Treatment For Small Cell Lung Cancer

What is small cell lung cancer?

Cancer is a broad term that encompasses a variety of illnesses. Cancer comes in a variety of forms. Cancer, on the other hand, begins when a collection of cells in the body develops out of control. Cancer cells continue to develop and might drown out healthy ones. This makes it difficult for the body to function properly. Cancer can begin in any part of the body. It can begin in the breast, lungs, colon, or even the bloodstream. Lung cancer is a type of cancer that begins in the lungs. Cancerous cells have the potential to spread to other regions of the body. Cancer cells in the lungs, for example, can move to the bone and thrive there. The term "metastasis" refers to the spread of cancer cells.

Small cell lung cancer is a disorder in which malignant (cancer) cells develop in lung tissues. Small cell lung cancer is divided into two categories.

These two categories of cells contain a wide range of cell types. Each type of cancer cell grows and spreads in a unique way. The many varieties of small cell lung cancer are called after the different types of cells seen in the tumour and how they appear under a microscope:

1. Small cell carcinoma
2. Combined small cell carcinoma

Causes and stages of small cell lung cancer

A risk factor is something that enhances your chances of contracting a disease. Having a risk factor does not guarantee that you will develop cancer; similarly, not having a risk factor does not guarantee that you will remain cancer-free. If you suspect you might be at risk for lung cancer, talk to your doctor. 

The following are some of the risk factors for lung cancer: 

• Whether it's currently or in the past, you've smoked cigarettes, pipes, or cigars. This is the most significant lung cancer risk factor. The sooner a person begins smoking, the more frequently they smoke, and the longer they smoke, the greater their risk of lung cancer
• As a result of being exposed to secondhand smoking
• Workplace exposure to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar
• Being exposed to any of the following sources of radiation:
  • Radiation to the breasts or the chest. 
  • Radon in the workplace or at home. 
  • CT scans are examples of imaging tests. 
  • Radiation from an atomic explosion. 

• Living in a polluted environment. 
• Having a history of lung cancer in one's family. 
• The human immunodeficiency virus (HIV) infection (HIV). 
• Being a heavy smoker and taking beta carotene pills. 

The biggest risk factor for most malignancies is getting older. As you become older, your chances of developing cancer increase.

Most clinicians classify SCLC into two stages for therapy purposes: limited stage and comprehensive stage. In the case of early-stage cancer, more aggressive therapies such as chemotherapy mixed with radiation therapy may be used to try to cure the cancer. Chemotherapy alone is considered to be a better option for controlling (not curing) cancer in advanced stages.

Limited stage

This indicates that the cancer is limited to one side of the chest and can be treated with just one radiation field. This usually refers to cancers that have only affected one lung (unless the tumour has grown throughout the lung) and have spread to the lymph nodes on the same side of the chest. 

As long as the cancer is on the same side of the chest as the lymph nodes above the collarbone (called supraclavicular nodes), the cancer may still be deemed restricted stage. Even if lymph nodes in the centre of the chest (mediastinal lymph nodes) are closer to the other side of the chest, some clinicians include them.

What matters is that the cancer is contained within a small enough area that it may be treated with radiation therapy in a single "port" or treatment area. When SCLC is first discovered, only around one out of every three persons has limited stage cancer.

Extensive stage

Malignancies that have spread widely throughout the lung, to the other lung, to lymph nodes on the other side of the chest, or to other areas of the body are referred to be metastatic cancers (including the bone marrow). Many clinicians consider SCLC that has progressed to the fluid around the lungs to be at the advanced stage. When SCLC is first discovered, almost 2 out of every 3 persons has significant disease.

Difference between small cell lung cancer and non-small cell lung cancer

Lung cancer diagnoses are divided into two categories: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

SCLC frequently begins in the bronchi, or airways that run from the trachea into the lungs and split off into smaller structures. SCLC swiftly expands and spreads to other regions of the body, particularly the lymph nodes, after impacting the bronchi. This form of lung cancer accounts for less than 20% of all lung cancers and is usually induced by tobacco use. SCLC is further subdivided into two types: small cell carcinoma and mixed small cell carcinoma. When seen under a microscope, these two groups are utilised to differentiate the little cells. Small cell carcinoma is the most frequent kind of SCLC, and it resembles oats when viewed under a microscope. A tumour made up of small cell carcinoma cells plus a small number of non-small cell lung cancer cells is known as a combined small cell carcinoma.

Nearly nine out of ten cancer diagnoses are NSCLC, which grows at a slower rate than SCLC. This type of lung cancer usually develops slowly, with little or no signs until it has progressed. NSCLC is divided into three types: lung adenocarcinoma, squamous cell carcinoma, and large-cell undifferentiated carcinoma. Adenocarcinoma is the most frequent type of lung cancer, accounting for roughly 40% of all non-small cell lung cancer cases and 30% of all cases overall. Other prevalent cancers that contain this sort of malignancy include breast cancer and prostate cancer. It is detected in the outer area of the lung, in mucus-secreting glands, in NSCLC. Squamous cell lung cancer, which accounts for roughly 30% of all non-small cell lung cancers, is commonly connected to smoking. This sort of cancer starts in the lung's core. Lung cancer with large-cell undifferentiated carcinoma accounts for about 10-15% of all NSCLC cases. It can start in any area of the lungs and is known to spread rapidly.

Symptoms and diagnosis 

Small cell lung cancer in its early stages that hasn't progressed causes little symptoms. You may experience the following symptoms as the condition progresses: 

• Pain or discomfort in the chest
• Cough that doesn't go away or gets worse
• coughing blood (hemoptysis)
• Breathing problems
• Swelling of the face
• Fatigue
• Hoarseness
• Appetite loss is common
• Veins in the neck are swollen
• Weight loss that hasn't been explained
• Wheezing

X-rays of the chest are usually the initial step in detecting any sort of lung cancer. If your healthcare provider notices worrisome spots on your lungs, he or she may order one or more of the following diagnostic tests: 

• Lung cancers are detected by computed tomography (CT) and positron emission tomography (PET) studies. These tests can also be used to determine how far cancer has spread. CT scans are the most common approach to detect lung cancer
• Sputum cytology: This test examines sputum, or mucus coughed up from the lungs, for cancer cells. 
• A needle biopsy is a procedure that extracts tissue samples from the lungs. Pathologists in the lab examine the biopsies for cancer cells
• Bronchoscopy: A bronchoscope is used to look for cancers inside the lungs' airways. Providers can also take tissue samples for biopsy at the same time

Risk factors

For those with small cell lung cancer, metastasis, or cancer spread, is a major worry. Small cell lung cancer has the potential to spread swiftly to the brain, bones, liver, and adrenal glands. Small cell lung cancer that spreads can be treated, although it is rarely curable. There are also the following complications: 

• Pleural effusion is a type of pleural effusion that (fluid buildup in the area outside of the lungs)
• After therapy, cancer recurs (returns), most commonly in the central nervous system (brain or spine) or the chest
• Pain
• Breathing problems

Treatment options for small cell lung cancer

Surgery

1a. Lobectomy

The lungs are divided into five lobes (3 on the right and 2 on the left). The entire lobe containing the tumor(s) is excised during this procedure. This is frequently the recommended form of procedure for NSCLC if it is possible.

1b. Pneumonectomy

This procedure involves the removal of a complete lung. If the tumour is towards the middle of the chest, this may be necessary.

1c. Wedge resection or segmentectomy

Only a portion of a lobe is removed in these procedures. If a person's normal lung function is insufficient to sustain the removal of the entire lobe, this procedure may be utilised.

Chemotherapy

Because of how quickly SCLC can spread, chemotherapy is the most common treatment. Chemotherapy is the use of medications to kill cancer cells by preventing them from growing, dividing, and producing new ones. A chemotherapy regimen, often known as a schedule, consists of a defined number of cycles administered over a set length of time. A patient may be administered one medicine at a time or a mixture of drugs at the same time. Treatment options vary depending on whether the disease is classified as limited or extensive stage SCLC. Chemotherapy and chest radiation therapy are administered daily for several weeks to persons with restricted stage SCLC. Chemotherapy is given to people with advanced stage SCLC for 3 to 4 months at first. People with advanced stage SCLC are treated with a combination of chemotherapy and immunotherapy for three to four months, after which they are treated with maintenance immunotherapy.

SCLC is usually treated with a mix of chemotherapeutic medicines, such as: 

• Cisplatin and etoposide (both accessible as generics) 
• Carboplatin with etoposide (available as a generic drug) 
• Cisplatin with irinotecan (Camptosar) 
• Carboplatin with irinotecan (Camptosar)

The FDA has also approved the chemotherapy medication lurbinectedin for persons with SCLC that has spread after receiving earlier platinum-based chemotherapy treatment (Zepzelca).

Radiotherapy

3a. Conventional external beam radiotherapy

Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) as well as surrounding areas where the cancer has spread are treated with EBRT. Treatments are normally scheduled every weekday for four to six weeks, however this can vary depending on individual needs. The following EBRT approaches are used to target treatment to malignant lung locations (and possibly other cancerous sites as well) while protecting healthy tissue: 

SBRT is used to treat early-stage lung cancer when surgery is not an option. If cancer has migrated to the liver or adrenal gland, it may also be used. Targeted high-dose radiation beams are delivered to the tumour from numerous angles during SBRT. 

Three-dimensional conformal radiation therapy (3D-CRT) creates a three-dimensional representation of the exact location of a tumour. Radiation beams are formed in a variety of ways to hit the tumour from different angles. 

In malignancies that are close to structures like the spinal cord, intensity-modulated radiation treatment (IMRT) is frequently employed. The power of the radiation beams can be regulated to prevent injury to healthy tissues.

3b. Stereotactic radiotherapy

For solitary cancers that have spread to the brain, it can occasionally be used instead of or in addition to surgery. A machine concentrates roughly 200 beams of radiation on the tumour from different angles over a few minutes to hours in one form of this treatment. Your head is held in place by a stiff frame. In another form, a computer-controlled linear accelerator (a machine that produces radiation) rotates around your head, delivering radiation to the tumour from a variety of angles. If necessary, these treatments can be repeated.

3c. Internal radiotherapy

You may need internal radiation if the malignancy has blocked one of your airways (brachytherapy). The majority of people only have one treatment session. Using a bronchoscope, the doctor inserts a thin tube (catheter) into the lung through the nose or throat. They placed a small bit of radioactive material adjacent to the tumour inside the catheter. They leave it in place for a few minutes to give the cancer a dosage of radiation. The catheter is then removed along with it.

Immunotherapy

The immune system's ability to prevent itself from attacking normal cells in the body is crucial. It accomplishes this by utilising "checkpoints," or proteins on immune cells that must be turned on (or off) in order to initiate an immunological response. Checkpoints are used by cancer cells to escape being attacked by the immune system. Drugs that target these checkpoints, on the other hand, can be utilised to treat small cell lung cancer in some people (SCLC). Atezolizumab (Tecentriq) and durvalumab (Imfinzi) are antibodies that target PD-L1, a protein similar to PD-1 present on tumour cells and immune cells. By inhibiting this protein, the immune system's response to cancer cells can be boosted. These medicines, coupled with etoposide and a platinum chemo agent, can be utilised as part of the first-line treatment for advanced SCLC (like carboplatin or cisplatin). After that, either medicine can be used as maintenance therapy on its own. Some persons with SCLC appear to benefit from a combination of PD-L1 immunotherapy and chemotherapy. 

These medications are administered as an intravenous (IV) infusion every 2, 3, or 4 weeks.

Laser treatment

Laser therapy is a cancer treatment that kills cancer cells by using a laser beam (a narrow beam of strong light).

Endoscopic stent placement

An endoscope is a narrow, tube-like equipment that is used to examine internal body tissues. An endoscope is a viewing device with a light and a lens that can be used to put a stent in a body structure to keep it open. A stent can be used to unblock an airway that has been obstructed by aberrant tissue.

Side effects of treatment

During your treatment, you may have some adverse effects. The side effects will be explained to you by your doctor, nurse, or radiographer so you know what to expect. Inform them of any side effects you're experiencing. They often have things they can do to assist. They'll also provide you tips on how to deal with any negative effects. 

It may take up to two weeks following therapy for side effects to subside. The majority of negative effects normally fade away after that.

Swallowing problems 

You could have: 

When you swallow heartburn indigestion, you may experience difficulties swallowing pain or discomfort. 

This is due to the fact that radiotherapy might promote gullet inflammation (oesophagus). 

Your doctor may be able to give medication to assist alleviate the symptoms. If you have trouble eating, you can substitute nutritious, filling snacks for meals.

Tiredness 

Over the course of your treatment, you may become tired. You may feel more tired if you are undergoing other therapies. Try to keep a steady pace and get plenty of rest. Tiredness can last for weeks or months after treatment is completed. Tell your doctor or nurse if it does not improve. 

Coughing and a lack of breath 

It's possible that your breathing will get worse during radiotherapy and for a few weeks or months afterward. This is due to the fact that radiotherapy might create inflammation in the lung area being treated. It might also cause a dry cough. Always inform your doctor or nurse if you experience any of the following symptoms: 

If you have these symptoms, they will worsen. 

They might prescribe steroids to help you feel better.

Changes in the skin 

It's possible that the skin in the treated region will become dry and inflamed. The professionals at the hospital will provide you advice on how to care for your skin. If it becomes inflamed, your doctor may prescribe a lotion to relieve the pain. 

Hair loss is a common problem. 

Only in the treatment area does this happen. Men's chest hair may fall out, although it normally regrows. Hair loss can be permanent in some cases.

Recent research for the treatment of small cell lung cancer

Some people with breast cancer have tumours that express a lot of the protein HER-2, or HER-2 mutations that enable the cancers grow and proliferate. The good news for those with breast cancer is that the medicine trastuzumab deruxtecan can target this protein (T-DXd). The good news for lung cancer patients is that HER-2 mutations have been detected in some patients, particularly those who are young, female, and nonsmokers.

More than half of the study participants with advanced HER-2-mutant non-small-cell lung cancer (NSCLC) responded to T-DXd, with 92 percent experiencing tumour shrinkage, according to a small study presented at the European Society for Medical Oncology Annual Meeting and published on September 18 in The New England Journal of Medicine. 

The next step is to conduct two phase 2 studies, one to assess a lower dose of T-DXd in lung cancer patients and the second to assess its efficacy in targeting HER-2 mutations in other cancers.

Conclusion

People with small cell lung cancer are living longer thanks to advances in cancer detection and treatment. If you have a history of smoking and are at high risk for small cell lung cancer, talk to your doctor about undergoing annual lung cancer screenings. These tests can detect cancer at an early stage, when it is most curable. Even if you already have lung cancer, it's never too late to quit smoking and reap health benefits. Your healthcare practitioner may be able to assist you with quitting.