Stage 3 lung cancer is small cell. What is small cell lung cancer

Instrumental methods for diagnosing small cell lung cancer (radiography, CT, bronchoscopy, etc.) must be confirmed by the results of a biopsy of the tumor or lymph nodes, and cytological analysis of pleural exudate. Surgical treatment of small cell lung cancer is advisable only in the early stages; The main role is given to polychemotherapy and radiation therapy.

Small cell lung cancer

Small cell lung cancer is one of the rapidly proliferating tumors with a high malignancy potential. In pulmonology, small cell lung cancer is much less common (15-20%) than non-small cell lung cancer (80-85%), but it is characterized by rapid development, seeding of the entire lung tissue, and early and extensive metastasis. In the vast majority of cases, small cell lung cancer develops in patients who smoke, more often in men. The highest incidence is recorded in the age group. Almost always, the tumor begins to develop as central lung cancer, but very soon metastasizes to bronchopulmonary and mediastinal lymph nodes, as well as distant organs (skeletal bones, liver, brain). Without special antitumor treatment, the median survival is no more than 3 months.

Causes of small cell lung cancer

The main and most significant cause of small cell lung cancer is considered to be tobacco smoking, and the main aggravating factors are the patient’s age, length of nicotine addiction and the number of cigarettes smoked per day. Due to the increasing prevalence of addiction among women, in recent years there has been a tendency to increase the incidence of small cell lung cancer among the fairer sex.

Other potentially significant risk factors include: hereditary burden of cancer, unfavorable ecology in the region of residence, harmful working conditions (contact with arsenic, nickel, chromium). The background against which lung cancer most often occurs may be previous respiratory tuberculosis or chronic obstructive pulmonary disease (COPD).

The problem of the histogenesis of small cell lung cancer is currently considered from two positions - endodermal and neuroectodermal. Supporters of the first theory are inclined to the point of view that this type of tumor develops from cells of the epithelial lining of the bronchi, which in structure and biochemical properties are close to small cell carcinoma cells. Other researchers are of the opinion that the development of small cell cancer is initiated by cells of the APUD system (diffuse neuroendocrine system). This hypothesis is confirmed by the presence of neurosecretory granules in tumor cells, as well as an increase in the secretion of biologically active substances and hormones (serotonin, ACTH, vasopressin, somatostatin, calcitonin, etc.) in small cell lung cancer.

Classification of small cell lung cancer

Staging of small cell cancer according to the international TNM system does not differ from that for other types of lung cancer. However, to date, a classification that distinguishes localized (limited) and widespread stages of small cell lung cancer is relevant in oncology. The limited stage is characterized by unilateral tumor lesions with enlargement of the hilar, mediastinal and supraclavicular lymph nodes. In the advanced stage, the tumor moves to the other half of the chest, cancerous pleurisy, and metastases. About 60% of identified cases are of the common form (stage III–IV according to the TNM system).

Morphologically, small cell lung cancer is divided into oat cell carcinoma, cancer from intermediate type cells and mixed (combined) oat cell carcinoma. Oat cell carcinoma is microscopically represented by layers of small spindle-shaped cells (2 times larger than lymphocytes) with round or oval nuclei. Intermediate cell cancer is characterized by larger cells (3 times more lymphocytes) that are round, oblong or polygonal in shape; cell nuclei have a clear structure. A combined tumor histotype is indicated when the morphological signs of oat cell carcinoma are combined with signs of adenocarcinoma or squamous cell carcinoma.

Symptoms of small cell lung cancer

Usually the first sign of a tumor is a prolonged cough, which is often regarded as smoker's bronchitis. An alarming symptom is always the appearance of blood in the sputum. Also characteristic are chest pain, shortness of breath, loss of appetite, weight loss, and progressive weakness. In some cases, small cell lung cancer clinically manifests with obstructive pneumonia caused by bronchial occlusion and atelectasis of part of the lung, or exudative pleurisy.

In the later stages, when the mediastinum is involved in the process, mediastinal compression syndrome develops, including dysphagia, hoarseness due to paralysis of the laryngeal nerve, and signs of compression of the superior vena cava. Various paraneoplastic syndromes are common: Cushing's syndrome, Lambert-Eaton myasthenic syndrome, syndrome of inappropriate antidiuretic hormone secretion.

Small cell lung cancer is characterized by early and widespread metastasis to the intrathoracic lymph nodes, adrenal glands, liver, bones and brain. In this case, the symptoms correspond to the localization of metastases (hepatomegaly, jaundice, pain in the spine, headaches, attacks of loss of consciousness, etc.).

To correctly assess the extent of the tumor process, a clinical examination (examination, analysis of physical data) is supplemented by instrumental diagnostics, which is carried out in three stages. At the first stage, visualization of small cell lung cancer is achieved using radiation methods - chest X-ray, CT of the lungs, positron emission tomography.

The task of the second stage is morphological confirmation of the diagnosis, for which bronchoscopy with biopsy, pleural puncture with exudate sampling, lymph node biopsy, and diagnostic thoracoscopy are performed. Subsequently, the obtained material is subjected to histological or cytological analysis. At the final stage, MSCT of the abdominal cavity, MRI of the brain, and skeletal scintigraphy can exclude distant metastasis.

Treatment and prognosis of small cell lung cancer

Clear staging of small cell lung cancer determines the possibilities of its surgical or therapeutic treatment, as well as predicting survival. Surgical treatment of small cell lung cancer is indicated only in the early stages (I-II). But even in this case, it is necessarily supplemented by several courses of postoperative chemotherapy. With this patient management scenario, the 5-year survival rate within this group does not exceed 40%.

The remaining patients with a localized form of small cell lung cancer are prescribed from 2 to 4 courses of treatment with cytostatics (cyclophosphamide, cisplatin, vincristine, doxorubicin, gemcitabine, etoposide, etc.) in monotherapy or combination therapy in combination with irradiation of the primary lesion in the lung, lymph nodes root and mediastinum. When remission is achieved, prophylactic irradiation of the brain is additionally prescribed to reduce the risk of metastatic damage. Combination therapy can extend the life of patients with a localized form of small cell lung cancer by an average of 1.5-2 years.

Patients with locally advanced small cell lung cancer are advised to undergo 4-6 courses of polychemotherapy. For metastatic damage to the brain, adrenal glands, and bones, radiation therapy is used. Despite the sensitivity of the tumor to chemotherapy and radiation treatment, relapses of small cell lung cancer are very common. In some cases, relapses of lung cancer turn out to be refractory to antitumor therapy - then the average survival rate usually does not exceed 3-4 months.

Small cell lung cancer - treatment in Moscow

Directory of diseases

Respiratory diseases

Last news

for informational purposes only

and does not replace qualified medical care.

Small cell lung cancer

One of the most common and difficult-to-treat diseases among men is small cell lung cancer. At the initial stage, the disease is quite difficult to recognize, but with timely treatment, the chances of a favorable outcome are high.

Small cell lung cancer is one of the most malignant tumors according to histological classification, which is very aggressive and gives extensive metastases. This form of cancer accounts for about 25% of other types of lung cancer and, if not detected early and treated properly, is fatal.

For the most part, this disease affects men, but recently there has been an increase in incidence among women. Due to the absence of signs of the disease in the early stages, as well as the rapid growth of the tumor and the spread of metastases, in most patients the disease takes an advanced form and is difficult to cure.

All information on the site is for informational purposes only and is NOT a guide to action!
Only a DOCTOR can give you an ACCURATE DIAGNOSIS!
We kindly ask you NOT to self-medicate, but to make an appointment with a specialist!
Health to you and your loved ones! Do not give up

Causes

Smoking is the first and most important cause of lung cancer. The age of the person who smokes, the number of cigarettes per day and the duration of the habit affect the likelihood of developing small cell lung cancer.

A good prevention is to give up cigarettes, which will significantly reduce the possibility of disease, however, a person who has ever smoked will always be at risk.

Statistically, smokers develop lung cancer 16 times more often than non-smokers, and lung cancer is diagnosed 32 times more often in those who started smoking in adolescence.

Nicotine addiction is not the only factor that can trigger the disease, so there is a possibility that non-smokers may also be affected by lung cancer.

Heredity is the second most important reason that increases the risk of the disease. The presence of a special gene in the blood increases the likelihood of developing small cell lung cancer, so there are fears that those people whose relatives suffered from this type of cancer may also get sick.

Ecology is a reason that has a significant impact on the development of lung cancer. Exhaust gases and industrial waste poison the air and, along with it, enter the human lungs. Also at risk are people who have frequent contact with nickel, asbestos, arsenic or chromium due to their professional activities.

Severe lung diseases are prerequisites for the development of lung cancer. If a person has had tuberculosis or chronic obstructive pulmonary disease throughout his life, this may cause the development of lung cancer.

Symptoms

Lung cancer, like most other organs, at the initial stage does not bother the patient and does not have pronounced symptoms. It can be noticed with timely fluorography.

Depending on the stage of the disease, the following symptoms are distinguished:

the most common symptom is a persistent cough. However, it is not the only accurate sign, since in people who smoke (and it is in them that a malignant tumor is diagnosed more often than in non-smokers), chronic cough is observed even before the disease. At a later stage of cancer, the nature of the cough changes: it intensifies, is accompanied by pain and expectoration of bloody fluid
with small cell lung cancer, a person often experiences shortness of breath, which is associated with difficult air flow through the bronchi, which disrupts the proper functioning of the lung;
At stages 2 and 3 of the disease, sudden fevers or periodic increases in temperature are not uncommon. Pneumonia, which often affects smokers, can also be one of the signs of lung cancer;
systematic chest pain when coughing or trying to breathe deeply;
The greatest danger is posed by pulmonary bleeding, which is caused by tumor growth into the pulmonary vessels. This symptom indicates the neglect of the disease;
when the tumor increases in size, it can depress neighboring organs, which can result in pain in the shoulders and limbs, swelling of the face and hands, difficulty swallowing, hoarseness in the voice, prolonged hiccups;
in the advanced stage of cancer, the tumor seriously affects other organs, which further worsens the unfavorable picture. Metastases that reach the liver can cause jaundice, pain under the ribs, metastases to the brain lead to paralysis, loss of consciousness and disorders of the speech center of the brain, metastases to the bones cause pain and aches in them;

All of the above symptoms may be accompanied by sudden weight loss, loss of appetite, chronic weakness and fatigue.

Based on how intense the symptoms manifest themselves and how promptly a person seeks help from a doctor, we can make a forecast about the chances of his recovery.

You can learn about the symptoms of lung cancer in the early stages here.

Diagnostics

Adults, especially those who smoke, should be periodically screened for lung cancer.

Diagnosis of a tumor in the lung consists of the following procedures:

Fluorography to detect any changes in the lungs. This procedure is carried out during a medical examination, after which the doctor prescribes other examinations that will help in making the correct diagnosis.
Clinical and biochemical blood test.
Bronchoscopy is a diagnostic method that examines the extent of lung damage.
Biopsy is the surgical removal of a tumor sample to determine the type of tumor.
Radiation diagnostics, which includes X-ray examination, magnetic resonance imaging (MRI) and positive emission tomography (PET), which allows you to determine the location of tumor foci and clarify the stage of the disease.

Video: About early diagnosis of lung cancer

Treatment

Treatment tactics for small cell lung cancer are developed based on the clinical picture of the disease and the general well-being of the patient.

There are three main methods of treating lung cancer, which are often used in combination:

surgical removal of the tumor;
radiation therapy;
chemotherapy.

Surgical removal of the tumor makes sense at an early stage of the disease. Its purpose is to remove the tumor or part of the affected lung. This method is not always possible for small cell lung cancer due to its rapid development and late detection, therefore more radical methods are used to treat it.

The possibility of surgery is also excluded if the tumor affects the trachea or neighboring organs. In such cases, chemotherapy and radiation therapy are immediately resorted to.

Chemotherapy for small cell lung cancer can give good results if used in a timely manner. Its essence lies in taking special medications that destroy tumor cells or significantly slow down their growth and reproduction.

The patient is prescribed the following medications:

The drugs are taken at intervals of 3-6 weeks and at least 7 courses must be completed to achieve remission. Chemotherapy helps reduce the size of the tumor, but cannot guarantee complete recovery. However, it can prolong a person’s life even at the fourth stage of the disease.

Radiation therapy, or radiotherapy, is a method of treating cancer using gamma radiation or X-rays to kill or slow the growth of cancer cells.

It is used for inoperable lung tumors, when the tumor has affected the lymph nodes, or when surgery is not possible due to the patient’s unstable condition (for example, a serious disease of other internal organs).

During radiation therapy, the affected lung and all areas of metastasis are irradiated. For greater effectiveness, radiation therapy is combined with chemotherapy if the patient is able to tolerate such combination treatment.

One of the possible options for providing care to a patient with lung cancer is palliative treatment. It is applicable when all possible methods to stop the development of the tumor have failed, or when lung cancer is detected at a very late stage.

Palliative care is designed to ease a patient's final days, provide psychological support, and relieve pain from severe cancer symptoms. Methods of such treatment depend on the person’s condition and are purely individual for each person.

There are various traditional methods of treating small cell lung cancer, which are popular in narrow circles. Under no circumstances should you rely on them and self-medicate.

Every minute is important for a successful outcome, and often people waste precious time in vain. At the slightest sign of lung cancer, you should immediately consult a doctor, otherwise death is inevitable.

The choice of treatment method for a patient is an important stage on which his future life depends. This method should take into account the stage of the disease and the psycho-physical condition of the patient.

This article will tell you what radiology diagnostics of central lung cancer is.

You can learn more about the treatment methods for peripheral lung cancer in this article.

How long do people live (life expectancy) with small cell lung cancer?

Despite the transient course of small cell lung cancer, it is more sensitive to chemotherapy and radiotherapy compared to other forms of cancer, so with timely treatment the prognosis can be favorable.

The most favorable outcome is observed when cancer is detected at stages 1 and 2. Patients who start treatment on time manage to achieve complete remission. Their life expectancy already exceeds three years and the number of people cured is about 80%.

At stages 3 and 4, the prognosis worsens significantly. With complex treatment, the patient's life can be extended by 4-5 years, and the percentage of survivors is only 10%. If left untreated, the patient dies within 2 years from the date of diagnosis.

Lung cancer is one of the most common cancer diseases, which is very difficult to cure, but there are many ways to prevent its occurrence. First of all, it is necessary to cope with nicotine addiction, avoid contact with harmful substances and undergo regular medical examination.

Timely detection of small cell lung cancer in the early stages significantly increases the chances of defeating the disease.

Evgeniy on Blood test for cancer cells
Marina on Treatment of sarcoma in Israel
Nadezhda on Acute leukemia
Galina on Treatment of lung cancer with folk remedies
maxillofacial and plastic surgeon to record Osteoma of the frontal sinus

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action.

Do not self-medicate. Consult your healthcare provider.

Small cell lung cancer

In the structure of oncological diseases, lung cancer is one of the most common pathologies. It is based on malignant degeneration of the epithelium of the lung tissue and impaired air exchange. The disease is characterized by high mortality. The main risk group is older men who smoke. A feature of modern pathogenesis is a decrease in the age of primary diagnosis, an increase in the likelihood of lung cancer in women.

Small cell cancer is a malignant tumor that has the most aggressive course and widespread metastasis. This form accounts for about 20-25% of all types of lung cancer. Many scientific experts regard this type of tumor as a systemic disease, in the early stages of which there are almost always metastases in the regional lymph nodes. Men suffer from this type of tumor most often, but the percentage of affected women is growing significantly. Almost all patients have a fairly severe form of cancer, which is associated with rapid tumor growth and widespread metastasis.

Causes of small cell lung cancer

In nature, there are many reasons for the development of malignant neoplasms in the lungs, but there are main ones that we encounter almost every day:

smoking;
radon exposure;
pulmonary asbestosis;
viral infection;
dust exposure.

Clinical manifestations of small cell lung cancer

Symptoms of small cell lung cancer:

Fatigue and feeling of weakness

a cough of a prolonged nature, or a new cough with changes in the patient’s usual cough;
lack of appetite;
weight loss;
general malaise, fatigue;
shortness of breath, pain in the chest and lungs;
voice change, hoarseness (dysphonia);
pain in the spine and bones (occurs with bone metastases);
epilepsy attacks;
Lung cancer, stage 4 - speech impairment occurs and severe headaches appear.

Grades of small cell lung cancer

Stage 1 - the tumor size is up to 3 cm in diameter, the tumor has affected one lung. There is no metastasis.
Stage 2 – the size of the tumor in the lung is from 3 to 6 cm, blocks the bronchus and grows into the pleura, causing atelectasis;
Stage 3 - the tumor rapidly spreads to neighboring organs, its size has increased from 6 to 7 cm, and atelectasis of the entire lung occurs. Metastases in neighboring lymph nodes.
Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs of the human body, which in turn causes symptoms such as:

headache;
hoarseness or loss of voice altogether;
general malaise;
loss of appetite and sudden weight loss;
back pain, etc.

Diagnosis of small cell lung cancer

Despite all the clinical examinations, history taking and listening to the lungs, a high-quality diagnosis of the disease is also necessary, which is carried out using methods such as:

skeletal scintigraphy;
chest x-ray;
detailed, clinical blood test;
computed tomography (CT);
liver function tests;
magnetic resonance imaging (MRI)
positron emission tomography (PET);
sputum analysis (cytological examination to detect cancer cells);
thoracentesis (sampling of fluid from the chest cavity around the lungs);
Biopsy is the most common method for diagnosing malignancy. It is carried out in the form of removing a particle of a fragment of the affected tissue for further examination under a microscope.

There are several ways to perform a biopsy:

bronchoscopy in combination with biopsy;
puncture biopsy is performed using CT;
endoscopic ultrasound with biopsy;
mediastinoscopy in combination with biopsy;
open lung biopsy;
pleural biopsy;
videothoracoscopy.

Treatment of small cell lung cancer

The most important place in the treatment of small cell lung cancer is chemotherapy. Without appropriate treatment for lung cancer, the patient dies 5-18 weeks after diagnosis. Polychemotherapy helps to increase the mortality rate to 45–70 weeks. It is used both as an independent method of therapy and in combination with surgery or radiation therapy.

The goal of this treatment is complete remission, which must be confirmed by bronchoscopic methods, biopsy and bronchoalveolar lavage. As a rule, the effectiveness of treatment is assessed 6-12 weeks after the start of therapy, and based on these results, the likelihood of cure and the patient’s life expectancy can be assessed. The most favorable prognosis is for those patients who achieve complete remission. This group includes all patients whose life expectancy exceeds 3 years. If the tumor has decreased by 50%, and there is no metastasis, it is possible to talk about partial remission. Life expectancy is correspondingly shorter than in the first group. For tumors that cannot be treated and are actively progressing, the prognosis is poor.

After determining the stage of lung cancer, it is necessary to assess the patient’s health from the point of view of whether he is able to tolerate induction chemotherapy combined with combination treatment. It is carried out in the absence of previous chemotherapy and radiation therapy, also if the patient maintains working capacity, there are no severe concomitant diseases, heart or liver failure, bone marrow function is preserved, PaO2 when breathing atmospheric air exceeds 50 mm Hg. Art. and no hypercapnia. But it is also worth noting that the mortality rate from induction chemotherapy is present and reaches 5%, which is comparable to the mortality rate with radical surgical treatment.

If the patient’s health condition does not meet the specified standards and criteria, the dose of antitumor drugs is reduced to avoid complications and severe side effects. An oncologist should carry out induction chemotherapy. The patient requires special attention in the first 4 months. Infectious, hemorrhagic and other severe complications are also possible during the treatment process.

Localized form of small cell lung cancer (SCLC) and its treatment

treatment efficiency 65-90%;
The 5-year survival rate is 10% and reaches 25% for patients who began treatment in good general health.

Fundamental in the treatment of localized forms of SCLC is chemotherapy (2-4 courses) in combination with radiation therapy in a total focal dose of Gy. It is considered correct to start radiation therapy against the background of chemotherapy during or after 1-2 courses. When observing remission, it is advisable to perform brain irradiation with a total dose of 30 Gy, since SCLC is characterized by rapid and aggressive metastasis to the brain.

In the case of a common form of SCLC, combined treatment is indicated, and it is advisable to carry out irradiation in the presence of special indicators:

the presence of metastasis in the bones;
metastasis, brain;
metastasis in the adrenal glands;
metastasis in the lymph nodes, mediastinum with compression syndrome of the superior vena cava.

Note! In case of metastasis to the brain, treatment with a gamma knife is possible.

After a statistical study, it was revealed that the effectiveness of chemotherapy in the treatment of advanced SCLC is about 70%, while in 20% of cases complete remission is achieved, which gives survival rates close to those of patients with a localized form.

Chemotherapy

Limited stage

At this stage, the tumor is located within one lung, and nearby lymph nodes may also be involved.

Treatment methods used:

combined: chemo+radiation therapy followed by prophylactic cranial irradiation (PCR) during remission;
chemotherapy with or without PCO, for patients who have deteriorating respiratory function;
surgical resection with adjuvant therapy for patients with stage 1;
The combined use of chemotherapy and thoracic radiotherapy is the standard approach for patients with limited-stage, small cell LC.

According to clinical trial statistics, combination treatment compared to chemotherapy without radiation therapy increases the 3-year survival prognosis by 5%. Drugs used: platinum and etoposide. Prognostic indicators for life expectancy are months and a 2-year survival rate forecast of 50%.

Ineffective ways to increase your forecast:

increasing the dose of drugs;
effect of additional types of chemotherapy drugs.

The duration of the chemotherapy course is not defined, but, nevertheless, the duration of the course should not exceed 6 months.

Question about radiation therapy: Many studies show its benefits during 1-2 cycles of chemotherapy. The duration of the course of radiation therapy should not exceed more than one day.

It is possible to use standard radiation courses:

1 time per day for 5 weeks;
2 or more times a day for 3 weeks.

Hyperfractionated thoracic radiotherapy is considered preferable and results in a better prognosis.

Older patients (65-70 years old) tolerate treatment much worse; the treatment prognosis is much worse, since they respond rather poorly to radiochemotherapy, which in turn manifests itself in low effectiveness and major complications. Currently, the optimal therapeutic approach for elderly patients with small cell LC has not been developed.

Patients who have achieved remission of the tumor process are candidates for prophylactic cranial irradiation (PCR). Research results indicate a significant reduction in the risk of metastases in the brain, which is 60% without the use of PCO. PCO improves the prognosis of 3-year survival from 15% to 21%. Often, patients who survive non-small cell lung cancer experience impairments in neurophysiological function, but these impairments are not associated with undergoing PCO.

Extensive stage

The tumor spreads beyond the lung in which it originally appeared.

Standard therapy methods:

combination chemotherapy with or without prophylactic cranial irradiation;
etoposide + cisplatin or etoposide + carboplatin is the most common approach with proven effectiveness. Other approaches have not yet shown significant benefits;
cyclophosphamide + doxorubicin + etoposide;
ifosfamide + cisplatin + etoposide;
cisplatin + irinotecan;
cyclophosphamide + doxorubicin + etoposide + vincristine;
cyclophosphamide + etoposide + vincristine.

Radiation is given for negative responses to chemotherapy, especially for metastases in the brain, spinal cord or bones.

A fairly positive response of 10-20% remission is given by cystplatin and etoposide. Clinical studies show the benefits of combination chemotherapy that includes platinum. But despite this, cisplatin is often accompanied by significant side effects, which can lead to serious consequences in patients suffering from cardiovascular diseases. Carboplatin is less toxic compared to cisplatin.

Note! The use of increased doses of chemotherapy drugs remains an open question.

For limited stage, in case of a positive response to chemotherapy, extensive stage small cell lung cancer, prophylactic cranial irradiation is indicated. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. No significant deterioration in health was detected after PCO.

Patients diagnosed with advanced SCLC have a deteriorating health status that complicates aggressive therapy. Clinical studies have not revealed an improvement in survival prognosis when reducing drug doses or switching to monotherapy, but, nevertheless, the intensity in this case should be calculated from an individual assessment of the patient’s health status.

Disease prognosis

As mentioned earlier, small cell lung cancer is one of the most aggressive forms of all cancers. The prognosis of the disease and how long patients live depends directly on the treatment of lung cancer. A lot depends on the stage of the disease and what type it is. There are two main types of lung cancer - small cell and non-small cell.

SCLC, which affects smokers, is less common, but spreads very quickly, forming metastases and affecting other organs. It is more sensitive to chemical and radiation therapy.

Small cell lung cancer, life expectancy in the absence of appropriate treatment, ranges from 6 to 18 weeks, and the survival rate reaches 50%. With the use of appropriate therapy, life expectancy increases from 5 to 6 months. The worst prognosis is for patients with a 5-year illness period. Approximately 5-10% of patients remain alive.

Informative video on the topic: Smoking and lung cancer

How useful was the article for you?

If you find an error, simply highlight it and press Shift + Enter or click here. Thank you very much!

There are no comments or reviews for “Small cell lung cancer”

Add a comment Cancel reply

Types of cancer

Folk remedies

Tumors

Thank you for your message. We will fix the error soon

Intercellular cancer

Small cell carcinoma is an extremely malignant tumor with an aggressive clinical course and widespread metastasis. This form accounts for 20-25% of all types of lung cancer. Some researchers regard it as a systemic disease, in which there are almost always metastases in regional and extrathoracic lymph nodes already in the initial stages. The majority of patients are male, but the percentage of affected women is increasing. The etiological connection of this cancer with smoking is emphasized. Due to the rapid growth of the tumor and widespread metastases, most patients suffer from severe disease.

Symptoms

A new cough or a change in the cough that is usual for a patient who is a smoker.

Fatigue, lack of appetite.

Shortness of breath, chest pain.

Pain in the bones, spine (with metastases to bone tissue).

An attack of epilepsy, headaches, weakness in the limbs, speech impairment - possible symptoms of brain metastases at stage 4 of lung cancer./blockquote>

Forecast

Small cell lung cancer is one of the most aggressive forms. How long such patients live depends on the treatment. Without treatment, death occurs within 2-4 months, and survival rates reach only 50 percent. With the use of treatment, the life expectancy of cancer patients can increase several times - up to 4-5. The prognosis is even worse after 5 years of illness - only 5-10 percent of patients remain alive.

Stage 4

Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs and systems, which causes symptoms such as:

headaches, etc.

Treatment

Chemotherapy plays an important role in the treatment of small cell lung cancer. Without treatment, half of patients die 6-17 weeks after diagnosis. Polychemotherapy allows you to increase this indicator. It is used both as an independent method and in combination with surgery or radiation therapy.

The goal of treatment is to achieve complete remission, which must be confirmed by bronchoscopic methods, including biopsy and bronchoalveolar lavage. The effectiveness of treatment is assessed 6-12 weeks after its start. Based on these results, it is already possible to predict the probability of cure and the patient’s life expectancy. The most favorable prognosis is for those patients who managed to achieve complete remission during this time. All patients whose life expectancy exceeds 3 years belong to this group. If the tumor mass has decreased by more than 50% and there are no metastases, they speak of partial remission. The life expectancy of such patients is shorter than in the first group. If the tumor is untreatable or progresses, the prognosis is poor.

Once the stage of the disease has been determined (early or late, see “Lung cancer: stages of the disease”), the patient’s general condition is assessed to determine whether he is able to tolerate induction chemotherapy (including as part of a combination treatment). It is carried out only if neither radiation therapy nor chemotherapy have been previously carried out, if the patient has maintained working capacity, there are no severe concomitant diseases, heart, liver and kidney failure, bone marrow function is preserved, PaO2 when breathing atmospheric air exceeds 50 mm Hg . Art. and no hypercapnia. However, even in such patients, mortality during induction chemotherapy reaches 5%, which is comparable to mortality during radical surgical treatment.

If the patient's condition does not meet these criteria, the dose of antitumor drugs is reduced to avoid severe side effects.

Induction chemotherapy should be administered by an oncologist; special attention is required in the first 6.12 weeks. During treatment, infectious, hemorrhagic and other severe complications are possible.

Treatment of localized small cell lung cancer (SCLC)

The treatment statistics for this form of SCLC have good indicators:

the effectiveness of treatment is 65-90%;

tumor regression is observed in 45-75% of cases;

median survival reaches months;

2-year survival rate is 40-50%;

The 5-year survival rate is about 10%, while for patients who started treatment in good general condition this figure is about 25%.

The basis for the treatment of a localized form of SCLC is chemotherapy (2-4 courses) according to one of the regimens indicated in the table in combination with radiation therapy of the primary lesion, mediastinum and lung root in a total focal dose of Gy. It is advisable to start radiation therapy against the background of chemotherapy (during or after 1-2 courses). If the patient experiences complete remission, it is also advisable to irradiate the brain with a total dose of 30 Gy, since SCLC is characterized by a high probability (about 70%) of metastasis to the brain.

Treatment of advanced small cell lung cancer (SCLC)

Patients with advanced MDR are treated with combination chemotherapy (see table), and it is advisable to carry out irradiation only if there are special indications: for metastatic damage to the bones, brain, adrenal glands, mediastinal lymph nodes with compression syndrome of the superior genital vein, etc.

For metastatic brain lesions, it may be advisable to consider treatment with Gamma Knife in some cases.

According to statistics, the effectiveness of chemotherapy in the treatment of advanced SCLC is about 70%, while in 20% of cases complete regression is achieved, which gives survival rates close to those of patients with a localized form.

Chemotherapy

At this stage, the tumor is located within one lung, and nearby lymph nodes may also be involved. The following treatment methods are possible:

Combined chemotherapy/radiation therapy followed by prophylactic cranial irradiation (PCR) in remission.

Chemotherapy with or without PCO for patients with worsened respiratory function.

Surgical resection with adjuvant therapy for patients with stage I.

The combined use of chemotherapy and thoracic radiotherapy is the standard approach for patients with limited-stage small cell LC. According to statistics from various clinical studies, combination therapy compared with chemotherapy without radiation increases the 3-year survival prognosis by 5%. Platinum and etoposide are the most commonly used drugs.

Average prognostic indicators are a month's life expectancy and a 2-year survival rate within 40-50%. The following ways to improve the prognosis were ineffective: increasing the dose of drugs, using additional types of chemotherapy drugs. The optimal course duration has not been determined, but should not exceed 6 months.

The question of the optimal use of radiation also remains open. Several clinical studies suggest the benefits of early radiation therapy (during cycles 1-2 of chemotherapy). The duration of the irradiation course should not exceed more. It is possible to use both a standard irradiation regimen (once a day for 5 weeks) and a hyperfractionated one (2 or more times a day for 3 weeks). Hyperfractionated thoracic radiotherapy is considered preferable and results in a better prognosis.

Age over 70 years significantly worsens the prognosis of treatment. Elderly patients respond much worse to radiochemotherapy, which results in low effectiveness and complications. Currently, the optimal therapeutic approach for elderly patients with small cell LC has not been developed.

In rare cases, with good respiratory function and limited tumor process within the lung, surgical resection with or without subsequent adjuvant chemotherapy is possible.

The tumor spreads beyond the lung in which it originally appeared. Standard treatment approaches include the following:

Combined chemotherapy with or without prophylactic cranial irradiation.

etoposide + cisplatin or etoposide + carboplatin is the most common approach, the effectiveness of which is confirmed by clinical studies. Other approaches have not yet shown significant benefits.

cyclophosphamide + doxorubicin + etoposide

ifosfamide + cisplatin + etoposide

cyclophosphamide + doxorubicin + etoposide + vincristine

cyclophosphamide + etoposide + vincristine

Radiation therapy - used in case of a negative response to chemotherapy, especially for metastases in the brain, spinal cord or bones.

The standard approach (cystplatin and etoposide) gives a positive response in 60-70% of patients and leads to remission in 10-20%. Clinical studies indicate the benefits of combination chemotherapy that includes platinum. However, cisplatin is often accompanied by significant side effects, which can lead to serious consequences in patients suffering from cardiovascular diseases. Carboplatin is less toxic compared to cisplatin. The advisability of using higher doses of chemotherapy drugs remains an open question.

As for the limited stage, in case of a positive response to chemotherapy for the extensive stage of small cell lung cancer, prophylactic cranial irradiation is indicated. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. No significant deterioration in health was detected after PCO.

Combined radiochemotherapy does not improve the prognosis compared to chemotherapy, but thoracic irradiation is advisable for palliative treatment of distant metastases.

Often, patients diagnosed with advanced SCLC have a deteriorating health status that complicates aggressive therapy. However, clinical studies have not revealed an improvement in survival prognosis when reducing drug doses or switching to monotherapy. However, the intensity in this case should be calculated from an individual assessment of the patient’s health status.

Lifespan

How long do people live with lung cancer and how can one determine the life expectancy with lung cancer? It’s sad, but with such a terrifying diagnosis, patients without surgical intervention always face death. About 90% of people die in the first 2 years of life after the disease is diagnosed. But you should never give up. It all depends on what stage your disease was detected at and what type it is. First of all, there are two main types of lung cancer - small cell and non-small cell.

Small cell, mainly affecting smokers, is less common, but spreads very quickly, forming metastases and affecting other organs. It is more sensitive to chemical and radiation therapy.

How long do they live?

The prognosis for lung cancer depends on many factors, but primarily on the type of disease. The most disappointing is small cell cancer. Within 2-4 months after diagnosis, every second patient dies. The use of chemotherapy treatment increases life expectancy by 4-5 times. The prognosis for non-small cell cancer is better, but also leaves much to be desired. If treatment is started in a timely manner, the 5-year survival rate is 25%. There is no definite answer to how long people live with lung cancer; life expectancy is affected by the size and location of the tumor, its histological structure, the presence of concomitant diseases, etc.

Among the variety of all known types of cancer, small cell lung cancer is one of the most common forms of cancer and, according to recent statistics, accounts for about 20% of all tumors affecting the lungs.

The danger of this type of cancer lies, first of all, in the fact that metastasis (the formation of secondary tumor nodes in organs and tissues) occurs quite rapidly, and not only the abdominal organs and lymph nodes are affected, but also the brain.

Small cell lung cancer can be found equally often in both elderly and young people, but the age of 40-60 years can be considered the peak incidence. It is also worth noting that the vast majority of men are susceptible to this disease.

If diagnosed late, such a tumor cannot be treated and, no matter how scary it may sound, leads to death. If the disease is detected in the early stages, the chances of recovery are quite high.

External manifestations

Like many other serious diseases, until a certain point it may not manifest itself at all. However, there are certain indirect signs that in the early stages may raise suspicions about the presence of this type of oncology. These include:

lingering dry cough, and in later stages – cough with blood;
wheezing, hoarse breathing;
chest pain;
decreased appetite and sudden weight loss;
blurred vision.

In the process of metastasis formation, the following signs are added to these signs:

headache;
a sore throat;
pain in the spine;
the skin may take on a slightly yellowish tint.

Diagnostics

If the above symptoms occur in a complex manner, you should immediately consult a doctor, since lung cancer can be absolutely accurately diagnosed only after special laboratory tests:

general and biochemical blood tests;
and lung biopsy (the extent of lung damage is determined);
X-ray examinations of internal organs;
tomography (like X-ray examination, this type of diagnosis is designed to determine the stage of the disease, as well as the intensity of metastasis);
molecular genetic research.

Why is small cell lung cancer dangerous?

For successful treatment of this disease, timely diagnosis is extremely important. Disappointing statistics indicate that only 5% of cases are diagnosed before the disease affects the lymph nodes.

Metastases in this cancer spread to the liver, adrenal glands, lymph nodes, affect bone tissue and even the brain.

Smokers are primarily at risk because... Tobacco smoke contains a huge amount of carcinogens. In addition, many people have a hereditary predisposition to the formation of malignant tumors.

Possible complications and concomitant diseases of small cell lung cancer:

Pneumonia, bronchitis, pneumonia;
Pulmonary hemorrhages;
Cancerous inflammation of the lymph nodes (as a result - difficulty breathing, increased sweating);
Oxygen deficiency;
Negative effects of chemotherapy and radiation on the body (damage to the nervous system, hair loss, disturbances in the gastrointestinal tract, etc.)

The effectiveness of modern methods of treating small cell lung cancer

After all the necessary tests have been passed, studies have been carried out and the diagnosis is confirmed, the doctor prescribes the most optimal method of treatment.

Surgery

Surgery is considered the most effective way to get rid of cancer. During the operation, the affected part of the lung is removed. However, this type of treatment is justified only at an early stage of the disease.

Chemotherapy

This type of treatment is prescribed to patients with a limited stage of lung cancer, when the process of metastasis has already affected other organs. Its essence lies in taking certain drugs in courses. Each course lasts from 2 to 4 weeks. The number of courses prescribed is from 4 to 6. Short breaks must be taken between them.

Radiation therapy

Radiation is most often carried out in combination with chemotherapy, but can be considered as a separate type of treatment. Radiation therapy is applied directly to the foci of pathological formations - the tumor itself and identified metastases. This method of cancer treatment is also used after surgical removal of a malignant tumor - to influence cancerous foci that could not be removed surgically. At an extensive stage, when the tumor has spread beyond one lung, radiation therapy is used to irradiate the brain and also prevent intensive metastasis.

For prevention small cell lung cancer It is necessary to stop smoking, protect yourself from the influence of harmful environmental substances, monitor your health and take measures for the timely diagnosis of various diseases.

(Moscow, 2003)

N. I. Perevodchikova, M. B. Bychkov.

Small cell lung cancer (SCLC) is a unique form of lung cancer, significantly different in its biological characteristics from other forms collectively referred to as non-small cell lung cancer (NSCLC).

There is strong evidence that the occurrence of SCLC is associated with smoking. This is confirmed by the changing frequency of this form of cancer.

An analysis of 20 years of SEER data (1978-1998) showed that, despite the annual increase in the number of patients with lung cancer, the percentage of patients with SCLC decreased from 17.4% in 1981 to 13.8% in 1998, which, according to -apparently associated with the intensive fight against smoking in the United States. Noteworthy is the relative, compared to 1978, reduction in the risk of death from SCLC, first registered in 1989. In subsequent years, this trend continued, and in 1997, the risk of death from SCLC corresponded to 0.92 (95% Cl 0.89 - 0.95,<0,0001) по отношению к риску смерти в 1978 г., принятому за единицу. Эти достаточно скромные, но стойкие результаты отражают реальное улучшение результатов лечения больных МРЛ -крайне злокачественной, быстро растущей опухоли, без лечения приводящей к смерти в течение 2-4 месяцев с момента установления диагноза.

The biological features of SCLC determine the rapid growth and early generalization of the tumor, which at the same time has a high sensitivity to cytostatics and radiation therapy compared to NSCLC.

As a result of the intensive development of methods for treating SCLC, the survival rate of patients receiving modern therapy has increased 4-5 times compared with untreated patients, about 10% of the entire patient population has no signs of the disease within 2 years after the end of treatment, 5-10% live longer 5 years without signs of relapse of the disease, i.e. they can be considered cured, although they are not guaranteed against the possibility of tumor regrowth (or the occurrence of NSCLC).

The diagnosis of SCLC is finally established by morphological examination and is built clinically on the basis of radiological data, which most often reveals the central location of the tumor, often with symptoms of atelectasis and pneumonia and early damage to the lymph nodes of the root and mediastinum. Patients often experience mediastinal syndrome - signs of compression of the superior vena cava, as well as metastatic lesions of the supraclavicular and less commonly other peripheral lymph nodes and symptoms associated with the generalization of the process (metastatic lesions of the liver, adrenal glands, bones, bone marrow, central nervous system).

About two-thirds of patients suffering from SCLC already have signs of metastasis at the first visit, and 10% have brain metastases.

Neuroendocrine paraneoplastic syndromes occur more often than in other forms of lung cancer in SCLC. Research in recent years has made it possible to clarify a number of neuroendocrine characteristics of SCLC and identify markers that can be used to monitor the course of the process, but not for early diagnosis. The markers CYFRA 21-1 and neuron-specific enolase (NSE) are of greatest practical importance when monitoring patients with SCLC. carcinoembryonic antigen (CEA).

The importance of “antioncogenes” (tumor suppressor genes) in the development of SCLC is shown and genetic factors that play a role in its occurrence are identified.

A number of monoclonal antibodies to the surface antigens of small cell lung cancer cells have been isolated, but so far the possibilities of their practical use are limited mainly to the identification of SCLC micrometastases in the bone marrow.

Staging and prognostic factors.

When diagnosing SCLC, assessment of the prevalence of the process, which determines the choice of therapeutic tactics, is of particular importance. After morphological confirmation of the diagnosis (bronchoscopy with biopsy, transthoracic puncture, biopsy of metastatic nodes), CT of the chest and abdominal cavity is performed, as well as CT or MRI of the brain with contrast and bone scanning.

Recently, there have been reports that positron emission tomography (PET) can further clarify the stage of the process.

With the development of new diagnostic techniques, bone marrow puncture has largely lost its diagnostic value, which remains relevant only in the case of clinical signs of bone marrow involvement in the process.

With SCLC, as with other forms of lung cancer, staging is used according to the international TNM system, however, most patients with SCLC at the time of diagnosis already have stages III-IV of the disease, which is why the Veterans Administration Lung Cancer Study Group classification, according to which distinguish between patients with localized SCLC (Limited Disease) and widespread SCLC (Extensive Disease).

In localized SCLC, the tumor lesion is limited to one hemithorax with the involvement of regional and contralateral lymph nodes of the mediastinal root and ipsilateral supraclavicular lymph nodes, when irradiation using a single field is technically possible.

Widespread SCLC is considered to be a process that goes beyond the localized one. Ipsilateral pulmonary metastases and the presence of tumor pleurisy indicates advanced SCLC.

The stage of the process, which determines therapeutic options, is the main prognostic factor in SCLC.

Surgical treatment is possible only in the early stages of SCLC - with a primary tumor T1-2 without regional metastases or with damage to bronchopulmonary lymph nodes (N1-2).

However, surgical treatment alone or a combination of surgery and radiation does not provide satisfactory long-term results. A statistically significant increase in life expectancy is achieved using postoperative adjuvant combination chemotherapy (4 courses).

According to the summary data of modern literature, the five-year survival rate of operable patients with SCLC who received combination chemotherapy or combined chemoradiotherapy in the postoperative period is about 39%.

A randomized trial showed the advantage of surgery over radiation therapy as the first stage of complex treatment of technically resectable patients with SCLC; The five-year survival rate for stages I-II in the case of surgery with postoperative chemotherapy was 32.8%.

The feasibility of using neoadjuvant chemotherapy for localized SCLC, when patients underwent surgical treatment after achieving the effect of induction therapy, continues to be studied. Despite the attractiveness of the idea, randomized studies have not yet made it possible to give a clear conclusion about the advantages of this approach.

Even in the early stages of SCLC, chemotherapy is a mandatory component of complex treatment.

In later stages of the disease, the basis of therapeutic tactics is the use of combination chemotherapy, and in the case of localized SCLC, the feasibility of combining chemotherapy with radiation therapy has been proven, and in advanced SCLC, the use of radiation therapy is possible only when indicated.

Patients with localized SCLC have a significantly better prognosis compared to patients with advanced SCLC.

The median survival of patients with localized SCLC using combinations of chemotherapy and radiation therapy in the optimal regimen is 16-24 months with a 40-50% two-year survival rate and a 5-10% five-year survival rate. In a group of patients with localized SCLC who started treatment in good general condition, a five-year survival rate of up to 25% is possible. In patients with advanced SCLC, median survival can be 8–12 months, but long-term disease-free survival is extremely rare.

A favorable prognostic sign for SCLC, in addition to a localized process, is good general condition (Perfomance Status) and, according to some data, female gender.

Other prognostic signs - age, histological subtype of the tumor and its genetic characteristics, serum LDH level - are ambiguously assessed by various authors.

The response to induction therapy also allows one to predict the results of treatment: only achieving a full clinical effect, i.e., complete tumor regression, allows one to count on a long relapse-free period until cure. There is evidence that patients with SCLC who continue to smoke during treatment have worse survival compared to patients who quit smoking.

In case of relapse of the disease, even after successful treatment of SCLC, it is usually not possible to achieve a cure.

Chemotherapy for SCLC.

Chemotherapy is the mainstay of treatment for patients with SCLC.

Classic cytostatics of the 70-80s, such as cyclophosphamide, ifosfamide, nitroso derivatives CCNU and ACNU, methotrexate, doxorubicin, epirubicin, etoposide, vincristine, cisplatin and carboplatin, have antitumor activity in SCLC of the order of 20-50%. However, monochemotherapy is usually not effective enough, the resulting remissions are unstable, and the survival rate of patients receiving chemotherapy with the drugs listed above does not exceed 3-5 months.

Accordingly, monochemotherapy has retained its importance only for a limited group of patients with SCLC whose general condition is not subject to more intensive treatment.

Based on a combination of the most active drugs, combination chemotherapy regimens have been developed, which are widely used in SCLC.

Over the last decade, the combination of EP or EC (etoposide + cisplatin or carboplatin) has become the standard for the treatment of patients with SCLC, replacing the previously popular combinations CAV (cyclophosphamide + doxorubicin + vincristine), ACE (doxorubicin + cyclophosphamide + etoposide), CAM (cyclophosphamide + doxorubicin + methotrexate) and other combinations.

It has been proven that combinations of EP (etoposide + cisplatin) and EC (etoposide + carboplatin) have antitumor activity in advanced SCLC of the order of 61-78% (full effect in 10-32% of patients). Median survival ranges from 7.3 to 11.1 months.

A randomized trial comparing the combination of cyclophosphamide, doxorubicin and vincristine (CAV), etoposide with cisplatin (EP) and alternating CAV and EP showed equal overall effectiveness of all three regimens (ER -61%, 51%, 60%) with no significant difference in time to progression (4.3, 4 and 5.2 months) and survival (median 8.6, 8.3 and 8.1 months), respectively. Inhibition of myelopoiesis was less pronounced when using EP.

Because cisplatin and carboplatin are equally effective in SCLC and carboplatin is better tolerated, combinations of etoposide with carboplatin (EC) and etoposide with cisplatin (EP) are used as interchangeable therapeutic regimens for SCLC.

The main reason for the popularity of the EP combination is that, having equal antitumor activity with the CAV combination, it inhibits myelopoiesis to a lesser extent compared to other combinations, limiting less the possibilities of using radiation therapy - according to modern concepts, a mandatory component of the treatment of localized SCLC.

Most new modern chemotherapy regimens are based on either adding a new drug to the EP (or EC) combination, or replacing etoposide with a new drug. A similar approach is used for well-known drugs.

Thus, the pronounced antitumor activity of ifosfamide in SCLC served as the basis for the development of the ICE combination (ifosfamide + carboplatin + etoposide). This combination turned out to be highly effective, however, despite the pronounced antitumor effect, severe hematological complications served as obstacles to its widespread use in clinical practice.

At the Russian Scientific Research Center named after. N. N. Blokhin of the Russian Academy of Medical Sciences has developed a combination of AVP (ACNU + etoposide + cisplatin), which has pronounced antitumor activity in SCLC and, most importantly, is effective in brain metastases and visceral metastases.

The AVP combination (ACNU 3-2 mg/m2 on day 1, etoposide 100 mg/m2 on days 4, 5, 6, cisplatin 40 mg/m2 on days 2 and 8, repeated every 6 weeks) was used to treat 68 patients (15 with localized and 53 with advanced SCLC). The effectiveness of the combination was 64.7% with complete tumor regressions in 11.8% of patients and a median survival of 10.6 months. In SCLC metastases to the brain (29 patients evaluated), complete regression as a result of using the AVP combination was achieved in 15 (52% of patients), partial in three (10.3%) with a median time to progression of 5.5 months. Side effects of the AVP combination were of the nature of myelosuppression (leukopenia III-IV stage -54.5%, thrombocytopenia III-IV stage -74%) and were reversible.

New antitumor drugs.

In the nineties of the 20th century, a number of new cytostatics with antitumor activity in SCLC came into practice. These include taxanes (Taxol or paclitaxel, Taxotere or docetaxel), gemcitabine (Gemzar), topoisomerase I inhibitors topotecan (Gicamtin) and irinotecan (Campto), and the vinca alkaloid Navelbine (vinorelbine). A new anthracycline, Amrubicin, is being studied in Japan for SCLC.

Due to the proven possibility of curing patients with localized SCLC using modern chemoradiotherapy, for ethical reasons, clinical trials of new anticancer drugs are carried out on patients with advanced SCLC, or in patients with localized SCLC in case of disease relapse.

Table 1
New drugs for advanced SCLC (first line of therapy) / according to Ettinger, 2001.

A drug	Number of units (estimated)	Overall effect (%)	Median survival (months)


Taxotere
Topotecan
Irinotecan
Irinotecan
Vinorelbine
Gemcitabine
Amrubicin

Summary data on the antitumor activity of new antitumor drugs in SCLC are presented by Ettinger in a review in 2001. .

Information is included on the results of the use of new anticancer drugs in previously untreated patients with advanced SCLC (first line chemotherapy). Based on these new drugs, combinations have been developed that are undergoing phase II-III clinical studies.

Taxol (paclitaxel).

In the ECOG study, 36 previously untreated patients with advanced SCLC received Taxol at a dose of 250 mg/m2 as daily intravenous infusions once every 3 weeks. 34% had a partial response, and the calculated median survival was 9.9 months. In 56% of patients, treatment was complicated by stage IV leukopenia, 1 patient died from sepsis.

In the NCTG study, 43 patients with SCLC received similar therapy protected by G-CSF. 37 patients were assessed. The overall effectiveness of chemotherapy was 68%. No overall effects were recorded. Median survival was 6.6 months. Grade IV neutropenia complicated 19% of all chemotherapy courses.

In case of resistance to standard chemotherapy, Taxol at a dose of 175 mg/m2 was effective in 29%, the median time to progression was 3.3 months. .

The pronounced antitumor activity of Taxol in SCLC served as the basis for the development of combination chemotherapy regimens including this drug.

The possibility of combined use in SCLC of combinations of Taxol and doxorubicin, Taxol and platinum derivatives, Taxol with topotecan, gemcitabine and other drugs has been studied and continues to be studied.

The feasibility of using Taxol in combination with platinum derivatives and etoposide is being most actively studied.

In table 2 presents his results. All patients with localized SCLC received additional radiation therapy to the primary lesion and mediastinum simultaneously with the third and fourth cycles of chemotherapy. The effectiveness of the studied combinations was noted with the pronounced toxicity of the combination of Taxol, carboplatin and topotecan.

table 2
Results of three therapeutic regimens including Taxol for SCLC. (Hainsworth, 2001) (30)

Therapeutic regimen	Number of patients II r/l	Overall efficiency	Median survival (months)	Survival	Hematological complications
					Leukopenia III-IV Art.	Thrombocytopenia	Death from sepsis
Taxol 135 mg/m2 Carboplatin AUC-5

Taxol 200 mg/m2 Carboplatin AUC-6 Etoposide 50/100 mg x 10 days. every 3 weeks

Taxol 100 mg/m2 Carboplatin AUC-5 Topotecan 0.75* mg/m2 Zdn. every 3 weeks

p-advanced SCLC
l-localized SCLC

The multicenter randomized study CALGB9732 compared the effectiveness and tolerability of combinations of etoposide 80 mg/m2 on days 1-3 and cisplatin 80 mg/m2 on day 1, repeating the cycle every 3 weeks (group A) and the same combination supplemented with Taxol 175 mg/m 2 - 1 day and G-CSF 5 mcg/kg days 8-18 of each cycle (gr. B).

Based on the experience of treating 587 patients with advanced SCLC who had not previously received chemotherapy, it was shown that the survival of patients in the compared groups did not differ significantly:

In group A, the median survival was 9.84 months. (95% CI 8.69 - 11.2) in group B 10, 33 months. (95% CI 9, 64-11.1); 35.7% (95% CI 29.2-43.7) of patients in group A and 36.2% (95 CI 30-44.3) of patients in group B lived for more than a year. Toxicity, including stage V toxicity. (drug-related death) was higher in group B, which allowed the authors to conclude that the addition of Taxol to combinations of etoposide and cisplatin in the first line of chemotherapy for advanced SCLC increases toxicity without significantly improving treatment outcomes (Table 3).

Table 3
Results of a randomized trial assessing the effectiveness of the additional inclusion of Taxol in the combination of etoposide with cisplatin in 1 line chemotherapy for advanced SCLC (study CALGB9732)

	Number of patients	Survival		Toxicity > III degree.
	Number of patients	Median (months)		neutropenia	thrombocytopenia	neurotoxicity	Lek. death
Etoposide 80 mg/m2 1-3 days, cisplatin 80 mg/m2 - 1 day. every 3 weeks x6		9,84 (8,69- 11,2)	35,7% (29,2-43,7)
Etoposide 80 mg/m2 1-3 days, cisplatin 80 mg/m2 - 1 day, Taxol 175 mg/m2 1 day, G-CSF 5 mcg/kg 4-18 days, every 3 weeks x6		10,33 (9,64-11,1)

From an analysis of summary data from ongoing phase II-III clinical trials, it is clear that the inclusion of Taxol may increase the effectiveness of combination chemotherapy,

increasing, however, the toxicity of some combinations. Accordingly, the feasibility of including Taxol in combination chemotherapy regimens for SCLC continues to be intensively studied.

Taxotere (doietaxel).

Taxotere (docetaxel) entered clinical practice later than Taxol and, accordingly, later began to be studied in SCLC.

During a phase II clinical study in 47 previously untreated patients with advanced SCLC, Taxotere showed an efficacy of 26% with a median survival of 9 months. Neutropenia IV degree complicated treatment in 5% of patients. Febrile neutropenia was registered, one patient died from pneumonia.

The combination of Taxotere and cisplatin was studied as first line chemotherapy in patients with advanced SCLC in the Chemotherapy Department of the Russian Cancer Research Center named after. N. N. Blokhin RAMS.

Taxotere at a dose of 75 mg/m2 and cisplatin 75 mg/m2 were administered intravenously once every 3 weeks. Treatment was continued until progression or intolerable toxicity. In case of complete effect, 2 additional cycles of consolidation therapy were performed.

Of the 22 patients subject to evaluation, a complete effect was recorded in 2 patients (9%) and a partial effect in 11 (50%). Overall effectiveness was 59% (95% CI 48, 3-69.7%).

The median duration of response was 5.5 months, the median survival was 10.25 months. (95% Cl 9.2-10.3). 41% of patients survived 1 year (95% Cl 30.3-51.7%).

The main manifestation of toxicity was neutropenia (18.4% - stage III and 3.4% - stage IV), febrile neutropenia occurred in 3.4%, and there were no drug-related deaths. Non-hematological toxicity was moderate and reversible.

Topoisomerase I inhibitors.

Among the drugs from the group of topomerase I inhibitors for SCLC, topotecan and irinotecan are used.

Topotecan (Gikamtin).

In the ECOG study, topotecan (Hycamtin) at a dose of 2 mg/m2 was administered daily for 5 consecutive days every 3 weeks. In 19 of 48 patients, a partial effect was achieved (efficacy 39%), the median survival of patients was 10.0 months, 39% of patients survived one year. 92% of patients who did not receive CSF had grade III-IV neutropenia and grade III-IV thrombocytopenia. registered in 38% of patients. Three patients died from complications.

As a second-line chemotherapy, topotecan was effective in 24% of patients who had previously responded to treatment and in 5% of refractory patients.

Accordingly, a comparative study of topotecan and the combination of CAV was organized in 211 patients with SCLC who had previously responded to first line chemotherapy (“sensitive” relapse). In this randomized study, topotecan 1.5 mg/m2 was administered intravenously daily for five consecutive days every 3 weeks.

The results of topotecan did not differ significantly from the results of chemotherapy with the CAV combination. The overall efficacy of topotecan was 24.3%, CAV was 18.3%, time to progression was 13.3 and 12.3 weeks, and median survival was 25 and 24.7 weeks, respectively.

Stage IV neutropenia complicated topotecan therapy in 70.2% of patients, CAV therapy in 71% (febrile neutropenia in 28% and 26%, respectively). The advantage of topotecan was a significantly more pronounced symptomatic effect, which is why the US FDA recommended this drug as second-line chemotherapy for SCLC.

Irinotecan (Campto, CPT-II).

Irinotecan (Campto, CPT-II) turned out to have quite pronounced antitumor activity in SCLC.

In a small group of previously untreated patients with advanced SCLC, it was effective at 100 mg/m2 weekly in 47-50%, although the median survival of these patients was only 6.8 months. .

In several studies, irinotecan was used in patients with relapsed disease after standard chemotherapy, and its effectiveness ranged from 16 to 47%.

The combination of irinotecan with cisplatin (cisplatin 60 mg/m2 on day 1, irinotecan 60 mg/m2 on days 1, 8, 15, repeating the cycle every 4 weeks, 4 cycles in total) was compared in a randomized study with the standard combination EP (cisplatin 80 mg/m2 -1 day, etoposide 100 mg/m2 days 1-3) in patients with previously untreated advanced SCLC. The combination with irinotecan (SR) was more effective than the EP combination (overall efficacy 84% versus 68%, median survival 12.8 months versus 9.4 months, 2-year survival 19% versus 5%, respectively).

The toxicity of the compared combinations was comparable: neutropenia was more often complicated by ER (92%) compared to the SR regimen (65%), diarrhea grade III-IV. occurred in 16% of patients receiving CP.

Also noteworthy is the report on the effectiveness of the combination of irinotecan with etoposide in patients with relapsed SCLC (overall effectiveness 71%, time to progression 5 months).

Gemcitabine.

Gemcitabine (Gemzar) at a dose of 1000 mg/m2 escalated to 1250 mg/m2 weekly for 3 weeks, repeating the cycle every 4 weeks, was used in 29 patients with advanced SCLC as 1st line chemotherapy. The overall effectiveness was 27% with a median survival of 10 months. gemcitabine was well tolerated.

The combination of cisplatin and gemcitabine, used in 82 patients with advanced SCLC, was effective in 56% of patients with a median survival of 9 months. .

Good tolerability and results of using gemcitabine in combination with carboplatin in SCLC, comparable to standard regimens, served as the basis for organizing a multicenter randomized trial comparing the results of using the combination of gemcitabine with carboplatin (GC) and the combination of EP (etoposide with cisplatin) in patients with SCLC with a poor prognosis. Patients with advanced SCLC and patients with localized SCLC with unfavorable prognosis factors were included - a total of 241 patients. The GP combination (gemcitabine 1200 mg/m2 on days 1 and 8 + carboplatin AUC 5 on day 1 - every 3 weeks, up to 6 courses) was compared with the EP combination (cisplatin 60 mg/m2 on day 1 + etoposide 100 mg/m2 per os 2 times a day on days 2 and 3 every 3 weeks). Patients with localized SCLC who responded to chemotherapy received additional radiation therapy and prophylactic irradiation of the brain.

The effectiveness of the GC combination was 58%, the EP combination was 63%, median survival was 8.1 and 8.2 months, respectively, with satisfactory tolerability of chemotherapy.

Another randomized trial, including 122 patients with SCLC, compared the results of 2 combinations containing gemcitabine. The PEG combination included cisplatin 70 mg/m2 on days 2, etoposide 50 mg/m2 on days 1-3, gemcitabine 1000 mg/m2 on days 1 and 8. The cycle was repeated every 3 weeks. The PG combination included cisplatin 70 mg/m2 on day 2, gemcitabine 1200 mg/m2 on days 1 and 8 every 3 weeks. The PEG combination was effective in 69% of patients (complete effect in 24%, partial in 45%), the PG combination in 70% (complete effect in 4% and partial in 66%).

The study of the possibility of improving the results of treatment of SCLC through the use of new cytostatics continues.

It is still difficult to unambiguously determine which of them will change the current treatment options for this tumor, but the fact that the antitumor activity of taxanes, topoisomerase I inhibitors and gemcitabine has been proven allows us to hope for further improvement of modern therapeutic regimens for SCLC.

Molecularly targeted "targeted" therapy for SCLC.

A fundamentally new group of antitumor drugs are molecularly targeted, so-called targeted drugs that have true selectivity of action. The results of molecular biology studies provide convincing evidence that the 2 main subtypes of lung cancer (SCLC and NSCLC) have both common and significantly different genetic characteristics. Due to the fact that SCLC cells, unlike NSCLC cells, do not express epidermal growth factor receptors (EGFR) and cycloxygenase 2 (COX2), there is no reason to expect the possible effectiveness of drugs such as Iressa (ZD1839), Tarceva (OS1774) or Celecoxib, which are being intensively studied in NSCLC.

At the same time, up to 70% of SCLC cells express the Kit proto-oncogene, which encodes the CD117 tyrosine kinase receptor.

The Kit tyrosine kinase inhibitor Gleevec (ST1571) is in clinical trials for SCLC.

The first results of the use of Gleevec at a dose of 600 mg/m2 orally daily as the only drug in previously untreated patients with advanced SCLC showed its good tolerability and the need to select patients depending on the presence of a molecular target (CD117) in the patient's tumor cells.

Among the drugs in this series, Tirapazamine, a hypoxic cytotoxin, and Exizulind, which affects apoptosis, are also being studied. The feasibility of using these drugs in combination with standard therapeutic regimens in hopes of improving patient survival is being assessed.

Therapeutic tactics for SCLC

Therapeutic tactics for SCLC are determined primarily by the prevalence of the process and, accordingly, we specifically focus on the issue of treating patients with localized, advanced and recurrent SCLC.

Some general problems are preliminarily considered: intensification of doses of antitumor drugs, the advisability of maintenance therapy, treatment of elderly patients and patients in severe general condition.

Dose intensification for chemotherapy of SCLC.

The question of the feasibility of intensifying doses of chemotherapy in SCLC has been actively studied. In the 80s, there was an idea that the effect was directly dependent on the intensity of chemotherapy. However, a number of randomized studies have not revealed a clear correlation between the survival of patients with SCLC and the intensity of chemotherapy, which was confirmed by a meta-analysis of materials from 60 studies devoted to this problem.

Arrigada et al. used a moderate initial intensification of the therapeutic regimen, comparing in a randomized study cyclophosphamide at a course dose of 1200 mg/m2 + cisplatin 100 mg/m2 and cyclophosphamide 900 mg/m2 + cisplatin 80 mg/m2 as 1 cycle of treatment (hereinafter therapeutic modes were the same). Among 55 patients who received higher doses of cytotoxic drugs, the two-year survival rate was 43%, compared with 26% for 50 patients who received lower doses. Apparently, the favorable moment was precisely the moderate intensification of induction therapy, which made it possible to obtain a pronounced effect without a significant increase in toxicity.

An attempt to increase the effectiveness of chemotherapy by intensifying therapeutic regimens using autologous bone marrow transplantation, peripheral blood stem cells and the use of colony-stimulating factors (GM-CSF and G-CSF) showed that despite the fact that such approaches are fundamentally possible and the percentage of remissions can be increased, The survival rate of patients cannot be significantly increased.

In the chemotherapy department of the Clinical Research Center of the Russian Academy of Medical Sciences, 19 patients with a localized form of SCLC received therapy according to the CAM regimen in the form of 3 cycles with an interval of 14 days instead of 21 days. GM-CSF (Leukomax) at a dose of 5 μg/kg was administered subcutaneously daily for days 2–11 of each cycle. When compared with the historical control group (25 patients with localized SCLC who received CAM without GM-CSF), it turned out that despite the intensification of the regimen by 33% (the dose of cyclophosphamide was increased from 500 mg/m2/week to 750 mg/m2/week , Adriamycin from 20 mg/m2/week to 30 mg/m2/week and Methotrexate from 10 mg/m2/week to 15 mg/m2/week), the treatment results in both groups are identical.

A randomized study showed that the use of GCSF (lenograstim) at a dose of 5 mcg/kg per day in the intervals between VICE cycles (vincristine + ifosfamide + carboplatin + etoposide) allows increasing the intensity of chemotherapy and increasing two-year survival, but the toxicity of the intensified regimen significantly increases (out of 34 patients, 6 died from toxicosis).

Thus, despite ongoing research into early intensification of therapeutic regimens, there is no convincing evidence of the benefits of this approach. The same applies to the so-called late intensification of therapy, when patients who have achieved remission after conventional induction chemotherapy are administered high doses of cytostatics under the protection of autologous bone marrow or stem cell transplantation.

In a study by Elias et al, patients with localized SCLC who achieved complete or significant partial remission after standard chemotherapy underwent high-dose consolidation chemotherapy with autologous bone marrow transplantation and radiation. After such intensive therapy, 15 of 19 patients had complete tumor regression, and the two-year survival rate reached 53%. The late intensification method is the subject of clinical research and has not yet gone beyond the scope of a clinical experiment.

Maintenance therapy.

The idea that long-term maintenance chemotherapy can improve long-term outcomes in patients with SCLC has been refuted by a number of randomized trials. There was no significant difference in survival between patients who received long-term maintenance therapy and those who did not. Some studies have shown an increase in time to progression, which, however, was achieved at the expense of a decrease in the quality of life of patients.

Modern therapy for SCLC does not provide for the use of maintenance therapy, either with cytostatics or with the help of cytokines and immunomodulators.

Treatment of elderly patients with SCLC.

The possibility of treating elderly patients with SCLC is often questioned. However, age even over 75 years cannot serve as a basis for refusing treatment for patients with SCLC. In cases of severe general condition and the inability to use chemoradiotherapy, treatment of such patients can begin with the use of oral etoposide or cyclophosphamide, followed, if the condition improves, by switching to standard chemotherapy EC (etoposide + carboplatin) or CAV (cyclophosphamide + doxorubicin + vincristine).

Modern treatment options for patients with localized SCLC.

The effectiveness of modern therapy for localized SCLC ranges from 65 to 90%, with complete tumor regression in 45-75% of patients and a median survival of 18-24 months. Patients who start treatment in good general condition (PS 0-1) and respond to induction therapy have a chance of five years of disease-free survival.

The combined use of combination chemotherapy and radiation therapy for localized forms of small cell lung cancer has gained universal acceptance, and the benefits of this approach have been proven in a number of randomized studies.

A meta-analysis of data from 13 randomized trials evaluating the role of chest irradiation in combination with combination chemotherapy for localized SCLC (2140 patients) showed that the risk of death in patients receiving chemotherapy in combination with radiation was 0.86 (95% confidence interval 0.78 - 0.94) in relation to patients who received only chemotherapy, which corresponds to a 14% reduction in the risk of death. Three-year overall survival with the use of radiation therapy was better by 5.4 + 1.4%, which confirmed the conclusion that the inclusion of radiation significantly improves the results of treatment of patients with localized SCLC.

N. Murray et al. studied the issue of the optimal timing of radiation therapy in patients with localized SCLC receiving alternating courses of combination chemotherapy with CAV and EP. 308 patients were randomized to receive 40 Gy in 15 fractions starting in the third week, simultaneously with the first EP cycle, and to receive the same radiation dose during the last EP cycle, i.e., from week 15 of treatment. It turned out that although the percentage of complete remissions did not differ significantly, relapse-free survival was significantly higher in the group who received radiation therapy earlier.

The optimal sequence of chemotherapy and radiation, as well as specific therapeutic regimens, are the subject of further research. In particular, a number of leading American and Japanese specialists prefer the use of a combination of cisplatin with etoposide, starting radiation simultaneously with the first or second cycle of chemotherapy, while in the Research Center of the Russian Academy of Medical Sciences, radiation therapy in a total dose of 45-55 Gy is more often carried out sequentially.

A study of long-term liver outcomes in 595 patients with inoperable SCLC who completed therapy at the Cancer Research Center more than 10 years ago showed that the combination of combination chemotherapy with irradiation of the primary tumor, mediastinum and supraclavicular lymph nodes made it possible to increase the number of clinical complete remissions in patients with a localized process to 64%. The median survival of these patients reached 16.8 months (in patients with complete tumor regression, the median survival is 21 months). 9% have been alive without signs of the disease for more than 5 years, that is, they can be considered cured.

The optimal duration of chemotherapy for localized SCLC is not entirely clear, but there is no evidence of improved survival in patients treated for more than 6 months.

The following combination chemotherapy regimens have been tested and become widespread:
EP - etoposide + cisplatin
EC - etoposide + carboplatin
CAV - cyclophosphamide + doxorubicin + vincristine

As mentioned above, the effectiveness of the EP and CAV regimens for SCLC is almost the same, however, the combination of etoposide with cisplatin, which inhibits hematopoiesis less, is easier to combine with radiation therapy.

There is no evidence of benefit from alternating courses of CP and CAV.

The feasibility of including taxanes, gemcitabine, topoisomerase I inhibitors and targeted drugs in combination chemotherapy regimens continues to be studied.

Patients with localized SCLC who achieve complete clinical remission have a 60% actuarial risk of developing brain metastases within 2-3 years of starting treatment. The risk of developing brain metastases can be reduced by more than 50% when using prophylactic brain irradiation (POI) with a total dose of 24 Gy. A meta-analysis of 7 randomized trials evaluating POM in patients in complete remission showed a reduction in the risk of brain damage, improvement in disease-free survival and overall survival in patients with SCLC. The three-year survival rate increased from 15 to 21% with the use of prophylactic cerebral irradiation.

Principles of therapy for patients with advanced SCLC.

In patients with advanced SCLC, in whom combination chemotherapy is the main treatment method, and radiation is carried out only for special indications, the overall effectiveness of chemotherapy is 70%, but complete regression is achieved in only 20% of patients. At the same time, the survival rate of patients who achieve complete tumor regression is significantly higher than that of patients treated with a partial effect, and approaches the survival rate of patients with localized SCLC.

For SCLC metastases to the bone marrow, metastatic pleurisy, and metastases to distant lymph nodes, combination chemotherapy is the treatment of choice. For metastatic lesions of the mediastinal lymph nodes with compression syndrome of the superior vena cava, it is advisable to use combined treatment (chemotherapy in combination with radiation therapy). For metastatic lesions of the bones, brain, and adrenal glands, radiation therapy is the method of choice. For brain metastases, radiation therapy at 30 Gy gives a clinical effect in 70% of patients, and in half of them complete regression of the tumor is recorded according to CT data. Recently, data have emerged on the possibility of using systemic chemotherapy for SCLC metastases to the brain.

Experience of the Russian Cancer Research Center named after. N. N. Blokhin Russian Academy of Medical Sciences for the treatment of 86 patients with central nervous system lesions showed that the use of combination chemotherapy can lead to complete regression of SCLC metastases to the brain in 28.2% and partial regression in 23%, and in combination with brain irradiation the effect is achieved in 77.8% of patients with complete tumor regression in 48.2%. The problems of complex treatment of SCLC metastases in the brain are discussed in the article by Z. P. Mikhina and co-authors in this book.

Therapeutic tactics for recurrent SCLC.

Despite the high sensitivity to chemotherapy and radiation therapy, SCLC mostly recurs, and in such cases the choice of therapeutic tactics (2nd line chemotherapy) depends on the response to the first line of therapy, the time interval that has passed since its completion and on the nature of tumor spread (localization of metastases) .

It is customary to distinguish between patients with sensitive relapse of SCLC who had a complete or partial effect from first-line chemotherapy and progression of the tumor process no earlier than 3 months after the end of induction therapy, and patients with refractory relapse who progressed during induction therapy or less than 3 months after its end. .

The prognosis for patients with relapsed SCLC is extremely unfavorable and there is no reason to expect a cure. It is especially unfavorable for patients with refractory relapse of SCLC, when the median survival after detection of relapse does not exceed 3-4 months.

In case of sensitive relapse, an attempt may be made to re-use the therapeutic regimen that was effective during induction therapy.

For patients with refractory relapse, it is advisable to use antitumor drugs or their combinations that were not used during induction therapy.

The response to chemotherapy for relapsed SCLC depends on whether it is a sensitive or refractory relapse.

Topotecan was effective in 24% of patients with sensitive relapse and 5% of patients with resistant relapse.

The effectiveness of irinotecan in sensitive relapsed SCLC was 35.3% (time to progression 3.4 months, median survival 5.9 months); in refractory relapse, the effectiveness of irinotecan was 3.7% (time to progression 1.3 months. , median survival 2.8 months).

Taxol at a dose of 175 mg/m2 for refractory relapsed SCLC was effective in 29% of patients with a median time to progression of 2 months. and median survival of 3.3 months. .

A study of Taxotere in relapsed SCLC (without dividing into sensitive and refractory) showed its antitumor activity of 25-30%.

Gemcitabine in refractory relapsed SCLC was effective in 13% (median survival 4.25 months).

General principles of modern treatment tactics for patients with SCLC can be formulated as follows:

For resectable tumors (T1-2 N1 Mo), surgery followed by postoperative combination chemotherapy (4 courses) is possible.

The feasibility of using induction chemotherapy and chemoradiotherapy followed by surgery continues to be studied, but convincing evidence of the benefits of this approach has not yet been obtained.

For inoperable tumors (localized form), combination chemotherapy (4-6 cycles) in combination with irradiation of the tumor area of the lung and mediastinum is indicated. Maintenance chemotherapy is not appropriate. If complete clinical remission is achieved, preventive irradiation of the brain is performed.

In the presence of distant metastases (a common form of SCLC), combination chemotherapy is used, radiation therapy is carried out according to special indications (metastases to the brain, bones, adrenal glands).

Currently, the possibility of curing about 30% of patients with SCLC in the early stages of the disease and 5-10% of patients with inoperable tumors has been convincingly proven.

The fact that in recent years a whole group of new antitumor drugs active in SCLC has appeared allows us to hope for further improvement of therapeutic regimens and, accordingly, improved treatment outcomes.

A list of references for this article is provided.
Please, introduce yourself.

Lung cancer ranks first in the frequency of diagnosis among all cancers. The most aggressive form of lung oncology is small cell lung cancer, which is characterized by a latent course of the disease, early metastasis and an unfavorable prognosis.

What is small cell lung cancer

Small cell cancer is a malignant neoplasm that is localized in the human respiratory system. This tumor can initially be divided into two types - small cell carcinoma of the left and right lung. The name of this disease can be explained by the size of the cellular structures, which are small in size, only 2 times larger than the size of blood cells (erythrocytes).

Leading clinics in Israel

Small cell cancer is not as common as non-small cell cancer (diagnosed in 80% of cases). Most often, this pathology is observed in smoking men aged 50-62 years. Due to the increasing number of female smokers, the number of cases among women is also increasing.

The tumor almost always begins as a central cancer; this type is fleeting - it spreads very quickly, seeding the entire lung tissue, forming metastases in neighboring organs. This type of lung oncology is an intensively proliferating subtype of tumors with a high malignancy potential. Metastases affect not only the retroperitoneal organs and lymph structures, but also the brain.

This type of oncology is based on cancerous degeneration of the epithelium of lung tissue and impaired air exchange. This type of lung cancer is the most difficult to treat; it is fatal in 85% of cases.

Video on the topic:

Causes

The causes of tumor pathogenesis can be:

smoking. This is the root cause of the beginning of the transformation of the cell structure of the lung tissue;
heredity (the presence of a similar disease in relatives in the medical history increases the risk of getting this disease);
unfavorable ecology in the patient’s area of residence;
previously suffered severe lung diseases (asthma, chronic obstructive pulmonary disease, pulmonary tuberculosis, and other infectious diseases and pathological neoplasms);
prolonged contact with carcinogenic substances (arsenic, nickel, chromium). Contact is possible both at places of residence and at places of work;
the impact of radioactive ions on the body (for example, possible during various man-made disasters);
pulmonary asbestosis;
dust exposure;
influence of radon.

Symptoms of the disease

At the initial stages of formation, small cell cancer is not expressed by specific symptoms; the symptoms can be disguised as other pathologies of the pulmonary system. But with the further spread of small cell lung cancer and its rapid metastasis, the symptoms begin to be clearly visible and become noticeable.

In the early stages, it is possible to suspect this type of lung cancer only by some indirect signs:

cough (at the initial stages, dry and lingering, later acquiring a paroxysmal character and becoming persistent, with sputum and blood discharge);
pain in the chest area;
mediastinal compression;
causeless shortness of breath that occurs from time to time;
weakness, general malaise;
severe loss of appetite, sudden weight loss, cachexia;
Possible decreased vision;
hoarseness occurs when breathing, hoarseness in the voice when speaking (dysphonia).

With late diagnosis, metastases of this cancer spread and the clinical picture is complemented by the following symptoms:

intense headaches of various types (pulsating and pulling, localized in one place, to migraine-like tingling that covers the entire head);
pain localized in the entire back area, often radiating to the projection of the spine, bone pain, aching joints (this is associated with metastases in bone tissue).

In the final stages, when mediastinal tissues are involved in the cancer process, mediastinal compression syndrome develops, consisting of:

dysphagia (eating disorder, when it becomes difficult for the patient to swallow food or it is simply impossible);
hoarseness (appears with laryngeal nerve paralysis);
abnormal swelling of the neck and face (usually unilateral, appears when the superior vena cava is compressed).

With metastases in the liver, icterus of the skin and the development of hepatomegaly are possible. Hyperthermic manifestations, paraneoplastic syndrome (Lambert-Eaton myasthenic syndrome, antidiuretic hormone secretory disorder syndrome, Cushingoid manifestations) may occur.

At stage 4, speech impairment is observed and high-intensity headaches occur, noisy breathing, dermatitis may appear, deformation of the fingers in the image of “drum sticks” is observed, symptoms of general intoxication, temperature increases, obstructive pneumonia, and confused consciousness occurs.

Signs of pathology may vary depending on the location of the original neoplasm.

Small cell cancer is usually central; peripheral cancer is less common. A primary tumor (as opposed to a secondary tumor) is detected extremely rarely by radiography.

Stages of the disease and types of cancer

The division of small cell cancer according to the TNM classification has no fundamental differences and consists of the following positions: T - shows the state of the primary tumor, N - the state of regional lymph nodes, M - the presence and absence of distant metastasis.

A clear division into stages helps determine the methods of treating the tumor - surgical or therapeutic.

Stage 1 – tumor size is within 3 cm, the tumor affects one lung, there are no metastases.

Stage 2 – the size of the neoplasm is 3-6 cm, it blocks the bronchus and penetrates the pleura, causing atelectasis;

Stage 3 – cancer quickly spreads to neighboring organs, the tumor grows to 6-7 cm, atelectasis of the entire lung occurs, and metastases are present in neighboring lymph nodes.

Stage 4 – malignant cells are present in distant organs.

More than half of patients are diagnosed with stage 3 or 4, so this type of cancer is considered according to the criteria of two important categories: localized (limited) or widespread cancer:

the localized form involves only one lung in the process (right-sided and left-sided forms are divided);
the common variant (it is comparable to stages 3-4 according to the TNM system) occurs in 60-65% of cases. It covers two parts of the chest together with the tumor process, with the addition of cancerous pleurisy and the rapid appearance of metastases.

According to histology, lung cancer is divided into the following types:

Squamous cell (epidermoid) carcinoma, which has subspecies:

highly differentiated;
moderately differentiated;
poorly differentiated.

Small cell cancer It happens:

oat cell, fine granular, spindle cell;
intermediate (intercellular);
pleomorphic (multicellular).

Adenocarcinoma divided into:

highly differentiated;
moderately differentiated;
poorly differentiated (poorly differentiated);
bronchoalveolar.

Large cell carcinoma has two subspecies:

clear cell;
giant cell.

Mixed type cancer happens:

adenocarcinoma and small cell;
squamous cell and adenocarcinoma, etc.

The histological characteristics are rather arbitrary, since the clinical course may differ even in tumors with the same structure.

Don't waste your time searching for inaccurate cancer treatment prices

*Only upon receipt of information about the patient’s disease, a representative of the clinic will be able to calculate the exact price for treatment.

Diagnosis of the disease

To make a diagnosis, various instrumental and laboratory tests are carried out, consisting of:

chest x-ray;
MRI, PET, computed tomography (CT);
skeletal scintigraphy;
liver function tests;
blood test;
sputum analysis (cytology test to detect cancer cells);
thoracentesis (sampling of fluid from the chest cavity near the lungs);
IAP (intra-abdominal pressure) measurements;
analysis for tumor markers;
biopsy of the tumor or nearby lymph nodes.

There are several ways to do a biopsy, using:

bronchoscopy;
endoscopic ultrasound examination;
mediastinoscopy.

Also do:

pleural biopsy;
open lung biopsy;
videothoracoscopy.

Treatment of small cell lung cancer

The main methods of treating this cancer are: polychemotherapy and radioirradiation. It makes sense to perform surgical intervention only in the early stages.

Lung cancer therapy is also carried out using other treatment methods:

immunotherapy
brachytherapy;
photodynamic therapy;
targeted therapy;
laser coagulation;
radiofrequency ablation;
cryodestruction;
chemoembolization;
radioembolization;
biotherapy.

Each of these methods can be used in the treatment of lung cancer.

The goal of therapy for small cell lung cancer is to achieve absolute remission, which is confirmed by biopsy, bronchial examination (bronchoscopy), and bronchoalveolar lavage. The effectiveness of treatment can be assessed 6-12 weeks after the start of therapy, and then a prognosis for life expectancy can be made.

Chemotherapy is considered the most effective treatment for lung cancer, carried out as an independent method of treatment and as an addition to radiation exposure. Women are more sensitive to treatment.

Chemotherapy is used only when neither chemotherapy nor radiotherapy has been performed before, there are no concomitant severe diseases, heart or liver failure, and bone marrow potential is within normal limits. If the patient's condition does not meet these indicators, the dosage of chemotherapy is reduced to avoid serious side effects.

Chemotherapy for small cell cancer is effective at any stage - in the initial stages it can prevent the spread of metastases, in the latter stages it helps alleviate the course of the disease and prolong the patient’s life. Avastin is also used to suppress tumor angiogenesis, which affects this process of tumor development by binding to the VEGF protein.

A limited form of lung tumor (right or left) requires a small number (2-4) courses of chemotherapy. Cytostatic drugs are usually used: Doxorubicin, Cyclophosphamide, Gemcitabine, Cisplatin, Etoposide, Vincristine and others. Cytostatics are used as monotherapy or in combination with irradiation of the primary tumor site. During remission, radioirradiation of the brain is additionally performed to reduce the risk of metastatic contamination.

Combination therapy for a limited form of small cell cancer gives a chance to prolong life up to 2 years. With an advanced form of lung cancer, the number of chemotherapy courses increases to 4-6. In the presence of metastases in nearby and distant organs (adrenal glands, skeletal system, brain and others), chemotherapy is carried out accompanied by radiotherapy.

Drug (palliative) treatment is more often used to maintain the vital functions of already affected organs and alleviate the patient’s condition. This type of treatment is supportive. Drugs of various pharmacological groups are used:

pain medications (including narcotic drugs),
anti-inflammatory drugs;
antibiotic substances to prevent infection and worsen the disease;
medications to protect the liver (Essentiale);
means for supplying oxygen to cell structures (“Pantogam”, “Glycine”) - in case of damage to brain cells;
lowering temperature (Nimesulide, Paracetamol, Ibuprofen) for hyperthermia.

Surgical intervention for small cell cancer is carried out at stages 1-2 and is necessarily accompanied by a course of postoperative chemotherapy. When excision of malignant organ tissues, life expectancy increases. If this lung cancer is determined to be in the last stages and the cancer process has spread to other organs, surgical treatment is not performed due to the increasing risk of death during the operation. In addition to the classic method of tumor removal, gentle surgical intervention can be used using a cyber knife.

Treatment of localized small cell cancer and prognosis

When treating this form of cancer, the prognosis is as follows:

tumor regression occurs in 45-75% of cases;
effectiveness of therapy - 65-90%;
2-year survival rate - 40-50%;
The 5-year survival rate is 10-25% for patients who begin treatment in good general health.

The main method of treating a localized form of this cancer is chemotherapy (2-4 courses) in combination with radiation therapy. Radiation therapy is carried out during chemotherapy or after the patient has received several courses of chemotherapy. During remission, irradiation of the brain is performed, since this type of cancer has a tendency to quickly and aggressively metastasize to the brain.

Treatment regimens used:

combined: chemotherapy and radiation therapy with prophylactic cranial irradiation (PCR) in the presence of remission;
chemotherapy with or without PCO, for patients with deteriorating respiratory function;
surgical resection in combination with adjuvant therapy for patients at stage 1;
combined use of chemotherapy and thoracic radiation therapy - used for patients with limited stage.

How to treat advanced small cell cancer

In the case of a common form, combined treatment is carried out; irradiation makes sense when the following indicators occur:

ongoing process of metastasis in the adrenal glands;
bone metastases;
metastasis in the lymph nodes, mediastinum with compression syndrome of the superior vena cava;
metastases in the brain.

Methods of therapy used:

combination chemotherapy with or without cranial irradiation;
"Ifosfamide" together with "Cisplatin" and "Etoposide";
"Cisplatin" + "Irinotecan";
combination of Etoposide, Cisplatin and Carboplatin;
"Cyclophosphamide" together with "Doxorubicin", "Etoposide" and "Vincristine";
combination of Doxorubicin with Cyclophosphamide and Etoposide;
Cyclophosphamide in combination with Etoposide and Vincristine.

Radiation is used when chemotherapy is ineffective, especially for metastases in the spinal cord, brain or bones.

The combination of Cisplatin and Etoposide gives a good effect. Although Cisplatin often has significant side effects, leading to serious consequences for those with cardiovascular diseases. Carboplatin is not as toxic as Cisplatin.

Nutrition for lung cancer, as for other types of oncology, should be gentle and nutritious; adherence to a diet, diet and giving up bad habits is mandatory.

The use of folk remedies is possible as an addition to the main treatment and only with the permission of the attending physician. Refusal of basic treatment in favor of traditional medicine can lead to a deterioration in the patient’s condition and the transience of the disease, followed by death.

It is useful to drink decoctions of medicinal herbs during the stages of remission, as well as to reduce pain syndromes during the main treatment, informing the doctor.

Would you like to receive an estimate for treatment?

*Only upon receipt of data on the patient’s disease, a representative of the clinic will be able to calculate an accurate estimate for treatment.

How long do you live with small cell lung cancer?

With timely diagnosis and treatment, there is a chance of recovery.

A transient disease provides about 8-16 weeks of life (after which the patient dies) if treatment is refused or resistant to it.

All patients who have crossed the 3-year life expectancy threshold belong to the group of complete remission; their survival rate can reach 70-92% of the total number of this disease.

If the size of the tumor after treatment has decreased by half or more from its original size, then this indicates partial remission, and the life expectancy of these patients is half as long as the previous one.

Only 5-11% of all patients overcome the five-year survival threshold.

The general prognosis for life expectancy depends on:

timely diagnosis;
stage of the detected disease;
high-quality comprehensive treatment;
postoperative (or after a course of polychemotherapy) observation;
the general health of the patient.

With combined treatment at stages I and II, the chances of crossing the 5-year threshold are about 40%.

In later stages, with combination therapy, life expectancy increases by an average of two years.

In patients with a localized tumor (not an early stage, but without distant metastasis) using complex therapy, the two-year survival rate is about 65-75%, about 5-10% of patients can overcome the 5-year threshold, with good health the chances of surviving up to 5 years increase in 25% of patients.

For advanced stage 4 lung cancer, survival is usually up to 1 year. The prognosis for absolute cure (without relapses) is unlikely.

Small cell lung cancer is a malignant neoplasm that develops as a result of pathological changes in the cells of the mucous membrane of the respiratory tract. The disease is dangerous because it develops very quickly, and even in the initial stages it can metastasize to the lymph nodes. The disease occurs more often in men than in women. At the same time, smokers are most susceptible to its occurrence.

As in any other cases, there are 4 stages of small cell type lung cancer. Let's look at them in more detail:

Stage 1	the tumor is small in size, localized in one segment of the organ, there is no metastasis
Stage 2 SCLC	the prognosis is quite comforting, although the size of the tumor is much larger, can reach 6 cm. Single metastases are observed. Their location is regional lymph nodes
Stage 3 SCLC	the prognosis depends on the characteristics of a particular case. The tumor can exceed 6 cm in size. It spreads to adjacent segments. Metastases are more distant, but are located within regional lymph nodes
Stage 4 SCLC	the prognosis is not as comforting as in previous cases. The neoplasm extends beyond the organ. Extensive metastasis occurs

Of course, the success of treatment, as with any cancer, will depend on the timeliness of its detection.

Important! Statistics show that small cell makes up 25% of all existing varieties of this disease. If metastasis occurs, in most cases it affects 90% of the thoracic lymph nodes. The share of the liver, adrenal glands, bones and brain will be slightly smaller.

Clinical picture

The situation is aggravated by the fact that the symptoms of small cell lung cancer at the initial stage are practically invisible. They can often be confused with a common cold, because a person will experience a cough, hoarseness, and difficulty breathing. But when the disease becomes more serious, the clinical picture becomes clearer. A person will notice such signs as:

worsening cough that does not go away after taking regular cough medications;
pain in the chest area that occurs systematically, increasing in intensity over time;
hoarseness of voice;
blood in the sputum;
shortness of breath even in the absence of physical activity;
loss of appetite and, accordingly, weight;
chronic fatigue, drowsiness;
difficulty swallowing.

Such symptoms should prompt immediate medical attention. Only timely diagnosis and effective therapy will help improve prognosis for SCLC.

Diagnosis and treatment features

Important! Most often, SCLC is diagnosed in people aged 40-60 years. At the same time, the proportion of men is 93%, and women suffer from this form of cancer only in 7% of the total number of cases.

High-precision diagnostics performed by experienced specialists is the key to successful recovery from the disease. It will allow you to confirm the presence of oncology, as well as determine exactly what type of cancer you are dealing with. It is quite possible that we are talking about non-small cell lung cancer, which is considered a less aggressive type of disease and allows for more comforting prognoses.

The main diagnostic methods should be:

laboratory blood tests;
sputum analysis;
chest x-ray;
CT scan of the body;

Important! A lung biopsy is required, followed by examination of the material. It allows you to more accurately determine the characteristics of the neoplasm and its nature. A biopsy may be performed during bronchoscopy.

This is a standard list of studies that the patient must undergo. It can be supplemented with other diagnostic procedures if necessary.

If we talk about the treatment of small cell lung cancer, the main method remains surgery, as with other types of oncology. It is carried out in two ways - open and minimally invasive. The latter is more preferable because it is considered less traumatic, has fewer contraindications, and is characterized by high accuracy. Such operations are performed through small incisions on the patient’s body and are monitored by special video cameras that display images on a monitor.

Considering the fact that the type of oncology in question progresses very quickly and is often detected already at the metastasis stage, doctors will use chemotherapy or radiation therapy as additional methods of treating SCLC. In this case, irradiation or therapy with antitumor drugs can be carried out before surgery, with the goal of stopping tumor growth, destroying cancer cells, and are also often performed after surgery - here they are needed to consolidate the result and prevent relapse.

Additional methods of therapy can be used in combination. This way you can achieve a more significant result. Sometimes doctors resort to polychemotherapy, combining several drugs. Everything will depend on the stage of the disease, the characteristics of the health status of the individual patient. Radiation therapy for SCLC can be internal or external - the appropriate method is determined by the size of the tumor, as well as the extent of metastases.

As for the question of how long people live with SCLC, it is difficult to give an unambiguous answer. Everything will depend on the stage of the disease. But, given the fact that pathology is often detected already in the presence of metastasis, the main factors determining life expectancy will be: the number of metastases and their location; professionalism of attending physicians; accuracy of the equipment used.

In any case, even in the last stage of the disease, there is a chance to prolong the patient’s life by 6-12 months, significantly alleviating the symptoms.