Treat small cell lung cancer. Why does small cell lung cancer develop and how does it manifest? Indications for surgery

Oncologists distinguish two main histological types of lung cancer (not counting other types that are much less common) - non-small cell (NSC) and small cell (SCLC). The latter variant of the disease is considered the most malignant and is characterized by a high likelihood of metastases and high metabolic activity. Treatment of the disease involves chemotherapy or radiation therapy.

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Features and causes of the disease

Small cell cancer lung develops from Kulchitsky cells, which are located in the bronchial epithelium. This type of LC is characterized by a highly aggressive course:
- fast growth;
- early generalization;
- active distant metastasis.
The most commonly reported metastases of SCLC are the brain or spinal cord, bones and red bone marrow. However, spread to the liver, kidneys, adrenal glands, contralateral lung and distant lymph nodes is also possible.

The causes of this type of LC are today completely unknown, as with any cancer. A hereditary predisposition to this cancer has been confirmed.

Risk factors that influence the occurrence of lung cancer are the following:
- smoking;
- household and chemical carcinogens (asbestos, chromium compounds, arsenic, vinyl chloride, coal or wood dust, PAHs (polyaromatic hydrocarbons), etc.);
- radiation (radon);
- infectious lung diseases (frequent ARVI, Pneumocystis pneumonia in HIV-infected people, inactive tuberculosis);
- chronic nonspecific lung diseases.
SCLC is a histological type of malignant pulmonary lesion, but there is also a conditional division into clinical and anatomical forms: central, peripheral cancer and atypical forms. An X-ray picture of the lungs helps to distinguish them.

The border between the central and peripheral RL is considered to be the subsegmental bronchus.

It is important, in addition to determining the histological identity and form of lung cancer, to establish the stage of the oncological process. The latter helps the doctor choose best scheme treatment. The stage is determined by the size of the tumor, its extent in the lymph nodes, and the presence of other tumors in the body that the doctor believes are related to the main tumor in the lungs (metastases). This process is carried out according to the TNM classification (T - tumor, N - lymph nodes, M - metastases). There are 4 stages in total, where the 4th has the worst prognosis.

Manifestations

To date, MRL does not have specific symptoms, All clinical manifestations that can be detected in a patient can also be observed in other diseases of the lungs and cardiovascular system.

Patients usually complain of:
- primary (local) symptoms;
- signs or syndromes of locally advanced cancer:
  - superior vena cava compression syndrome (headaches, puffy face (facial cyanosis), bull neck, venous pattern on the anterior chest wall);
  - Pencoast syndrome (shoulder pain, paresthesia (numbness, "pins and needles"), atrophy of the forearm muscles, Horner's syndrome (miosis, ptosis, enophthalmos, sweating disorder), shadow image of a tumor at the apex of the lung);
  - dysphagia (impaired swallowing);
  - hoarseness of voice (up to its loss - aphonia);
- symptoms of distant metastases (depending on their location);
- paraneoplastic syndromes (PS);
- general symptoms, signs of intoxication (decreased appetite, weight loss (even if the diet does not change), fatigue, weakness).
Manifestations of the first group depend on the location and form of tumor growth. Primary symptoms include:
- prolonged cough (dry or with mucous or purulent sputum);
- hemoptysis varying degrees, up to pulmonary hemorrhage;
- pain in the chest on the affected side;
- dyspnea;
- increase in body temperature.
All of the above symptoms are characteristic of the central form of LC.

A feature of the peripheral form of LC is its asymptomatic course. However, there are 2 options for development dynamics:
- appearance in the chest pain on the affected side (this is noted when the tumor grows into the pleura);
- the appearance of signs of central lung cancer (when the tumor invades a large bronchus).
Paraneoplastic syndromes

PS is understood as a complex of symptoms that occur in a patient with cancer. It should be remembered that there are a large number of them, they do not have high specificity, allowing one to suspect a particular tumor. Sometimes PS can be the only manifestation of the disease, which confuses the treating doctor.

The most common PSs encountered in patients with SCLC are:
- Itsenko-Cushing syndrome;
- Schwartz-Bartter syndrome;
- carcinoid syndrome;
- autonomic neuropathy;
- Eaton-Lambert syndrome;
- hyperpigmentation.
The above syndromes do not exclude the presence of other manifestations in the patient.

Diagnosis of the disease

All LC diagnostics consist of three types - mandatory (to detect the tumor itself), clarifying (to assess the spread of the oncological process) and functional (determining the patient’s condition).

To detect a malignant tumor in the lungs, the following mandatory tests are used: instrumental methods research:
- radiography of organs chest(OGK) in 2 projections (in case of tumor size more than 1 cm);
- computed tomography of the OGK (does not allow detection of pleurisy);
- bronchoscopy with biopsy of any suspicious area (highest efficiency).
It should be noted that the peripheral form of LC during bronchoscopy is difficult to detect for biopsy. Therefore, it is recommended to perform a blind biopsy (so-called blind biopsy) if there is suspicion. The essence of this method is scraping, which allows in 80% of cases to make a diagnosis without seeing the tumor itself.

In some rare situations, your doctor may order a biopsy of lymph nodes in the armpits and neck.

In oncology, there is the following rule - any tumor must be confirmed morphologically (that is, using a biopsy). Sometimes this procedure may be performed urgently during surgery.

The disease is expressed strong growth tumors and an increase in malignant cells in a person’s lungs, as a rule, implies stage 4 lung cancer and the prognosis for it, unfortunately, is unfavorable. With stage 4 cancer, extensive metastases form, which grow beyond the lungs, affect the lymph nodes, enter the liver, bone tissue, kidneys, into the human brain. As a result, the bronchial walls are affected, the mucous membrane is destroyed and blood vessels, chest pains appear more and more often. The pain that occurs in such cases is very closely related to damage to the tissues adjacent to the lungs - oddly enough, in the most lung tissue no pain receptors.

The picture of the disease is very pronounced: paroxysmal, hysterical cough with the presence of bleeding in sputum. Shortness of breath, angina pectoris develops, and heart rhythm is disturbed.

Prognosis for non-small cell cancer

There are several types of lung cancer, these include:

Non-small cell lung cancer is a malignant tumor formed from epithelial tissue. In 90% of affected men and 80% of women, the disease occurs due to smoking. On this moment There are 3 types of non-small cell cancer:

Squamous cell carcinoma is the most common and grows in the tissues of the respiratory tract.
Adenocarcinoma occurs in glandular tissues. Often found in people who do not smoke cigarettes and women.
Large cell carcinoma (undifferentiated carcinoma) is called cancer due to the fact that cancer cells clearly visible under a microscope. This disease can affect different parts of the organ. One in ten people gets sick.

Symptoms of the disease:

cough;
difficulty breathing, even without exertion;
sputum mixed with bloody bodies;
hoarseness;
chest pain;
lack of appetite, fatigue, uncontrolled weight loss;
violation of the swallowing reflex;
swelling of the facial part of the body.

The prognosis for stage 4 non-small cell lung cancer is disappointing, since usually the disease already affects both lungs and metastasizes to other organs. 60% of cases are detected very late, the life expectancy of patients for 5 years is no more than 17%. Squamous cell lung cancer arises from flat cells of the bronchial epithelium (which are not normally present).

As a rule, smokers and workers in hazardous industries get cancer.

In addition, a number of other reasons influence the occurrence of squamous cell carcinoma:

Dust and air pollution in big cities.
Work in a radioactive zone.
Frequent diseases of pneumonia, bronchitis, tuberculosis.

The disease is most often detected in people 40-50 years of age, and men are more often affected.

The reason for this is:
Marginal lifestyle.
Poor quality food.
Lack of vitamins in food.
Heredity.

Signs of the disease:

Lethargy and lack of interest in life are often mistaken for another disease.
Unreasonable, instant weight loss.
Constant low temperature.

The prognosis for stage 4 squamous cell lung cancer is unfavorable - it is incurable, since metastases penetrate almost all internal organs and the poisoning of the body begins. The organs necessary for human life cannot cope with their functions and the person fades away.

Prognosis for small cell cancer

Small cell lung cancer stage 4 prognosis: life expectancy without therapy ranges from 6 to 18 weeks. This is the aggressor tumor. The outbreak spreads throughout the body at tremendous speed. Characteristic signs illness - the same as with other types of cancer, with the addition of speech impairment and headache attacks.

Has two forms:

Small cell carcinoma is often an irreversible process that develops at lightning speed and attacks extensively.
Combined small cell carcinoma - includes a type of adenocarcinoma with features of squamous and oat cell carcinoma.

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 in Lately An increase in incidence among women has also been noted. 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.

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Health to you and your loved ones! Do not give up

Causes

Smoking is the first and most main reason lung cancer. Age of person smoking, number of cigarettes per day and duration addiction influence 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, is initial stage does not bother the patient and does not have a bright severe 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 persistent cough. However, it is not the only accurate sign, since people who smoke (namely, they malignant tumor diagnosed more often than in non-smokers), chronic cough is observed even before illness. 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 carried out at medical examination, after which the doctor prescribes other examinations that will help in making the correct diagnosis.
Clinical and biochemical analysis blood.
Bronchoscopy is a diagnostic method that examines the extent of lung damage.
Biopsy – removal of a tumor sample surgically to determine the type of tumor.
Radiation diagnostics, which includes X-ray examination, magnetic resonance imaging (MRI) and positive emission tomography (PET), which help determine the location of tumor foci and clarify the stage of the disease.

Video: About early diagnosis lung cancer

Treatment

Treatment tactics for small cell lung cancer are developed based on clinical picture illness and 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 is immediately resorted to and radiation therapy.

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 a malignant tumor using gamma radiation or x-ray radiation, which allows you to kill or slow down the growth of cancer cells.

Used for inoperable lung tumors, if the tumor affects the lymph nodes or if surgery is not possible due to the patient’s unstable condition (for example, 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 for 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.

About what it is radiology diagnostics central lung cancer, the article will tell.

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 examinations.

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

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Small cell lung cancer stage 3

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 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. Because of rapid growth tumors 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 as 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 has 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, PaO2 during breathing are preserved 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 effectiveness of treatment is 65-90%;

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 localized 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 the total focal doseGy. 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.

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. Possible following methods treatment:

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. Can be used as standard mode irradiation (once a day for 5 weeks) and hyperfractionated (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.

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.

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 with metastases in the brain and 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 severe 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.

Often, patients diagnosed with advanced SCLC have a deteriorating health status that complicates aggressive therapy. However, the clinical researches did not reveal 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. Use of chemo therapeutic 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.

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 human body, which in turn causes symptoms such as:

headache;
hoarseness or loss of voice altogether;
general malaise;
loss of appetite and a sharp decline in weight;
back pain, etc.

Diagnosis of small cell lung cancer

Despite all clinical examinations, history taking and listening to the lungs, it is also necessary high-quality diagnostics disease, 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 diagnosing a malignant neoplasm. 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.

Purpose 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

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

treatment efficiency 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 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.

Treatment of advanced small cell lung cancer (SCLC)

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.

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.

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

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.

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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. Surgery 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 last years There is a trend towards an increase in 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 increased secretion 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 international system TNM is no different from that of 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 an increase in 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 cells bigger size(3 times more lymphocytes) 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 allows you to exclude distant metastasis abdominal cavity, MRI of the brain, skeletal scintigraphy.

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 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.

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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.

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.

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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.

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.

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.

The patient is prescribed the following medications:

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).

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.

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?

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

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Do not self-medicate. Consult your healthcare provider.

Small cell lung cancer

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 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.

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.

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.

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.

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.

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.

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

Disease prognosis

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.

Informative video on the topic: Smoking and lung cancer

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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

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.

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.

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)

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

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 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.

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.

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

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.

Small cell lung cancer (SCLC) is one of the most severe forms of cancer. First of all, because of the rapid and dynamic development. In addition, statistics indicate that this type of cancer is quite common - it accounts for about 25% of all lung cancers. Men who smoke are at particular risk (95% of confirmed diagnoses), and if we consider the age limit, the disease mainly affects people over 40 years of age.

The main and most significant cause of small cell cancer is considered to be smoking, and the main aggravating factors are the person’s age, smoking history and the volume of cigarettes smoked per day. Since nicotine addiction is increasingly affecting women, it is not surprising that the incidence of this type of cancer among women has increased.

But no less serious risk factors include:

difficult working conditions (interaction with Ni, Cr, As);
poor ecology in the place of residence;
genetic predisposition.

In addition, pathology often occurs after tuberculosis or against the background of chronic obstructive pulmonary disease. Now the problem of the histogenesis of the disease is considered from two sides - neuroectodermal and endodermal. Proponents of the latter theory believe that this type of oncology develops from bronchial epithelial cells, which have a similar biochemical composition with small cell carcinoma cells.

Experts who adhere to the neuroectodermal theory believe that this cancer appears from cells of the diffuse neuroendocrine system. It is worth noting that the logical nature of this version is evidenced by the presence of neurosecretory granules in tumor cells, an increase in the concentration of hormones and the release of bioactive substances. But it is impossible to say for sure why this type of oncology occurs, since there have been cases when the pathology was diagnosed in people who followed a healthy lifestyle and did not have an oncological predisposition.

External manifestations

As a rule, the first manifestation of this pathology is a prolonged cough. It is often mistaken for smoker's bronchitis. A particularly warning sign for a person should be the appearance of blood streaks in the sputum. In addition, with this pathology, shortness of breath, chest pain, poor appetite, all-encompassing weakness and causeless loss of body weight are often observed. Sometimes the disease can be mistaken for obstructive pneumonia, so careful diagnosis is very important.

Prolonged hacking cough is the first manifestation of SCLC

At stages 3-4, new unpleasant symptoms appear: hoarseness due to paralysis of the vocal nerves and symptoms of compression of the superior vena cava. Paraneoplastic symptoms may also be observed: Cushing's syndrome, Lambert-Eaton, inadequate secretion of antidiuretic hormone. In addition, this pathology is typically characterized by the earlier appearance of metastases in the intrathoracic lymph nodes, liver, adrenal glands, bones and brain. In such circumstances, symptoms will appear indicating the localization of metastases (jaundice, pain in the spine or head).

Classification of the disease

The division into stages of this disease is identical to that for other types of lung cancer. But until now, oncology of this type is divided into a limited (localized) and widespread stage of the disease. The limited stage is characterized by tumor involvement on one side, with concomitant enlargement of the supraclavicular, mediastinal and hilar lymph nodes. In the case of an advanced stage, the formation of the other half of the chest is captured, the appearance of pleurisy and metastases. Unfortunately, more than half of patients have this particular form of small cell cancer.

If we consider the morphology, then within small cell oncology there are:

oat cell carcinoma;
cancer from intermediate cells;
mixed (combined) cancer.

In the first case, the formation is formed by layers of tiny spindle-shaped cells with round and oval nuclei. For intermediate type cancers, fairly large round, oblong and polygonal cells with a clear nuclear structure are typical. As for combined cancer, it is spoken of when oat cell cancer with manifestations of adenocarcinoma or squamous cell carcinoma is detected.

Diagnosis of pathology

To correctly assess the extent of the spread of pathology, clinical studies (visual assessment of the physiological state) are often combined with instrumental diagnostics. The latter includes 3 stages.

Visualization of manifestations of pathology using radiation techniques: x-ray of the sternum, CT of the lungs, positron emission tomography.
Morphological confirmation: bronchoscopy, biopsy, diagnostic thoracoscopy, pleural puncture with fluid removal. Further, the biomaterial is also sent for histological and cytological examination.
At the last stage of research, they try to exclude distant metastases. For this purpose, MRI of the brain, MSCT of the peritoneum and bone scintigraphy are performed.

Chest X-ray is the first step in diagnosing SCLC

Treatment

Dividing pathology into stages helps specialists navigate how to treat it and outlines the possibilities of its surgical or conservative treatment. It should immediately be noted that operative method Treatment of small cell lung cancer is used only in the initial stages of cancer. But it is necessarily accompanied by several courses of postoperative chemotherapy.

To date, treatment of small cell lung cancer in this way has shown fairly good results.

If the patient refuses complex therapy and from chemotherapy in particular, then with such a malignant formation of the lung, its life expectancy is unlikely to exceed 17 weeks.

The disease is usually treated with 2-4 courses of polychemotherapy using cytostatic agents. For example:

Etoposide;
Cisplatin;
Vincristine;
Cyclophosphamide;
Doxorubicin.

This type of treatment is combined with radiation. The initial foci of formation and lymph nodes are susceptible to radiation therapy. If a patient undergoes such a combination treatment against small cell lung cancer, the prognosis for his life expectancy improves - the person can live two years longer. However, it is important to understand that 100% healing in this case is impossible.

When the pathology is widespread, the patient is prescribed at least 5 courses of polychemotherapy. If metastasis spreads to the adrenal glands, brain and bones, then a course of radiation therapy is also strongly recommended. Although small cell lung cancer is extremely increased sensitivity polychemotherapy treatment and radiation, however, there still remains a fairly high risk of relapse.

After completion of therapy, the patient is advised to undergo systematic examinations for timely detection of secondary spread of oncology. However, if relapses of small cell cancer are resistant to antitumor therapy, a person’s life expectancy is rarely more than four months.

Forecast

The first question that interests patients with a confirmed diagnosis of small cell lung cancer is how long they live with such a disease. Without complex therapy for this type of oncology, the development pathological process invariably leads to death. It is foolish to expect that the disease will go away on its own. With small cell lung cancer, the patient's life expectancy directly depends on the correctly chosen treatment, as well as the intensity of development of the pathological process.

If the disease is detected at the initial stage, then five-year survival is observed in 22-39% of patients. If this type of oncology is detected, terminal stage, only 9% of patients reach the five-year mark. When, during treatment, doctors observe a decrease in the size of the formation, most experts agree that this is a favorable sign.

In this case, the patient has a good chance of living longer. Even if the therapy led to only a partial remission effect, the survival rate is 50%. If it is possible to achieve complete remission, then 70-90% of patients survive to the five-year mark. Therefore, even with such a depressing diagnosis, you should not despair and give up.

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