Small cell vs.

non-small cell lung cancer

Small cell and non-small cell are the two main
types of lung cancer. There are several key
differences, including the outlook.
In a person with small cell cancer, the cancerous
cells appear small and round under a microscope.
The cells of non-small cell lung cancer are larger.
Smoking is a major risk factor for both types. Of
those who receive a diagnosis of small cell lung
cancer, 95% have a history of smoking.
There are several subtypes of both small and non-
small cell lung cancer. Non-small cell lung cancers
include adenocarcinoma, squamous cell, and large
cell carcinoma.
Small cell cancers vary, depending on the
expression of specific genes.
Some types are more aggressive than others, but
generally, small cell cancer is more aggressive
than non-small cell lung cancer.
Lung cancer — both small and non-small cell — is
the second most common type of cancer among
adults in the United States, except for skin cancer.
Lung cancer overall accounts for 14% of new
cancer diagnoses. Small cell lung cancer accounts
for 10–15% of these cases.
Small and non-small cell lung cancers cause
similar symptoms. Sometimes, symptoms do not
appear until the cancer reaches later stages.
Symptoms include:
 a hoarse voice
 a persistent cough
 fatigue
 shortness of breath and wheezing
 difficulty swallowing
 a loss of appetite
 chest pain and discomfort
 blood in the mucus brought up by coughing
 swelling in the veins of the face and neck
 The symptoms of small and non-small cell
cancers are similar, but small cell cancer
spreads more rapidly.
 A person may be more likely to experience
symptoms after lung cancer has reached a later
stage.
Causes
Causes and risk factors for small and non-small
cell cancer tend to be similar.
Smoking is the main risk factor. Smoke and the
chemicals that it contains can damage the lungs.
This can lead to cellular changes that may result in
cancer.
Additional risk factors include:
 exposure to secondhand smoke
 living in an area with significant air pollution
 older age
 past exposure to radiation
 exposure to arsenic and other chemicals
 exposure to asbestos, nickel, chromium, soot,
or tar
 having a family history of lung cancer
 having HIV
If a person sees a doctor about a persistent cough
and other possible symptoms of lung cancer, the
doctor will ask questions and take a medical
history. They will also perform a physical
examination.
 If lung cancer may be present, the doctor will
also request imaging scans, such as an X-ray
 or CT scan, and look for signs of a tumor,
scarring, or a buildup of fluid.
 They may also request samples of phlegm in
order to perform a sputum test. This can help
indicate whether cancer is present. The doctor
will probably ask the person to provide a
sample every morning for 3 days in a row.
 They may also perform a biopsy. This
involves using a needle to take a sample of
cells from the lungs for examination under a
microscope. They may do this during surgery.
A biopsy can show:
 whether cells are cancerous
 what type of cancer is present, if any
Sometimes, the doctor requests a bronchoscopy.
This procedure involves inserting a tool with an
inbuilt camera through the mouth or nose and into
the lungs. This helps them see the area and take
tissue samples.
They may also carry out other tests to determine
whether the cancer has spread beyond the lungs.
Staging
The stage of cancer describes how far it has spread
within the body.
There are different ways to describe the stages.
One simple way is:
Localized: This means that the cancer is only in
one place.
Regional: The cancer has spread to nearby tissues.
Distant: The cancer has spread to other parts of
the body, for example, to the liver.
There is also stage 0, or “carcinoma in situ.” At
this stage, there may be precancerous cells. These
are not yet cancer, but they may become malignant
in time.
Stage 0 of lung cancer means that a doctor cannot
detect cancerous cells from traditional imaging
methods, but tests have revealed precancerous
cells in the mucus or elsewhere in the body.
Late stage, or metastatic, lung cancer has spread to
other areas of the body. What does this mean, and
what is the outlook? Learn more here.
Non-small cell lung cancer
For this type of cancer, doctors usually use a four-
stage system.
Stage 1: This signifies that the cancer is only in
the lungs.
Stage 2: The cancer has reached nearby lymph
nodes.
Stage 3: The cancer has spread to other lymph
nodes in the chest, possibly to those in the middle
or the other side of the chest.
Stage 4: The cancer has spread to both lungs, to
other parts of the body, or both.
Stages of small cell lung cancer
Doctors generally categorize small cell lung cancer
with one of two stages:
The limited stage: This means that the cancer is on
one side of the chest. It may be in one lung and,
possibly, nearby lymph nodes.
The extensive stage: The cancer has spread to
other parts of the chest and other organs.
Some doctors use further staging for small cell
lung cancer.
Can a person have both types?
Around 5–10% of small cell lung cancer cases are
“mixed.” This means that the person has small and
non-small cell cancers. Research suggests that it
may be easier to treat mixed cancer than small cell
lung cancer alone.
Treatment
After making a diagnosis, the doctor will describe
the treatment options and develop a treatment plan.
Factors that affect the plan will include:- the type
of cancer
 how far it has spread
 the individual’s age and overall health
 the availability of therapies
 personal preferences
Because each person’s situation is different,
treatment will vary accordingly.
For small cell lung cancer, treatment mainly aims
to manage the disease.
Options include:
 chemotherapy, which is the main treatment
  radiation therapy, which may help boost the
effectiveness of chemotherapy or help prevent
the cancer from spreading to the brain
 surgery with chemotherapy, when the cancer
has not yet reached the lymph nodes, which is
rare
Doctors may use a combination of treatments for
lung cancer, depending upon an individual’s
needs, the stage of the cancer, and the location of
the tumor.
Non-small cell lung cancer
Treatment options for non-small cell lung cancer
include:
Surgery: A surgeon will remove cancerous cells
and any nearby lymph nodes that may be affected.
However, if cancer affects a large portion of the
lungs, surgery may not be possible.
Chemotherapy: A doctor will administer
powerful drugs that can kill cancer cells.
Endoscopic stents: If a tumor has blocked part of
the airway, a surgeon may insert a stent.
Radiation therapy: A radiologist will direct a
beam of radiation toward malignant cells to
destroy them.
Targeted treatments: These drugs target specific
genes or other factors that enhance cancer’s ability
to grow. Blocking these factors can help stop or
delay the growth of some types of cancer.
Immunotherapy: This treatment aims to boost the
immune system’s ability to defend the body
against cancer. It is an emerging treatment.
Small cell lung cancer