Lung cancer

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Treatments for small cell lung cancer

If you have small cell lung cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for small cell lung cancer, your healthcare team will consider:

  • the stage of small cell lung cancer
  • your overall health
  • your personal preferences (what you want)

You may be offered one or more of the following treatments for small cell lung cancer.

Chemotherapy

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is the standard treatment for small cell lung cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is combined with radiation therapy to treat limited stage small cell lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Chemotherapy is used alone to treat extensive stage small cell lung cancer.

Small cell lung cancer grows quickly, so it often responds well to treatment with chemotherapy. It is most commonly treated with a combination of 2 drugs, which is more effective than one drug alone.

  • cisplatin and etoposide (Vepesid, VP-16)
  • carboplatin (Paraplatin, Paraplatin AQ) and etoposide

If small cell lung cancer comes back after treatment, the following combination of drugs may be used:

  • cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin) and vincristine (Oncovin)

Oral etoposide may be given to people who are not well enough to have combination chemotherapy or to treat cancer that comes back 3 to 6 months after treatment with other chemotherapy combinations.

Side effects of chemotherapy

Side effects can happen with any type of treatment for small cell lung cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given, if it is combined with radiation therapy and your overall health. Some common side effects of chemotherapy drugs used for small cell lung cancer are:

Information about specific cancer drugs

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Most people with small cell lung cancer have radiation therapy. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given.

External beam radiation therapy uses a machine to direct radiation at the lung tumour and the surrounding lymph nodes in the chest.

  • For limited stage small cell lung cancer, radiation therapy is combined with chemotherapy. This is called chemoradiation. The 2 treatments are given during the same time period.
  • For extensive stage small cell lung cancer, radiation therapy is used to relieve symptoms, such as coughing or pain (called palliative radiation therapy). It is also used to treat cancer that has spread to the bones (bone metastases).

Stereotactic radiation therapy is a type of external radiation therapy that uses special equipment to aim high-energy radiation beams at a tumour from different directions. It is used to treat small cell lung cancer that has spread to the brain (brain metastases).

Prophylactic cranial irradiation (PCI) is external beam radiation given to the whole brain. It is used to prevent small cell lung cancer from spreading to the brain, or to treat cancer cells that may have already spread there but cannot be seen by imaging tests. It may help prevent brain metastases and improve survival.

PCI may be offered to people with limited and extensive stage small cell lung cancer that has responded well to chemotherapy and radiation therapy. It is not offered for people with small cell lung cancer that has not responded to chemotherapy.

Side effects of radiation therapy for small cell lung cancer

Side effects can happen with any type of treatment for small cell lung cancer, but not everyone has them or experiences them in the same way. Side effects of radiation therapy will depend mainly on the size of the area being treated, the specific area or organs being treated, the total dose and the treatment schedule.

The following are the most common side effects that people experience with external beam radiation therapy for small cell lung cancer. Some people may experience all, some or none of these side effects. Others may experience different side effects:

If small cell lung cancer spreads to the brain, you may have radiation therapy. Side effects of radiation therapy to the brain may include:

  • skin reactions
  • thinning or loss of hair
  • somnolence syndrome – drowsiness, fatigue, confusion
  • cerebral edema – headache, nausea, vomiting, weakness

Surgery

Surgery is rarely used to treat small cell lung cancer because it has often spread to other parts of the body by the time it is diagnosed. But surgery may be used to diagnose a tumour in the lung. If the pathology report suggests that the tissue removed contains cancer cells, further surgery may be done if the surgeon thinks the entire tumour can be removed.

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