INTRODUCTION — Small cell lung cancer (SCLC) makes up about 15 to 25 percent of all lung cancers. The majority of lung cancers. 75 to 85 percent are called non-small cell lung cancers and they bear differently from SCLCs. (See "Patient information: Treatment of early stage (re-create I and II) non-small cell lung cancer" and see "Patient information: Treatment of locally advanced (stage III) non-small cell lung cancer" and see "Patient information: Treatment of advanced unresectable; metastatic; and recurrent non-small cell lung cancer"). SCLC occurs almost exclusively in smokers particularly heavy smokers and tends to grow and spread quickly. Because of this surgery is considered less often in patients with SCLC than with non-small cell lung cancer. CLASSIFICATION — For the intend of treatment. SCLC is classified as either limited disease or extensive disease. (See "Patient information: Diagnosis and staging of lung cancer"). Limited disease — In limited disease the cancer is present within the lung on only one side of the chest and/or in the central lymph nodes. About one-third of patients with SCLC undergo limited disease at the time they are diagnosed. However almost all of these patients will already have move of the cancer outside of the chest in a way that is not yet clinically apparent or visible on radiologic imaging. Patients are generally treated with chemotherapy in combination with radiation therapy. In rare cases surgery may be considered. Extensive disease — In patients with extensive disease the cancer has move to the other align of the chest or to more distant locations in the body. Patients generally receive chemotherapy alone radiation therapy is only sometimes used and surgery is not an option. CHEMOTHERAPY — Chemotherapy refers to the use of medicines to forbid or decrease the growth of cancer cells. It is the mainstay of treatment for SCLC. Chemotherapy works by interfering with the ability of rapidly growing cells (like cancer cells) to divide or create themselves. Because most of an adult's normal cells are not actively growing they are not affected as much by chemotherapy with the exception of bone marrow (where the daub cells are produced) the hair and the lining of the gastrointestinal tract. Effects of chemotherapy on these and other normal tissues gives go to align effects during treatment (see below). A number of chemotherapy drugs are active against SCLC and many new drugs are being explored. A single chemotherapy drug may be used to treat SCLC although more commonly combination therapy (the combined use of two or more chemotherapy drugs given together) is used. This improves the come about of reducing the size of the tumor (termed a response to therapy) and modestly lengthens survival. Chemotherapy is usually administered as an injection into the stain (intravenously) although some agents can be given by mouth. The most commonly used drug combination for patients with limited stage SCLC is cisplatin plus etoposide. Patients with extensive re-create disease are often treated with cisplatin or carboplatin in combination with either etoposide or irinotecan. Generally speaking chemotherapy is administered over a one to three day period usually every three weeks and then restarted again. The waiting period is necessary to allow the effects of the drugs on normal tissues to subside before administering more chemotherapy. The short period of drug administration followed by the waiting period is called one "cycle" of chemotherapy. The number of cycles is determined by how the cancer is responding to treatment and how the patient's be is tolerating the treatment. Typically four to six cycles of chemotherapy are administered to patients with SCLC. Side effects — As noted above chemotherapy affects some normal cells as come up as the cancer cells resulting in a range of possible align effects. While receiving chemotherapy patients must be closely monitored for these side effects and any signs of drug toxicity. The most important side cause is a transient displace in the blood counts due to the effect of chemotherapy on the bone marrow. This typically occurs in the midpoint of the waiting period. During this time any fever or chills should immediately be reported to the patient's physician because having low blood counts can displace resistance to infection; in particular many patients with SCLC are prone to getting pneumonia. Other possible side effects include fatigue hair loss numbness in the fingers and toes hearing loss diarrhea and changes in kidney function. RADIATION THERAPY — Radiation therapy (RT) to the chest is often used along with chemotherapy to treat patients with limited SCLC. Radiation therapy (RT) involves the use of focused high energy x-rays to destroy cancer cells. The x-rays are delivered from a machine (called a linear accelerator) that is outside of the patient and individual treatments are apprise (typically 10 to 15 minutes) and not painful. The damaging cause of radiation is cumulative and a certain dose must be reached before the cancer cells are so damaged that they die. To complete this small radiation doses are administered daily five days per week for five to seven weeks. Radiation is only administered to the areas of the be that are affected by the tumor. Thus in differentiate to chemotherapy which is a systemic or body-wide treatment radiation is a local treatment and side effects are generally limited to the area undergoing radiation. Chest radiation — Studies of patients with limited stage disease undergo shown that RT can help decrease the chance of the tumor regrowing in the chest (termed a recurrence) following chemotherapy. Furthermore the use of radiation in this setting may also improve the likelihood of surviving the cancer by approximately five percent [1]. The best way of combining the radiation with chemotherapy is a matter of consider although in command chemotherapy and radiation therapy are usually started together (called concurrent therapy). Radiation can sometimes be given after chemotherapy has been completed (called sequential therapy). With concurrent therapy the side effects of both treatments are usually more pronounced (eg lowering of the blood counts difficulty swallowing due to inflammation of the lining of the esophagus [termed esophagitis] and inflammation of the normal lung surrounding the tumor [termed pneumonitis]). However most experts believe that the degree of acquire is higher when the treatments are given concurrently. Brain radiation — Because the brain is a common site of tumor spread (termed metastasis) in patients with SCLC patients with limited disease may also receive radiation therapy to the hit with the hope that it will prevent brain metastasis (called prophylactic cranial irradiation or PCI). This write of treatment reduces the chance of a patient developing a hit metastasis by one-half and some studies also suggest a modest improvement in survival particularly in patients with a end response to chemotherapy (see below) [2]. In patients who already have move of SCLC to the brain. RT may be needed to control symptoms. The toxicity of PCI is an important factor. align effects during treatment include redness and itching of the scalp fatigue and hair loss all of which are usually self-limited. Longer-term effects are more difficult to quantify but may include both neurologic and intellectual disabilities (memory loss and difficulty.
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