Small cell lung cancer (SCLC)

Small cell lung cancer (SCLC) is one of the most aggressive forms of cancer. The size of a tumor in this form can double in a matter of weeks. Therefore, when making a diagnosis and at the beginning of treatment, many patients are already at a progressive stage of the disease, in which a surgical operation is no longer used.

Stages of small cell lung cancer

By stage, the disease is divided into two groups:

• A tumor is considered at a localized stage within the chest, if it is infiltrated into the pleura, mediastinal lymph nodes, supraclavicular region and lower part of the neck. It accounts for approximately 30% of all cases of lung cancer.
• Extended stage is when the tumor has spread beyond the lymph nodes of the supraclavicular region, and all other cases.

Risk factors for small cell lung cancer

The overall incidence and death rates of SCLC are constantly decreasing due to the introduction of a routine chest radiography.

The main risk factors for occurrence of SCLC are considered:

• Family history of lung cancer.
• Tobacco smoking in the present or in the past.
• Inhalation of tobacco smoke.
• Radiation exposure doses exceeding physiological norms.
• Living in areas with polluted air.

Very often lung cancer is detected by symptoms or a chest radiography. Symptoms can vary depending on involvement of the lung and breast tissue, and other body tissues, the presence of metastases and paraneoplastic syndrome. Symptoms can range from worsening coughing, shortness of breath, to swallowing disorders in advanced cases, and swelling of the face due to compression of the chest nerves and veins.

In the case of metastasis to the brain, personality disorders and dysfunction of the central nervous system can occur, as well as pain in the bone tissue during metastasis to the bone.

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Diagnosis

The management and treatment method is determined by the results of histological examination, stage of the disease, patient’s condition and concomitant diseases. During diagnosis, our Israeli oncologists determine the presence of precisely small cell lung cancer, or another type, as well as the stage of the disease, on which further treatment and the choice of targeted therapy will depend.

Diagnosis may include (as directed by the physician):

• Physical examination and disease history review.
• X-ray of the chest.
• Histopathological results of sputum.
• CT scan of the chest.
• Lung Biopsy with a fine needle FNA under x-ray or CT control or bronchoscopy.
• Mediastinoscopy.

When diagnosing, our Israeli specialists perform taking a biopsy procedure in a minimally invasive way.

Treatment of small cell lung cancer

Types of treatment for small cell lung cancer:

• Standard chemotherapy using etoposide + cisplatin or etoposide + carboplatin.
• Radiation therapy (radiotherapy)
• Chemotherapy with the use of drugs – monoclonal antibodies or control point inhibitors CTLA-4 and PD-1:
  • paclitaxel
  • docetaxel
  • topotecan
  • pembrolizumab (Keytruda)
  • nivolumab (Opdivo)
  • atezolizumab (Tecentriq) (2018)
  • durvalumab (2018)
  • erlotinib
  • gefitinib
  • osimertinib
• Surgery (in rare cases after RT and CT).

Basically, the treatment takes place with standard means using carboplatin and etoposide, and until 2018 more than 60 medicines were tested in clinical studies. Drugs that have not passed phase 3 clinical trials, because did not yield any median survival advantage. But now, a new generation of drugs, atezolizumab as class of control point inhibitors, has emerged, which double the survival rate compared to the classic treatment.

Israeli oncologists have achieved good results in the treatment of small cell lung cancer under the condition of immediate qualified medical assistance, right diagnosis and proper treatment.