Surgery for Small Cell Lung Cancer

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Surgery is not a common treatment for small cell lung cancer (SCLC), but there are times when it may be an option. For example, surgery can be a consideration if you have limited-stage SCLC.

If you are thinking about your treatment options for SCLC, you may want to discuss the pros and cons of lung cancer surgery with your doctor.

female doctor looking at an x-ray of lungs with COPD checking for lung cancer

AtnoYdur / iStock Photo

Surgery Recommendations for SCLC

SCLC grows and spreads quickly. In fact, in 60 to 70% of cases, SCLC has already metastasized (spread) beyond the lungs to other areas of the body by the time it is diagnosed. This is why surgery is not usually an effective cure for SCLC.

The more common type of lung cancer, non-small cell lung cancer (NSCLC), progresses more slowly than SCLC and is more likely to be cured with surgery if it's diagnosed in the early stages.

When Surgery Isn't Recommended

SCLC accounts for around 10 to 15% of lung cancers and includes two defined stages: limited stage and extensive stage.

Extensive-stage SCLC has spread beyond the primary tumor site to the other lung, the surrounding lymph nodes, and/or in other parts of the body. At the extensive stage, the tumors are too large and widespread for surgery to be an effective treatment. It's usually not possible for operations on multiple sites to successfully remove all of the cancer cells in a way that prolongs survival.

The most common sites of lung cancer metastasis include:

The first line of treatment for inoperable lung cancer usually combines chemotherapy and immunotherapy, which has been shown to extend life. Radiation therapy may also be used alone or in combination with chemotherapy.

When Surgery May Be Effective

In some instances— fewer than 1 out of 20 patients—SCLC is found when there is one main tumor that hasn't spread to distant lymph nodes or other organs. Although surgery is viewed as a controversial treatment option for SCLC, this may be early enough for surgery to be considered.

Surgery might be the best treatment option if your limited-stage SCLC meets these criteria:

  • One tumor is present in only one lung
  • Cancer is not present in lymph nodes or, if it is, it has spread only to lymph nodes near the primary tumor

Also, with limited-stage SCLC, surgery is more likely to be an option if the cancer is in the outer parts of the lungs.

Types of Surgery

There are several different surgeries that are done for SCLC. The choice often depends on the location and size of the tumor. If you and your doctor decide that surgery is a good option for you, you will discuss which type of procedure is the best choice for removing your cancer, preventing it from recurring, and optimizing your recovery.

Surgeries that are considered in the treatment of SCLC include:

  • Pneumonectomy: A pneumonectomy is the removal of an entire lung. If you have good lung function with the remaining lung, you can live a full, active life after this surgery by making some lifestyle adjustments.
  • Lobectomy: A lobectomy is the removal of one of the five lobes that make up your lungs. In studies comparing the different types of non-pneumonectomy surgeries for SCLC, a lobectomy shows the best outcome, with better survival rates.
  • Segmentectomy: The lobes of the lung are each divided into segments. During this surgery, the cancer is removed by resection of one or more of these segments.
  • Wedge resection: A wedge resection is a removal of the tumor plus a wedge-shaped area of surrounding tissue. The procedure is usually limited to small tumors (less than 2 centimeters) located on the outer parts of the lungs. A wedge resection spares more of your lung than a lobectomy or segmentectomy, but your prognosis may not be as favorable with wedge resection.
  • Sleeve resection: A sleeve resection is sometimes done as an alternative to a pneumonectomy if tumors surround the airways. Research has shown that this procedure offers outcomes similar to a lobectomy for treating SCLC.

Traditionally, lung surgery used to require a large chest incision and manipulation of the ribs for tumor access. Video-assisted thoracoscopic surgery (VATS), a less invasive option that is becoming more common, involves a few small incisions in the chest, and may result in fewer complications. During VATS, small camera-equipped instruments are used to remove the malignant tissue.

Prior to Surgery

Your pre-surgical evaluation will include tests to determine whether your cancer is still localized and whether you could be at risk of serious surgical complications.

Pre-operative testing includes:

  • Mediastinoscopy. During this minor procedure, camera scopes are inserted into the chest area between the lungs. Your doctor will check for evidence of cancer in the lymph nodes in this region (N2 lymph nodes). A tissue sample may be taken for analysis.
  • Sometimes PET/CT scans, which are non-invasive imaging tests, can be used to identify metastasis in the chest or elsewhere.
  • Pulmonary function tests will assess your lung function to determine whether you are likely to maintain adequate lung function after surgery.

Your doctor will need to review all medications you are taking (including supplements and vitamins). You might need to stop taking some of your medicines for a period of time prior to surgery.

Smoking Cessation

If you smoke, it's important to quit. Continuing to smoke can lead to surgical complications and reduce your body's ability to heal well; overall, it decreases your chances for a successful outcome from surgery.

There are many other benefits to stopping smoking—including improving your survival and lowering the risk that cancer will recur.

After Surgery

While the aim of surgery is to remove all cancerous cells, it's possible that your cancer could have spread beyond the tumors that your doctor was able to detect with your pre-operative testing. As a precaution, your doctor will recommend additional treatments, such as chemotherapy, immunotherapy, and/or radiation therapy to ensure that all cancer cells are eliminated. This should reduce your risk of cancer recurrence.

Chemotherapy, along with chest and cranial radiation therapy has been shown to extend patients' lives when added as adjunctive treatment with surgery. Prophylactic cranial irradiation (PCI), a type of radiation designed to help prevent the spread of cancer to the brain or skull, may lower the risk of brain metastases.

The risk of brain metastases occurring three years after surgery is estimated to be between 9.7 and 35.4% for limited-stage small cell lung cancer, depending on how advanced the cancer is at the time of diagnosis.

Some patients find that postoperative pulmonary rehabilitation improves lung function and enhances their quality of life.

Prognosis

Studies suggest that for people with early-stage (limited stage) SCLC (also designated as T1 or T2), surgery improves survival rate. 

Despite documented positive outcomes, some research suggests that surgery is not more effective than radiation therapy for the treatment of limited-stage SCLC.

It's important that you sit down with your doctors and loved ones to discuss your prognosis, anticipated outcomes, and what you hope to gain from treatment before deciding which options are best for you.

A Word From Verywell

It's important to keep in mind that everyone is different. Some limited-stage SCLCs may not be treatable with surgery due to factors like the location of the tumor. If you have other medical conditions, like severe heart disease, the risk of surgery could outweigh the potential benefits.

When deciding whether surgery is the best course for you, you may want to consider getting a second opinion. You can reach out to larger cancer treatment centers for a consultation or you can even ask your doctor to suggest a place where you could get a second opinion.

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