Extrapulmonary Small Cell Tumors
Yesterday, I heard from my male friend, who is 66 years old and who has been a smoker for at least 30 years. He has been diagnosed with a form of what is commonly called small cell cancer. It apparently started in his injured leg, not his lungs, and it has since metastasized through the bulk of his organs. He was told he has about six months to live. I suggested that he get seen for a second opinion, but in your professional opinion, is this situation possible? Wouldn't he have had some symptoms prior to the diagnosis? If he only has 6 months, wouldn't he be in a great deal of pain and on pain medication?
Barbara Campling, MD, Medical Oncologist, responds:
The story that your friend tells is a bit peculiar. "Small cell" cancer is one of the more common varieties of lung cancer and generally occurs in people who have smoked heavily over a number of years. Occasionally, the same type of cancer can originate in other organs, and this is called "extrapulmonary (outside of the lung) small cell cancer." For example, extrapulmonary small cell tumors can originate in such organs as the pancreas, bladder, prostate, cervix or esophagus. Many patients with extrapulmonary small cell cancers also have a significant smoking history. I have never heard of an extrapulmonary small cell cancer originating in the leg, but I suppose it is possible. I also wonder if his small cell cancer started elsewhere and then spread to the bones of the leg. This would be a common place for either a lung or extrapulmonary small cell cancer to spread. Another thought is that this could be a kind of a skin tumor called a "Merkel cell tumor" which looks like a small cell cancer under the microscope, and this cancer can spread in a similar fashion. It is hard to know exactly what is going on without more information.
Whether it is an extrapulmonary small cell cancer, Merkel cell cancer, or other cancer, it appears that your friend's tumor has spread to multiple sites. Thus, it would not be curable with any form of therapy. But it would certainly be treatable. Generally extrapulmonary small cell cancers, like small cell lung cancers, are quite responsive to chemotherapy. This treatment often will cause the tumors to shrink down, and when this happens, the symptoms caused by the tumor will improve, as will quality of life. Chemotherapy treatment for these tumors can also significantly improve survival. Doctors are generally not very accurate in predicting how long individual patients with cancer will live. Whoever told your friend that he had 6 months to live may be off base. Although this doctor may have said 6 months to indicate the average survival of someone with small cell cancer that has spread to distant parts of the body, your friend may live significantly longer than this, or he may unfortunately live shorter than this. It sounds like your friend does not have pain or other symptoms and has an excellent performance status. This is one of the most important things that predicts prognosis for patients with small cell cancer. Your friend would be well served to get a referral to another hospital. They will review all of his imaging and pathology slides and can come up with their own diagnosis and treatment plan for him.