Can lung cancer be found early? Updated October 1, 2019.

  8. Kanaji N, Sakai K, Ueda Y, et al. Peripheral-type small cell lung cancer is associated with better survival and higher frequency of interstitial lung diseaseLung Cancer. 2017;108:126-133. doi:10.1016/j.lungcan.2017.03.013

  9. American Cancer Society. Chemotherapy for small cell lung cancer. Updated October 1, 2019.

  10. Basumallik N, Agarwal M. Cancer, Lung Small Cell (Oat Cell) [Updated 2019 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482458/

  11. Higgins KA, Gorgens S, Sudmeier LJ, Faivre-Finn C. Recent developments in limited stage small cell lung cancer. Translational Lung Cancer Research. 2019. 8(Suppl 2):S147-S152. doi:10.21037/tlcr.2019.05.13