Small Cell Lung Cancer: Treatment Methods

Surgery is rarely used in small cell lung cancer. In fewer than one out of 20 cases, the small cell lung cancer is in only one tumor nodule, with no spread to lymph nodes or other organs. In these cases, surgery might be helpful and it is usually followed by further treatment with chemotherapy or radiation.

Several different operations can be used to treat small cell lung cancer:

• Pneumonectomy: the entire lung is removed in this surgery.
• Lobectomy: a section (lobe) of the lung is removed in this surgery.
• Segmentectomy or wedge resection: part of a lobe is removed in this surgery.

As a rule, lobectomy is the preferred operation for small cell lung cancers treated with surgery. With any of these operations, lymph nodes are also removed to look for possible spread of the cancer.

These operations are done with the patient asleep (under general anesthesia). You will most likely need to spend about a week in the hospital after the surgery. There will be some pain after the surgery because the surgeon has to cut through the ribs to get to the lungs. Other possible problems include bleeding, wound infections, and pneumonia.

Video-assisted thoracic surgery (VATS). There is a new kind of surgery for people with early stage lung cancer. It is called video-assisted chest surgery (VATS). A tiny camera can be placed through a small hole in the chest to help the surgeon see the tumor. One or 2 other small holes are made in the skin, and long instruments passed though these holes are used to remove the tumor. Only small cuts (incisions) are needed, so there is less pain after surgery. This approach is most often used for tumors smaller than about 1½ inches. The cure rate seems to be the same as for standard surgery. The doctor who does this surgery should have experience because it takes a great deal of skill.

Problems after surgery depend on how much surgery was done and a person's health before the operation. Serious problems can include a lot of bleeding, infection, and pneumonia. While it is rare, in some cases people may not survive the surgery, which is why it is very important that surgeons select patients with care. People whose lungs are in good shape (other than the cancer) can often return to normal activities after a lobe or even an entire lung is removed. But if they also have problems such as emphysema or chronic bronchitis (these are common in heavy smokers), they may have long-term shortness of breath.

If you have a thoracotomy, the incision will hurt for some time after surgery. Your activity will be limited for at least a month or two.

Surgery to relieve problems. In some cases, surgery may be used to help treat the symptoms of the cancer (rather than trying to remove all of the cancer). For instance, laser surgery can be used to relieve blockage of airways that may be causing pneumonia or shortness of breath. Sometimes, metal or plastic tubes (called stents) may be placed in the airways to help keep them open. Other methods like radiation (described in the next section) may also be used.

Sometimes fluid collects in the chest and makes it hard to breathe. This fluid can be removed through a small tube placed in the chest. After the fluid is drained out either talc or some type of drug is placed into the chest. This will start a reaction that will help seal the space and prevent future fluid build-up.

Lung Cancer and Radiation Therapy

Radiation therapy is treatment with high-energy rays (like X-rays) to kill or shrink cancer cells. The radiation comes from outside the body (external radiation). In small cell lung cancer it is most often used along with chemotherapy (in limited stage disease) to treat the tumor and lymph nodes in the chest.

Radiation might be used after surgery to kill small areas of cancer that can't be seen and removed during surgery. Or it could be used on the brain to try to prevent the spread of cancer there. Radiation can also be used to relieve symptoms such as pain, bleeding, trouble swallowing, or problems caused by the cancer spreading to the brain. It is usually given in small daily doses over many weeks.

Standard radiation is used less often than in the past. Newer methods allow doctors to be more precise in treating lung cancers while reducing radiation to nearby healthy tissues.

Side effects of radiation could include skin problems at the area being treated, nausea, vomiting, and tiredness. Chest radiation may cause lung damage and trouble breathing or swallowing. Often these problems go away after treatment ends.

Side effects of radiation therapy to the brain usually become most serious one or two years after treatment. These side effects could include memory loss, headaches, trouble with thinking, and less sexual desire. These side effects, though, are minor compared to those caused by lung cancer tumors that have spread to the brain.

Lung Cancer and Chemotherapy

Chemotherapy (often called simply "chemo") is treatment with drugs given into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body. This treatment is useful for cancer that has spread (metastasized) to organs beyond the lung. Chemo is usually the main treatment for small cell lung cancer.

Doctors give chemo in cycles, with each round of treatment followed by a rest period to allow the body time to recover. Chemo cycles last about three to four weeks, and the first round of treatments is most often four to six cycles. Chemo is not often used for patients in poor health, but older age by itself is not a barrier to getting chemo.

Chemo drugs kill cancer cells but they also damage some normal cells, causing side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment. You could have some of these short-term side effects: ·

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• feeling very tired all the time, called fatigue (due to low red blood cell counts)

Some chemotherapy drugs can damage nerves. This can cause numbness in the fingers and toes, and sometimes the arms and legs may feel weak. You should report this, as well as any other side effects or changes you notice while getting chemo so that they can be treated right away.

Most of these side effects go away when treatment is over. Be sure to tell your doctor or nurse if you have any side effects, as there are often ways to help.