Extensive stage small cell lung cancer (SCLC) is an aggressive form of lung cancer that has spread extensively. It may be present throughout one lung, both lungs, or other parts of the body.
There is no cure for extensive stage SCLC. However, doctors can use chemotherapy, radiation therapy, and other treatments to prolong survival.
This article looks at extensive stage SCLC in more detail, including its symptoms and treatment. It also discusses the outlook for people with this condition.
SCLC is a type of cancer that affects tissues in the lungs. It is typically fast-growing and aggressive, which makes it challenging to treat.
There are two stages of SCLC: limited stage and extensive stage. Doctors use these to describe how severe or advanced SCLC has become. Limited stage SCLC is present only on one side of the chest, while extensive stage SCLC has spread further than this.
Doctors may consider SCLC to be extensive if it has spread:
- widely throughout one lung
- to both lungs
- to lymph nodes on the opposite side of the chest
- to fluid surrounding the lungs
- to other parts of the body
About two-thirds of people who receive an SCLC diagnosis are in the extensive stage.
Another staging system is the tumor, nodes, and metastasis system, which classifies cancer into stages from 0–4. Some doctors use this system for SCLC, but it is generally more useful for non-SCLC.
People can survive for varying amounts of time if they have extensive stage SCLC. In most cases, treatment can shrink the size of tumors and prolong someone’s life.
However, treatment cannot cure extensive stage SCLC completely. After a course of treatment, the cancer can come back in a more aggressive form, and it may be resistant to the treatments that previously helped.
Through treatment, doctors aim to improve quality of life as much as possible in people with extensive stage SCLC. It is important to discuss all the options, and what to expect from them, when making decisions about care.
People with SCLC may experience a range of symptoms, including:
- chest pain or discomfort
- trouble breathing
- a cough that does not go away
- blood in the mucus
- feeling extremely tired
- loss of appetite
- unintentional weight loss
- difficulty swallowing
As extensive stage SCLC has spread throughout the chest or other parts of the body, some cancer treatments that people can undergo in the earlier stages may not be possible. Doctors will typically recommend:
Although various treatments for SCLC exist, chemotherapy is often the first choice. This treatment can shrink tumors around the body, helping someone live longer. It can also reduce a person’s symptoms. If someone is in good enough health, chemotherapy in combination with an immunotherapy drug may also be a viable first-line treatment.
However, chemotherapy can cause side effects. Some of the common ones include:
- hair loss
- easily bleeding and bruising
- appetite changes
- nausea or vomiting
- mouth and throat sores
- dry skin
- pain when swallowing
- tingling, pain, and numbness
- weight changes
- mood changes
- fertility problems
- changes in libido
Not everyone will experience significant side effects, and those who do may be able to take additional medications to control them.
If an individual responds well to chemotherapy, doctors may follow or combine it with one of the following:
- combination chemotherapy using two or more drugs
- combination chemotherapy and immune checkpoint inhibitor therapy that uses the person’s own immune system to fight the cancer
- radiation therapy using powerful X-rays to kill cancer cells
Doctors may also suggest that individuals participate in clinical trials for new therapies.
Radiation therapy as a secondary treatment option can help people with extensive stage SCLC live longer. Radiation to the chest may also help relieve symptoms such as bleeding or shortness of breath, as well as symptoms that are the result of cancer spreading to the bones or spinal cord.
Although radiation therapy can help symptoms, it is not without drawbacks. Side effects of radiation directed toward the chest include:
- severe fatigue that increases as treatment continues
- skin that is irritated, dry, itchy, and tender
- loss of appetite
- inflammation of the esophagus, if there is a tumor nearby
Radiation therapy for SCLC may also cause radiation pneumonitis. This inflammation of the lungs can develop following the end of radiation therapy. Some symptoms of this condition include shortness of breath, coughing, and fever.
Radiation pneumonitis often gets better on its own, but in some cases, the person may require oxygen or steroids.
Data from 2000–2010 found that the 1-year survival rate for people with SCLC was
However, survival rate statistics do not always apply to individual cases. A person’s outlook depends on a number of factors, such as how aggressive the cancer is, how far it has spread, and how the body responds to treatment. Additionally, treatments have improved with time.
If someone has extensive stage SCLC, but the cancer has not spread beyond the chest, they may have a better outlook. Data from 2010–2016 showed that people with regional SCLC were 16% as likely to survive for 5 years from diagnosis in comparison with the general population. For SCLC that had spread to distant parts of the body, this figure was 3%.
For individuals with low overall health, treatments such as chemotherapy or radiation therapy may not be possible. In these cases, doctors may recommend palliative care instead. This involves treating the symptoms of cancer in order to reduce pain and discomfort.
Palliative care may include:
- medications to reduce pain
- bronchodilator drugs to help a person breathe
- oxygen therapy
- procedures to remove blockages in the airways, such as laser therapy or a stent
- procedures to treat fluid buildup around the lungs or chest
Receiving a diagnosis of extensive stage SCLC can be extremely difficult, and it can affect the person’s family and friends, too. Support is available for dealing with the possible physical, emotional, and financial impacts of cancer.
The American Cancer Society provides several resources for people with cancer, including:
- a 24-7 helpline
- transport and lodgings for those undergoing treatment
- information centers
- help understanding end-of-life care
People can also search for local support groups via the society’s website.
Extensive stage SCLC is a type of aggressive lung cancer. Unlike limited stage SCLC, extensive stage SCLC has spread throughout one or both lungs. It may also have spread to other parts of the body.
Chemotherapy is often the first treatment for this condition, with radiation therapy a possible follow-up treatment. The goal of treatment is to maintain quality of life, improve symptoms, and prolong life.