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Small Cell Lung Cancer: Staging and Treatment

Autor: Christina Bach, MBE, LCSW, OSW-C, FAOSW
Contribuidor de contenido: Carolyn Vachani, MSN, RN, AOCN and Charles B. Simone II, MD
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Fecha de la última revisión: May 09, 2023

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What is staging for cancer?

Staging is the process of learning how much cancer is in your body and where it is. For small cell lung cancer (SCLC), a bronchoscopy, biopsy, chest x-ray, CT scan, MRI of the brain, and/or PET scan may be used to stage your cancer. Your providers need to know about your cancer and your health so that they can plan the best treatment for you.

Staging looks at the size of the tumor and where it is, and if it has spread to other organs.

A staging system called the “TNM system,” as described by the American Joint Committee on Cancer, helps to guide the staging of SCLC. It has three parts:

  • T-describes the size/location/extent of the "primary" tumor in the lung.
  • N-describes if the cancer has spread to the lymph nodes.
  • M-describes if the cancer has spread to other organs (metastases).

Your healthcare provider will use the results of the tests you had to determine your TNM result and combine these to get a stage from 0 to IV.

How is small-cell lung cancer staged?

Staging is important because it helps to guide your treatment options.

SCLC is often staged in two categories: limited stage or extensive stage. These stages are based on the “TNM” system.

  • Limited stage (TNM Stage I-III: TI-III, any N, No M):. The cancer is on one side of the chest. The cancer may have spread to the lymph nodes. The cancer has not spread to other organs
  • Extensive stage (TNM stage IV: Any T, Any N, M1a/b/c): The cancer has spread in the lung, spread to the other lung, to the lymph nodes, and to other parts of the body.

The staging systems are very complex. Below is a summary. Talk to your provider about the stage of your cancer.

  • Stage 0 (Tis, N0, M0): The cancer is only in the top layers of the airway and has not spread deeper into the lung. It has not spread to the lymph nodes or other organs.
  • Stage Ia1 (T1a, N0, M0): The tumor is not bigger than 1 cm across in size. It hasn’t spread to the area around the lungs (pleura)and it hasn’t grown into the main parts of the bronchi. It has not spread to the lymph nodes or other organs.
  • Stage IA2 (T1b, N0, M0): The tumor is between 1 and 2 cm across in size. It hasn’t spread to the area around the lungs (pleura) and it hasn’t grown into the main parts of the bronchi. It has not spread to the lymph nodes or other organs.
  • Stage IA3 (T1c, N0, M0): The tumor is 2-3 cm across in size. It hasn’t spread to the area around the lungs (pleura)and it hasn’t grown into the main parts of the bronchi. It has not spread to the lymph nodes or other organs.
  • Stage IB (T2a, N0, M0): The tumor has 2 of the following: (1) The tumor is 3-4 cm across in size, (2) it has grown in the main bronchus, or (3) the pleura and/or (4) is partially blocking the airways. It has not spread to the lymph nodes or other organs.
  • Stage IIA (T2b, N0, M0): The tumor has 1 or more of the following: (1) it is 4-5cm across in size, or (2) it has grown into the main bronchus, or (3) the pleura and/or (4) is partially blocking the airways. It has not spread to the lymph nodes or other organs.
  • Stage IIB
    • (T1a/T1b/T1C, T2a/T2b, N1, M0): The tumor is 3-5 cm across in size. It may or may not have spread to the main bronchus or the pleura or is blocking the airways. The cancer has spread to the lymph nodes in the lung and around the lung. These lymph nodes are found on the same side as the lung with the tumor. The cancer has not spread to other organs.
    • (T3, N0, M0): The tumor has 1 or more of the following (1) it is 5-7cm across in size or (2) has grown into the chest wall, the inner pleura, the phrenic nerve, or the area around the heart (parietal pericardium), or (3) there are 2 or more separate tumors in the same part of the lung. It has not spread to the lymph nodes or other organs.
    • (T1a/T1b/T1c, N2, M0): The tumor is not bigger than 3 cm across in size and hasn’t grown into the pleura or the bronchi. It has spread to the lymph nodes near the windpipe or the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
    • (T2s/T2b, N2, M0): The tumor has one or more of the following (1) it is 3-5 cm across in size, (2) it has spread into the main bronchus, (3) it has grown into the pleura, or (4) is blocking the airways. The cancer has also spread to the lymph nodes near the windpipe or the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
  • Stage IIIA
    • (T1a, T1b, T1c, N2, M0): The tumor is no bigger than 3 cm across in size. It hasn’t grown into the pleura and does affect the main parts of the bronchi. The cancer has spread to the lymph nodes near the windpipe and the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
    • (T2a/T2b, N2, M0): The tumor has one of more of the following: (1) It is 3-5 cm across in size, (2) it has grown into the main bronchus but isn’t within 2 cm of where the windpipe splits into the left/right bronchi, (3) if has grown into the pleura, (4) it is partially blocking the airways. The cancer has spread to the lymph nodes near the windpipe and the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
    • (T3, N1, M0): The tumor has one or more of the following: (1) it is 5-7cm across in size, or (2) the tumor has grown into the chest wall, the inner pleura, the phrenic nerve, or the area around the heart (parietal pericardium), or (3) there are 2 or more separate tumors in the same part of the lung. The tumor has also spread to the lymph nodes in the lung and around the lung. These lymph nodes are located on the same side as the lung with the tumor. The cancer has not spread to other organs.
    • (T4, N0 or N1, M0): The tumor has one or more of the following: (1) It is bigger than 7 cm across, or (2) the tumor has grown into the space between the lungs, the heart, the windpipe, the diaphragm, the esophagus, or the blood vessels near these organs, or (3) there are 2 or more tumors in different lobes of the same lung. The cancer may have also spread to the lymph nodes in the lung or near the bronchus. These lymph nodes are on the same side of the body as the tumor. The cancer has not spread to other parts of the body further from the tumor.
  • Stage IIIB
    • (T1a/T2a/T1c, N3, M0): The tumor is no bigger than 3 cm across in size. It has not grown into the pleura or the bronchi’s main branches. The cancer has spread to lymph nodes near the collarbone on either side of the body and to the lymph nodes near the other lung on the other side of the body from the primary tumor site. It has not spread to other parts of the body.
    • (T2a/T2b, N3, M0): The tumor has one or more of the following: (1) it is 3-5 cm across in size, (2) it has spread into the main bronchus, (3) it has grown into the pleura, or (4) is blocking the airways. The cancer has spread to lymph nodes near the collarbone on either side of the body and to the lymph nodes near the other lung on the other side of the body from the primary tumor site. It has not spread to other parts of the body.
    • (T3, N2, M0): The tumor has one or more of the following: (1) it is 5-7cm across in size, or (2) the tumor has grown into the chest wall, the inner pleura, the phrenic nerve, or the area around the heart (parietal pericardium), or (3) there are 2 or more separate tumors in the same part of the lung. The cancer has also spread to the lymph nodes near the windpipe and the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
    • (T4, N2, M0): The tumor has one or more of the following: (1) It is bigger than 7 cm across, or (2) the tumor has grown into the space between the lungs, the heart, the windpipe, the diaphragm, the esophagus, or the blood vessels near these organs, or (3) there are 2 or more tumors in different lobes of the same lung. The cancer has also spread to the lymph nodes near the windpipe and the space between the lungs (mediastinum). These lymph nodes are on the same side as the lung with the main tumor. The cancer has not spread to other organs.
  • Stage IIIC
    • (T3, N3, M0): The tumor has one or more of the following: (1) it is 5-7cm across in size, or (2) the tumor has grown into the chest wall, the inner pleura, the phrenic nerve, or the area around the heart (parietal pericardium), or (3) there are 2 or more separate tumors in the same part of the lung. The cancer has spread to lymph nodes near the collarbone on either side of the body and to the lymph nodes near the other lung on the other side of the body from the primary tumor site. It has not spread to other parts of the body.
    • (T4, N3, M0): The tumor has one or more of the following: (1) It is bigger than 7 cm across, or (2) the tumor has grown into the space between the lungs, the heart, the windpipe, the diaphragm, the esophagus, or the blood vessels near these organs, or (3) there are 2 or more tumors in different lobes of the same lung. The cancer has spread to lymph nodes near the collarbone on either side of the body and to the lymph nodes near the other lung on the other side of the body from the primary tumor site. It has not spread to other parts of the body.
  • Stage IVA
    • (Any T, Any N, M1a): The tumor can be any size, and may have grown into the pleura, bronchi, mediastinum, or other nearby parts of the body. It may have spread to the lymph nodes. It may also (1) have spread to the other lung or (2) be in the fluid around the lung (pleural effusion) or (3) in the fluid around the heart (pericardial effusion).
    • (Any T, Any M, M1b): The tumor can be any size, and may have grown into the pleura, bronchi, mediastinum, or other nearby parts of the body. It may have spread to the lymph nodes. The tumor has also grown to one space away from the chest. This could be a lymph node in another part of the body, the brain, the liver, or the bones.
  • Stage IVB
    • (Any T, Any M, M1c) The tumor can be any size and may have grown into the pleura, bronchi, mediastinum, or other nearby parts of the body. It may have spread to the lymph nodes. The tumor has also grown to more than one space away from the chest. This could be a lymph node in another part of the body, and/or the brain, the liver, or the bones.

How is small-cell lung cancer treated?

Treatment for SCLC depends on if your cancer is limited or extensive-stage SCLC. If you smoke, quit as soon as possible. Smoking may lessen how well your cancer treatments work and can make the side effects of treatment worse.

Your treatment may include some or all of the following:

  • Surgery.
  • Chemotherapy.
  • Immunotherapy.
  • Radiation therapy/PCI.
  • Palliative treatment.
  • Clinical trials.

Surgery

Surgery is not often used to treat SCLC unless your cancer is very early stage and hasn’t spread to your lymph nodes. This surgery would remove the lobe of the lung with the tumor and would be combined with other treatments like chemotherapy and radiation.

Chemotherapy is the use of anti-cancer medicines that go through your whole body. These medicines may be given through a vein (IV, intravenously) or by mouth. Chemotherapy for SCLC may be used with immunotherapy and/or radiation therapy. What treatment you receive and how often you have treatment will depend on if you have limited or extensive-stage cancer.

The medications used to treat SCLC include carboplatin, etoposide, cisplatin, topotecan, lurbinectedin, paclitaxel, docetaxel, irinotecan, temozolomide, cyclophosphamide, doxorubicin, vincristine, etoposide, vinorelbine, gemcitabine, and bendamustine.

Your provider will talk to you about what regimen you will receive and what the potential side effects are of your treatment.

Immunotherapy

Immunotherapy medications work with the immune system to kill cancer cells. Immunotherapy medications that may be used in the treatment of SCLC are nivolumab, ipilimumab, pembrolizumab, atezolizumab and durvalumab. Your provider will talk to you about if these medications will help treat your cancer and what side effects you may experience.

Radiation and Prophylactic Cranial Irradiation (PCI)

Radiation is the use of high-energy X-rays to kill cancer cells. If you have limited-stage SCLC radiation may be given with chemotherapy or after chemotherapy. In extensive-stage SCLC radiation to the chest may be used after chemotherapy. Radiation may also be used to treat areas where your cancer has metastasized like the brain or bone.

Prophylactic cranial irradiation(PCI) can lower the risk of the cancer spreading to the brain. This can be done in patients with limited or extensive-stage SCLC.

Palliative Treatment

Palliative therapy is used to relieve symptoms that are caused by the cancer. They do not cure the cancer. There are many options for palliative treatments including chemotherapy, radiation, surgery, stent placement, laser therapies, and removal of extra fluid from around the heart or lungs. Talk to your provider about your options for managing your symptoms.

Clinical Trials

You may be offered a clinical trial as part of your treatment plan. To find out more about current clinical trials, visit the OncoLink Clinical Trials Matching Service.

Making Treatment Decisions

Your care team will make sure you are included in choosing your treatment plan. This can be overwhelming as you may be given a few options to choose from. Take the time to meet with different providers and think about your options and what is best for you. This is a personal decision. Friends and family can help you talk through the options and the pros and cons of each, but they cannot make the decision for you. You need to be comfortable with your decision – this will help you move on to the next steps. If you ever have any questions or concerns, be sure to call your team.

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