The treatment that someone with small cell lung cancer (SCLC) receives can significantly affect their outlook. The most effective SCLC treatments often involve surgery, but not all individuals with SCLC are eligible for surgical procedures.

People with the option to undergo surgery have limited stage SCLC and receive their diagnosis in the early stages of the disease. Relatively few people with SCLC learn that they have the disease this early, and those who do must act quickly to determine whether surgery is a possibility.

There are different types of surgical procedures available to people with SCLC. In this article, we look at surgery for SCLC, what it involves, and the outlook after surgery.

Two surgeons in blue scrubs looking at a screen in an operating room before beginning surgery for small cell lung cancer.Share on Pinterest
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Yes — some people with limited stage SCLC may qualify for surgical procedures that can stop the cancer from spreading.

Doctors use a two-stage system to classify SCLC. Limited stage SCLC occurs when a tumor is only on one side of the chest, whereas extensive stage SCLC is present throughout the lungs, on both sides of the chest, or in other parts of the body.

Surgery is only possible in limited stage SCLC. According to the National Institutes of Health (NIH), around one-third of people with SCLC receive their diagnosis during the early stages of the disease. The remaining two-thirds receive a diagnosis of extensive stage SCLC.

SCLC treatment traditionally involves chemoradiotherapy. But recent studies suggest that people with limited stage SCLC who go through surgical resection and then chemotherapy have a reduced risk of the disease spreading and increased chances for long-term survival. The combined treatment has increased 5-year survival rates by as much as 35%.

There are several different types of SCLC surgery. Doctors select the most appropriate type of operation based on the tumor’s size and location, as well as on how well the person’s lungs are working.

Specific forms of SCLC surgery include:

  • Lobectomy: The lungs consist of five lobes — three in the right lung and two in the left. With a lobectomy, a surgeon will remove the entire lobe that contains the tumor or tumors. If possible, most doctors will choose this form of surgery to treat SCLC.
  • Pneumonectomy: With this surgery, the surgeon removes the whole lung. Doctors recommend this surgery for people with tumors located toward the center of the chest.
  • Bilobectomy: This procedure involves the removal of two of the three lobes in the right lung.
  • Segmentectomy or wedge resection: In this procedure, the surgeon removes only part of the lobe that contains the tumor. Doctors opt for this type of surgery when the person’s lungs are not functioning as well as they need to for a lobectomy.
  • Sleeve resection: This type of surgery can work to treat people with tumors in the larger airways of their lungs. The surgeon will remove the part of the airway that houses the tumor, then sew the remaining parts of the airway back together. Doctors may opt for this procedure instead of a pneumonectomy to maintain more lung function.

During all SCLC surgical procedures, surgeons remove lymph nodes and use them to assess the potential spread of the cancer.

Recovery time for these surgical procedures takes weeks or months, depending on the person’s health prior to surgery. Most people spend 5–7 days in hospital following surgery.

In some cases, surgeons use a thoracotomy — a procedure that expands the person’s ribs to reach the lungs. People undergoing this procedure typically need several months to recover, but those whose lungs are healthier prior to surgery can eventually return to their normal activities.

People considering SCLC surgery should understand the potential risks, which include:

  • blood clots in the lungs or legs
  • infections
  • pneumonia
  • excessive bleeding
  • negative reactions to anesthetic

In rare cases, major surgeries can be fatal. It is best to discuss the potential adverse effects of SCLC surgery extensively with a medical professional before making a decision.

Following SCLC surgery, most people undergo chemotherapy, radiation therapy, or both to destroy any cancer cells that may linger within the body. This combined treatment, which is known as adjuvant therapy, helps decrease the chance of the cancer returning.

In addition to surgery, the options for SCLC treatment include:

  • Chemotherapy: This treatment uses drugs to halt the growth, division, and spread of cancer cells. The types of drugs that doctors use in chemotherapy and the method of injection depend on the nature and stage of the cancer.
  • Radiation therapy: This treatment applies X-rays and other forms of radiation to destroy cancer cells. In external radiation therapy, machines near the person’s body send radiation to the site of the cancer.
  • Immunotherapy: This treatment uses substances that the body or lab technicians have produced to boost the immune system and increase its ability to combat cancer.
  • Laser therapy: This treatment employs a laser beam to destroy cancer cells.
  • Endoscopic stent placement: Doctors use a tube-like instrument known as an endoscope to place a stent in the body to reopen an airway.

Many people with SCLC experience a recurrence of the disease following treatment. However, according to a 2021 review, previous studies have shown that people who undergo a complete resection to remove tumors have around a 50% survival rate after 5 years.

This is a better survival rate than the averages for people with more advanced SCLC, who are not eligible for surgery.

Most doctors recommend periodic CT scanning for those recovering from SCLC. These procedures can help catch any recurrence in its early stages and pave the way for additional treatment.

Some people who are recovering from SCLC experience adverse effects from their cancer treatment, such as cardiac issues or pulmonary fibrosis. These individuals may benefit from care by a multidisciplinary team who can manage any long-term complications and improve the person’s quality of life.

People with limited stage SCLC may want to consider surgery as part of their cancer treatment. Most doctors recommend adjuvant therapy following SCLC surgery, including chemotherapy, radiation therapy, or a combination of the two.

People with SCLC who undergo surgery before receiving other therapies have better survival rates than those who do not. However, not everyone will be eligible for the procedure. It is important to discuss all the options and their risks and recovery times with a doctor.