Small cell lung cancer is characterized. Small cell lung cancer - what is it? What is Small Cell Lung Cancer

Commonly encountered oncological diseases include lung cancer... There are several forms of this ailment. In 20% of cases, patients are diagnosed with small cell lung cancer, which differs fast flow and the spread of metastases.

Description and statistics

With this disease, a person's respiratory system forms malignant tumor... It is initially classified as small cell carcinoma of the left or right lung. The name of the disease is associated with the histological features of the neoplasm - the cells that make up the tumor are small in size, barely exceeding the volume of blood cells - erythrocytes.

The malignant process begins to develop like a central pulmonary carcinoma, that is, from a large bronchus, but neoplasia does not continue infiltrative growth in one zone, but quickly spreads through the tissues of the organ, seeding it with atypical elements and giving metastases outside of it. Thus, it is an intense proliferating type of tumor, which is characterized by the most serious potential for malignancy. Rapid metastasis affects not only the organs of the chest and abdominal cavity, but also the lymphatic structures, and the brain.

If the diagnosis is delayed, the prognosis for survival is negative. Starting from the third stage, it is safe to say that the disease cannot be cured and leads to the inevitable death of a person. If the examination and adequate therapy are carried out on time, the chances of recovery are good.

In pulmonology, small cell lung cancer (SCLC) patients account for only 20% of cases, while non-small cell lung cancer (NSCLC) occurs in 80% of patients. According to statistics, among men, the disease is diagnosed more often. Almost always, the pathology proceeds in a severe form with extensive tumor growth and metastases - this is due to its late detection.

ICD-10 code: C34 Malignant neoplasm of the bronchi and lungs.

Causes

Various factors, both individually and in combination with each other, can cause oncological damage to the respiratory system. Let's list them:

• smoking. Lung cancer and nicotine addiction, according to scientists, have a direct relationship. Addiction to cigarettes becomes the root cause destructive changes v lung tissue... Inhaling tobacco smoke every day, a person provokes the degeneration of healthy cells into malignant ones. The longer the smoking experience and the daily amount of cigarettes, the higher this risk;
• history of chronic diseases of the respiratory system. Tuberculosis, asthma, frequent pneumonia and bronchitis - all this predisposes to the development of tumor conditions and requires a more attentive attitude to their own health;

• unfavorable heredity. If among blood relatives there were or are cases of lung cancer, it is not recommended to burden the existing predisposition with bad habits;
• unsatisfactory condition environment... If a person lives in a zone of contamination with carcinogenic hazardous substances, the risk of facing lung cancer is increased;
• prolonged contact with potentially hazardous substances - carcinogens, which include arsenic, nickel, etc. A similar risk factor is present in industries, less often in the area of ​​residence.

Who is at risk?

Most often, small cell lung cancer occurs among long-term smokers, mainly men over 50 years old. But, as statistics show, in the past 10 years, the incidence rate has been increasing among women, who are also not indifferent to this addiction.

Symptoms

At an early stage of development, small cell carcinoma does not cause a specific pattern of pathology or is disguised as signs of ailments of the respiratory system. With the progression of the disease, that is, with an increase in the area of ​​the neoplasm and the onset of metastasis, symptoms appear and grow within a short period of time.

Common signs of early stage small cell lung cancer include:

• chest pain;
• increasing shortness of breath;
• bouts of lingering cough without phlegm;
• general weakness;
• hoarseness of voice.

If the disease is not diagnosed in time, tumor growth begins and the clinical picture is supplemented with new symptoms. So, in the later stages of the oncological process, the signs of small cell lung cancer will be as follows:

• severe headaches;
• pain in the chest, radiating to the spine, joints and lower back, indicates tumor metastasis to bone tissue;

• dysphagia or problems with eating, up to the inability to carry out this process;
• hoarseness or lack of voice - associated with damage to the laryngeal nerve;
• swelling of the face and neck, often unilateral, as a result of compression of the genital vein;
• hyperthermic syndrome, increasing weakness, sleep and digestion disorders - common features cancer process.

Depending on where secondary oncological foci or metastases have arisen, the symptoms of the disease may vary. For example, with liver damage, hepatomegaly develops, severe discomfort in the right hypochondrium, jaundice, etc.

Classification of the international TNM system

Small cell lung cancer is classified according to the TNM grading, based on the assessment of three parameters, thanks to which the picture of the disease can be studied:

• Tumor (T) - primary tumor, its size;
• Nodus (N) - lesions of the lymph nodes;
• Metastasis (M) - distant metastases.

In accordance with this classification, the development of small cell lung cancer at any stage is considered. Consider them in the following table.

Consider a description of the criteria listed in the table.

T - primary tumor:

• Tis - non-invasive neoplasm;
• T1 - tumor less than 3 cm;
• T2 - neoplasm more than 3 cm;
• T3 - the size is arbitrary, there is a spread to the organs closest to the oncological focus, partial atelectasis;
• T4 - the tumor grows into adjacent tissues.

N - damage to the lymph nodes:

• N0 - there are no signs of damage;
• N1 - the peribronchial lymph nodes and / or the root of the lung are affected;
• N2 - mediastinal lymph nodes are affected;
• N3 - lymph nodes on both sides of the diaphragm are affected.

M - distant metastases:

• М0 - absent;
• M1 - observed.

Based on the TNM classification, the specialist determines the nature of small cell lung cancer and the tactics of its treatment.

Stages

For any tumor, several stages of development are characteristic, each of which has specific features and differences. Consider how they look in small cell lung cancer in the following table.

Stages	Description
I	The tumor is non-invasive, has a size of up to 3 cm. One lung is subject to damage - right or left. There is no dissimilation of atypical cells.
II	The neoplasm is 3 to 6 cm in size, blocks the bronchus and grows into the pleural cavity, causing partial atelectasis or collapse of the lung in the lesion.
III	The tumor grows rapidly, its size exceeds 6 cm. Invasive growth of malignant cells begins into neighboring healthy tissues. Atelectasis of the entire affected lung is noted. Metastases are detected in the nearest lymph nodes, during germination in blood vessels dissimilation of cancer cells throughout the body begins.
IV	The tumor is impressive in size, its signs can be seen in adjacent tissues, in particular the mediastinum or stomach. Metastases are detected throughout the body, their presence is accompanied by symptoms such as severe headaches, general weakness, loss of appetite, etc.

Types, types, forms

According to the histological type, the classification of lung tissue cancer is as follows:

• small cell carcinoma (SCLC);
• large cell or non-small cell carcinoma (NSCLC);
• adenocarcinoma (the tumor affects exclusively the glandular cells of the organ);
• mixed or intercellular cancer (characterized by a vast area of ​​the oncological process with the involvement of various cellular structures);
• squamous cell carcinoma.

In turn, IRL is divided into two forms:

1. Small cell type carcinoma. An oncological process with an extremely unfavorable prognosis due to the rapid development and spread of metastases. In this case, the only way to cope with the disease is intensive chemotherapy.
2. Small cell carcinoma of the combined type. The malignant process downstream similar to adenocarcinoma combined with symptoms of squamous cell carcinoma. With timely treatment started, the prognosis for recovery is more favorable compared to the previous form of the disease.

Diagnostics

Adults, especially smokers, should be screened periodically for lung cancer. Diagnostics of the oncological process includes the following activities:

• fluorography. X-ray method indicating changes in lung tissue. This procedure should be carried out annually, and in case of detection of visible destructive phenomena, the specialist refers the patient to other examinations;
• general and biochemical analyzes. Evaluation of changes in the qualitative and quantitative composition of blood makes it possible to draw conclusions about the presence of chronic and acute pathological processes in the body;
• test for tumor markers. If a small cell carcinoma of the respiratory system is suspected, a study of CEA - carcinoembryonic antigens, PRA - squamous cytokeratins, CA125 - oncoantigens and NSE - enolase neurons is prescribed. Depending on the degree of their concentration in the blood and the ratio with clinical norms, a conclusion is made about the presence or absence of lung cancer;
• bronchoscopy. A method that allows you to visually study the damage to the tissues of the respiratory tract;
• biopsy with histological examination. Based on taking a sample of a suspected tumor from an oncological focus in order to determine the type of neoplasm and confirm a malignant process;
• radiation diagnostics. It includes several research methods: MRI - magnetic resonance imaging, PET - positron emission tomography and radiography, which help to detect the exact localization of the oncological process and the stage of the disease.

Treatment

Therapy for small cell lung cancer depends on the nature of the primary tumor, the degree of damage to the respiratory system and adjacent anatomical structures, and the patient's history. What treatment options are used for this condition?

Chemotherapy. It is used to form the boundaries of a neoplasm before its surgical removal, in the postoperative period to destroy cancer cells and as an independent method of treatment. Chemotherapy drugs reduce the volume of a malignant tumor, and radiation helps to consolidate this result.

Radiation therapy. As an ionizing method, it kills cancer cells in the affected area. Modern technology makes it possible to generate rays in a narrowly targeted direction, directly at the tumor site, so that nearby healthy tissues receive a minimum of radiation, which causes their destruction.

The need for surgery and other procedures is considered by an oncologist. The goal of the therapy is to achieve remission, preferably complete.

Early treatment. Surgical intervention is the only chance to remove a malignant tumor localized in respiratory tract... The method is used at the first and second stages of the oncological process, while a segment of the lung can be removed, most of it or resection is carried out in full. It all depends on the area of ​​the tumor.

A mandatory step in treatment is postoperative chemotherapy, usually in combination with radiation. The scheme is prescribed by a doctor who calculates the dosage, amount and duration of taking medications, taking into account the body's response to their administration. If the patient's well-being worsens, the course is corrected. In addition to cytostatics, antiemetics are prescribed and special diet... Self-medication at this stage is excluded, even taking banal vitamins can worsen the patient's condition.

Treatment in the later stages. Starting from the 3rd stage, more complex schemes for combating the oncological process are used: polychemotherapy, consisting of several drugs at the same time, in combination with radiotherapy. Upon reaching remission, that is, stopping the growth of the neoplasm, prophylactic irradiation of the brain is mandatory. This approach extends life expectancy by up to 2 years.

According to observations, small cell carcinoma is highly sensitive to chemotherapy and radiotherapy. But the disease is insidious in that in the event of relapses, the secondary tumor will not respond to the same healing procedures... In the later stages of the oncological process, remission can last no longer than 4 months.

Metastases in pathology are carried with the general blood flow to distant organs, which are most intensively supplied with blood. Such anatomically important structures are the human brain, kidneys, liver and bones. If malignant cells have penetrated into the skeletal system, this in a fairly short period of time leads to complications such as pathological fractures and impaired motor activity.

If the above treatments are ineffective, palliative therapy is the final recommendation. It is aimed at improving the patient's quality of life. It is based on symptomatic agents, and most often these are analgesics. Additionally, the patient receives psychological assistance.

Traditional methods in the fight against small cell cancer are popular in narrow circles. Basically, they are approached by people with an incurable form of the disease or, for some reason, do not want to see a doctor. In no case should you self-medicate. Everyone has a chance, and in order to survive, you need not waste precious time on untested techniques, but contact a specialist. At the slightest suspicion of lung cancer, it is important to visit an oncologist as soon as possible, otherwise there is a high probability of a disastrous outcome.

Recovery process

If the lung has been removed partially or completely, the overall functionality of the respiratory system suffers. The compensatory period occurs no earlier than 6 months after the operation, and until this moment, competent supportive therapy is needed. It is assigned to each patient individually.

The duration and intensity of the recovery course is determined by the general condition of the person, if necessary, appropriate adjustments are made to it. For example, many patients after surgery develop inflammation of the pleura of the lung, or chronic empyema... In this case, a separate complex of rehabilitation procedures is recommended, based on surgical intervention or laser therapy with simultaneous sanitation of the entire bronchial tree.

Also complications on recovery stage occur after irradiation. This method effectively stops the growth of a neoplasm, and sometimes completely removes it, but it is almost impossible to avoid side effects when using it. After the end of radiotherapy, all patients are prescribed a course of antibiotics, anticoagulants, inhalation, magnetotherapy and breathing exercises.

On average, rehabilitation after treatment for small cell lung cancer lasts about 6 weeks. Depending on the complications that have arisen in its process, recovery period can be extended.

In addition, during rehabilitation, many patients after oncological diseases of the respiratory system develop cardiopulmonary insufficiency, since the remaining lung cannot cope with its functions in full, and therefore cardiac activity suffers. In this case, it is recommended to prescribe drugs of the group of glycosides, antispasmodics, diuretics, etc.

After discharge from the hospital, if the patient feels well, observation is carried out every 3 months for the first 3 years, then the frequency increases to six months. Chest X-ray and ultrasound are becoming mandatory examinations. Once a year, an MRI of the brain and a skeletal scan are shown. The task of observation is the timely detection of the progression of oncopathology.

Diet

Nutrition in the treatment of lung cancer and during the rehabilitation period is of no small importance. Thanks to a well-organized diet, you can improve the patient's well-being and speed up the healing process.

When it comes to lung cancer, doctors advise adhering to a protein diet. Surgical interventions, radiation and chemotherapy, however, like the disease itself, cause intense destruction of proteins in the body, which are necessary for the regeneration and building of healthy tissues. A sufficient amount of protein in the diet helps to significantly speed up recovery. Therefore, the menu should be based on meat, poultry and fish.

But, unfortunately, not all people with cancer can fully eat such dishes. Many are forced to fight nausea, vomiting and anorexia against the background of chemotherapy and radiation therapy. Therefore, they need light protein to digest, namely milk, yogurt, cottage cheese, cheese, nuts, eggs, and legumes. If a person has difficulty swallowing, his regular food is replaced with powdered milk, soy whey or special nutritional mixtures.

During treatment - before and after surgery and during chemotherapy - the diet should be high in calories and carefully balanced. Small portions of the suggested meals will help the food digest faster and avoid nausea and vomiting. The principles of a lung cancer diet will be as follows:

• eat more often, but in smaller portions;
• food should be thoroughly chopped before serving, and then chewed by the patient himself;
• food can be slightly salted and sweetened, so it will be better absorbed;
• the temperature of the dishes should be close to the temperature of the human body;
• caffeine and alcohol are completely excluded from the diet.

Fasting or, on the contrary, overeating and addiction to food additives will not help to improve your well-being. Everything should be in moderation.

The course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. Lung cancer in childhood- a rare, but, unfortunately, a common pathology. In the initial stages, it practically does not manifest itself - symptoms in the form of coughing, frequent SARS and weakness do not lead parents to think that the child may have cancer. Then there are secondary signs of cancer in the form of sputum mixed with blood, pathological enlargement of lymph nodes, sharp weight loss, etc. After the oncological process is detected, radical surgical treatment and chemotherapy are prescribed. If the disease is detected at the third or fourth stage, the prognosis for recovery is extremely poor.

Pregnancy and lactation. Small cell type lung carcinoma in expectant mothers is no exception. Especially if the woman started smoking before pregnancy. The course of the disease does not differ fundamentally from other groups of patients. Treatment depends on how long the woman is in gestation. Until the 20th week of pregnancy, doctors recommend having an induced abortion and starting therapy as soon as possible. For more later dates the issue of preserving the child is decided individually. A way out of the situation can be the appointment of chemotherapy drugs that do not penetrate the placental barrier and do not have a negative effect on the child, and radical measures in the form of surgery and radiation are prescribed later - after delivery. In any case, treatment issues for expectant mothers are resolved with an oncologist on an individual basis. Breastfeeding women are advised to immediately begin treatment and stop breastfeeding after detecting lung cancer.

Advanced age. Oncological lesions of the respiratory system are more common in old age, mainly among smokers with impressive experience. The course of the disease does not differ from other groups of patients, however, as well as the principles of treatment. Unfortunately, at this age there are many contraindications to the use of radical therapeutic methods, for example, to an operation, which significantly complicates the prognosis for survival.

Small cell lung cancer treatment in Russia, Israel and Germany

Among all malignant tumors, the undoubted "champion" is lung cancer. Every year in the world, it is detected in at least a million people. Consider how they are struggling with this ailment in different countries.

Treatment in Russia

Domestic cancer centers successfully use modern techniques used abroad. This has helped improve the rates of lung cancer treatment in our country.

As a rule, after confirming the diagnosis with the help of histology, the patient is prescribed a course of preoperative polychemotherapy, taking into account the sensitivity of the tumor to the drugs used. Then resection of the oncological focus with lymph nodes is performed.

After surgery, Russian cancer centers use radiation using modern technologies to exclude damage to healthy tissues. If the classical operation is not feasible, bloodless techniques are used, for example, the "cyber scalpel" or "gamma knife". Unfortunately, many approaches are effective only in the early stages of the disease.

Also to the latest techniques small cell lung cancer treatment includes targeted or targeted therapy biologically immune drugs blocking and destroying atypical cells in the tumor. This approach is also available in domestic cancer centers, in particular in the Sofia clinic in Moscow.

The cost of lung cancer treatment in Russia is much lower than abroad. Prices depend on various factors and are calculated for each individual. This is due to the fact that in a particular patient some methods can be used, while in another - completely different ones. On average, lung cancer diagnostics is from 19 thousand rubles, surgical removal of a tumor - from 25 thousand rubles, a course of chemotherapy from 50 to 400 thousand rubles, radiation from 10 to 40 thousand rubles.

Which clinics can I go to?

• Specialists perform all types of cancer surgical treatment, giving preference to organ-preserving operations.
• Moscow Research Oncological Institute (MNIOI) named after P. A. Herzen. Cancer treatment is carried out at a high level, reconstructive plastic surgeries are performed, methods of photodynamic therapy are used.
• GBUZ "St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Aid". Modern clinic, specializing in the provision of radiological, surgical and chemotherapy care for cancer patients.

Consider reviews of the listed institutions.

Irina, 43 years old. “In the Moscow Research and Development Institute named after Herzen, my brother had a small cell type lung tumor removed. Everything went well, now she is in remission for two years, we are glad that we have applied to this particular hospital. "

Treatment in Germany

In German clinics, specialists from various branches of medicine take part in the fight against lung cancer: thoracic surgeons, pneumonologists, hemato-oncologists, etc. In the course of treatment, preference is given to minimally invasive techniques using robotics, for example, the Da Vinci system. This makes it possible to reduce the area of ​​the operating field and to injure the tissues of the body to a minimum extent.

Treatment usually begins with a diagnosis. It should be noted that not all examination results that patients bring with them meet the requirements of German oncologists. In addition, German doctors can use other, completely new, and therefore more accurate diagnostic methods, with which it is easier to select effective rate treatment. On average, the examination at the clinic lasts about 5 days.

The cost of lung cancer diagnostics in Germany is from 4 thousand euros. The price of treatment, including surgery and chemotherapy, starts at 18,000 euros. The cost may vary depending on the complex of applied techniques.

Which clinics in Germany can I contact?

• Specializes in the treatment of lung cancer. The services of the institution comply with the international quality standard ISO 9001, which guarantees control over the condition of equipment, medicines and regular certification of medical personnel.
• Cancer Center "Bremen Mitte", Bremen. Largest center in Northern Germany. He specializes in the diagnosis and therapy of cancer, including the respiratory system.
• Clinic "Nordwest", Frankfurt am Main. Certified by the European Society of Medical Oncology. Experienced world-renowned specialists are engaged in the treatment of lung cancer.

Consider reviews of the listed clinics.

Anna, 35 years old. “My mother came to the Bremen Mitte Center with undifferentiated clear cell lung cancer. There was never a single doubt about the professionalism of the doctors, the help was provided with high quality. We are grateful to the specialists and believe that my mother will be able to live for a long time. ”

Small cell lung cancer treatment in Israel

The main treatment for lung cancer in this country is surgery, the volume of which depends on the size of the tumor and the stage of the disease. Early on, Israeli oncologists use minimally invasive techniques such as cryodestruction, focused ultrasound, and endoscopy. If indicated, lobectomy is performed (or removal of a segment of the lung with lymph nodes) or pulmonectomy - resection of the entire affected lung.

The operation is complemented by methods such as chemotherapy, radiation and the introduction of biologicals. To restore the patency of the bronchi, lost as a result of the disease, their stenting or the installation of a tubular frame is performed, which allows to normalize the functionality of the respiratory system.

Chemotherapy drugs and radioisotopes are used in treatment in a selective way, that is, by means of a catheter, which is inserted into the main arteries directed to the site of the oncological focus. Also, Israeli oncologists successfully apply in practice such approaches as treatment with monoclonal antibodies, gene and targeted therapy, and immunotherapy. All methods are available in clinics in this country, and their timely use significantly increases the chances of recovery.

The cost of fighting lung cancer in Israel requires serious costs, since innovative equipment and medicines are used for treatment. But compared to other countries, such as the United States or Switzerland, prices here will be slightly lower. Price surgical treatment lung cancer costs from 10 thousand dollars, a course of chemotherapy from 2 thousand dollars, brachytherapy - from 19 thousand dollars.

What medical institutions in Israel can I contact?

• Clinic "TOP Ichilov", Tel Aviv. Largest center private medicine countries where they are successfully engaged in the diagnosis and treatment of cancer at a high level.
• The oldest multidisciplinary hospital in Israel, a member of the American Association. More than 1 million people receive treatment here every year.
• Elisha Clinic, Haifa. The oncology center of the institution enjoys an impeccable reputation among patients. Help for cancer patients here is at the highest level.

Consider reviews of the listed medical institutions.

Amina, 45 years old. “I am grateful to the doctors in Israel, and specifically to the Hadassah clinic, for the assistance provided in small cell lung cancer. The treatment helped, remission was achieved. "

Julia, 40 years old. “In the oncology center of the Elisha clinic, I was removed lung tumors and radiation therapy. My condition improved immediately. Leaving for Israel, I didn’t believe in success, but I also didn’t want to wait until the turn for an operation at home would come. Now I have no regrets. "

Complications

To successfully cure a disease, its timely diagnosis is necessary. But the statistics are disappointing - small cell cancer is detected only in 5% of cases before the onset of metastases and the spread of atypical cells to regional lymph nodes. Secondary oncological foci with this pathology are most often found in the liver, kidneys, bone tissue and the brain. If distant metastases have arisen in the body, the oncological process acquires the status of irreversible.

Complications of small cell lung cancer are:

• inflammation in the bronchial and pulmonary tracts, for example, protracted pneumonia;
• bleeding during the decay of a tumor in the respiratory system, which is accompanied by a sharp deterioration in health and hemoptysis;
• damage to regional lymph nodes, leading to symptoms such as excessive sweating, breathing problems, fever, general weakness;
• oxygen deficiency against the background of contraction vital capacity lungs;
• side effects of chemotherapy and radiation, which can affect the functioning of the whole body.

The listed complications require symptomatic care and patient monitoring.

Relapses

Relapses of the disease most often occur in the first 4 months after discharge from the hospital. As statistics show, in the overwhelming majority of cases, the fight against them becomes unsuccessful, that is, the patient's chances of repeated remission are minimal.

Most often, such cancer patients are denied treatment, because after a short period of time a new intensive course of therapy the human body may not be able to withstand, besides, the repeated tumor has practically no sensitivity to chemotherapy and radiation. That is, the prognosis for the development of relapse is extremely unfavorable.

Forecast, life expectancy

Despite the fact that the disease is rapid and aggressive, if treatment is started on time, the prognosis will not necessarily be bad. Persons who began to fight the disease in the early stages manage to achieve long-term remission. Consider what the forecast looks like in the following table.

If there is no treatment for small cell lung cancer, for example, due to the reluctance of a patient with stage 4 metastases to receive oncological care, the person dies within 3-4 months after the diagnosis is made, that is, the answer to the question of how long such patients live, is quite obvious.

Prophylaxis

If we talk about preventive measures, then the best of them in relation to small cell lung cancer will be quitting smoking, including passive smoking. Also important is the prevention of colds and bronchopulmonary diseases and their timely treatment.

It is recommended to include lungs in the daily routine physical exercise such as jogging outdoors in the morning. The normal weight of a person will also positively affect the work of the lungs, so it is important not to overeat and monitor body weight.

In the presence of bad habits such as narcotic and alcohol addiction, you must completely abandon them. If a person's labor activity is associated with hazardous chemicals, it is recommended to change the place of work, and if this is not possible, it is imperative to observe safety precautions in the professional niche.

Don't panic when you see symptoms of small cell lung cancer. A timely visit to a doctor guarantees a positive prognosis for recovery.

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Small cell lung cancer (SCLC), accounting for 18-30% of all histological forms of this disease, in recent decades has attracted more and more attention of researchers of various specialties.

A quarter of a century ago, small cell lung cancer was isolated as a separate nosological unit due to the biological properties of the neoplasm, features of the clinical course (rapid progression of the process), extreme malignancy, a tendency to early metastasis, high sensitivity to drugs and radiation, expanding diagnostic capabilities and constantly changing views on treatment tactics.

Biological features of a tumor are known to be determined volume doubling time (VOD) and a tendency to lymphohematogenous metastasis.

For small cell lung cancer, VUO is on average 33 days, for squamous and glandular cancer - 103 and 189 days, respectively.

In tissue culture, the volume of this tumor doubles within 1 day. With small cell cancer more often than with other histological forms of lung cancer, metastases in the intrathoracic lymph nodes and distant organs.

Almost 2/3 of patients with small cell lung cancer already have signs of metastasis at the first visit, 10% have metastases in the brain (Bunn R.A., 1992).

Features of small cell lung cancer

According to the MNIOI them. P.A. Herzen, at initial examination only 7% of patients with small cell lung cancer did not have regional metastases, 63% had metastases in the intrathoracic lymph nodes and 30% in peripheral lymph nodes, bones, liver, the opposite lung, brain and bone marrow, kidneys, adrenal glands, etc. Often, several organs are affected at the same time.

Similar features of small cell lung cancer are reflected in the features of its course and clinical manifestations. This form of lung cancer has a short history, variety clinical symptoms by the time of diagnosis, due to the significant spread of the process, a high frequency of paraneoplastic syndromes (increased secretion of serotonin, adrenocorticotropic and antidiuretic hormones, calcitonin, somatostatin, etc.).

Research carried out in last years, made it possible to clarify a number of neuroendocrine characteristics of small cell lung cancer and to identify markers used to control the course of the disease.

The greatest practical value at dynamic observation patients with SCLC have markers CYFRA-21-1, neuron specific enolase (NSE) and cancer embryonic antigen (CEA).

The role of "anti-oncogenes" (tumor suppressor genes) in the development of small cell lung cancer is shown and the factors that play a role in its occurrence are identified.

A number of monoclonal antibodies to the surface antigens of small cell lung cancer cells, however, so far, their potential practical application are limited to the identification of micrometastases in the bone marrow (Goncharskaya M.A. et al., 1991; Lederman J.A., 1994).

The clinical picture of the disease is represented by all symptoms characteristic of lung cancer, which are more pronounced, accompanied by intoxication and often effusion in the serous cavities.

There was an erroneous opinion that small cell lung cancer is a relatively small primary tumor with an extensive metastatic component in the intrathoracic lymph nodes, which is almost a pathognomonic sign, as well as early and extensive distant metastasis.

An exclusively malignant course of the disease made it possible to consider small cell lung cancer as a primary generalized process, in which conservative antitumor treatment is the method of choice. To a large extent, this was also facilitated by the exaggerated opinion about the extreme sensitivity of such tumors to radiation and chemotherapy effects.

Clinical observations

With the accumulation of clinical observations with an in-depth analysis of clinical and morphological data and the results of treatment by various methods, the conviction was formed that small cell lung cancer, like other solid tumors, has a locoregional stage of development.

At the Moscow Research Institute for the Study of P.A. Herzen surgical treatment was carried out in more than 150 patients with small cell lung cancer. Morphological study of the removed preparations made it possible to study the dependence of the frequency and nature of lesions of the intrathoracic lymph nodes on the size of the primary tumor and the histological subtype of small cell lung cancer.

Contrary to popular belief, 25% of the operated patients had no metastases in the intrathoracic lymph nodes. It should be noted that in most of them the size of the primary tumor corresponded to T2 and T3, i.e. there was a lesion of the main bronchus in central cancer or the diameter of the tumor was more than 6 cm and it grew into neighboring organs in peripheral cancer.

In addition, 40.4% of patients had metastatic lesions of only bronchopulmonary lymph nodes or the lung root (N1), despite the large size of the primary tumor (T2-3).

These data confirm the fact that small cell lung cancer also has a locoregional stage of development that determines the treatment strategy. This makes it possible to carry out active diagnostic measures and radical treatment, detection of small cell carcinoma in relatively early stages and allows us to recommend using the International TNM classification to indicate the prevalence of the tumor process and for a given histological structure of lung cancer, especially in surgical patients.

At the same time, there is a need to revise the generally accepted staging scheme for small cell lung cancer. The detection of metastases in 70-90% of patients with stage III-IV SCLC allowed the Veterans Administration Lung Cancer Study Group back in 1973 to propose the following systematization: "localized process" - damage to the hemithorax, ipsilateral mediastinal and supraclavicular lymph nodes, contralateral root nodes, specific exudative pleurisy on the affected side; "Widespread process" - damage to both lungs, metastases in distant organs and / or in the supraclavicular lymph nodes on the opposite side.

Subsequently, this systematization was corrected. G. Abrams et al. (1988) proposed to attribute the defeat of the contralateral root lymph nodes to the "widespread process", and R. Stahel et al. (1989), K.S. Albain et al. (1990) - exclude ipsilateral pleurisy from the localized process category.

Such, even improved, division scheme for small cell lung cancer distracts clinicians-oncologists from possible solution problems of early diagnosis and more effective treatment this formidable disease.

Meanwhile, many years of research carried out at the Moscow Research Institute of the Ordinance P.A. Herzen, showed that small cell lung cancer can also be diagnosed at stages I-II, which determine the possibility of surgical treatment of this contingent of patients in combination with adjuvant chemotherapy (Trakhtenberg A.Kh. et al., 1984, 1987, 1992).

Later, many domestic and foreign surgeons came to this conclusion (Zharkov V. et al., 1994; Ginsberg RG, 1989; Karrer K. et al., 1989; Shepherd FA et al., 1991; Muller LC et al., 1992 ; Davis S. et al., 1993; Wada H. et al., 1995; Shields Th., Karrer K., 1998).

We have established a clear dependence of the frequency and nature of the lesion of the intrathoracic lymph nodes on the size of the primary tumor. So, with a primary tumor corresponding to T1, metastases in the intrathoracic lymph nodes were found in 33.3% of patients, T2 - in 68.6%, T3 - in 85% and T4 - in all patients (Fig. 10.1).

Rice. 10.1. The frequency of damage (in percentage) of intrathoracic lymph nodes in small cell (a) and large cell (b) lung cancer, mediastinal (c) and (d), respectively, depending on the size of the primary tumor (T).

With a primary tumor corresponding to T1, there were no metastases in the lymph nodes of the mediastinum (N2), with T2 the incidence of damage to these nodes was 26%, with T3 - 60%, with T4 - 75%.

Thus, even with a primary tumor corresponding to T3, in 15% of patients the intrathoracic lymph nodes were intact, in 25% the nodes of the first barrier (N1) were affected, and in 40% there were no metastases in the mediastinal lymph nodes. The frequency of SCLC metastasis to the intrathoracic lymph nodes is higher than in undifferentiated large cell carcinoma.

Indications for surgery

These data allow us to establish the indications for surgery as the first stage in the treatment of patients with small cell lung cancer: this is a primary tumor corresponding to T1, in which 66% of patients have no metastases and 33% of patients have lymph nodes of only the first barrier (N1), and a tumor corresponding to T2 , in which 32% of patients have no intrathoracic metastases and 42% have nodes of the first barrier (N1).

If a mild metastatic lesion of the mediastinal lymph nodes (stage IIIA) is confirmed during the examination of patients with small cell cancer, surgical intervention is also not excluded from the plan of possible combined treatment after neoadjuvant chemotherapy.

The operation is performed according to indications, depending on the direct effect of chemotherapy, in connection with which a new term has appeared in the English-language literature - adjuvant surgical treatment (Feld R., Ginsberg R.J., 1995).

In multicomponent therapy surgical method They are also used for resectable forms of small cell lung cancer in the absence of the effect of chemoradiation treatment, which suggests a combined subtype of the tumor, i.e. the presence of di- or trimorphic cancer (combination of small cell with other histological structures) or local intrathoracic recurrence after conservative treatment - salvage surgery (Shepherd F.A. et al., 1991).

The nature and frequency of metastasis to the intrathoracic lymph nodes depend on the subtype of small cell lung cancer: with the intermediate cell subtype, mediastinal lymph nodes were affected in 38.4% of patients, oat cell - in 59% and combined - in 57%. The established dependence of the lesion of the lymph nodes on the size of the primary tumor and the subtype of small cell carcinoma is confirmed by the results of treatment.

The clinical characteristics of patients with small cell lung cancer, X-ray and endoscopic semiotics, the features of the course of the disease are described in the previous sections. Conventional methods are usually used to diagnose lung cancer of this histological type.

Given the tendency of the tumor to massive metastasis, it is necessary to conduct a detailed study of regional lymph nodes with a transtracheobronchial puncture performed during bronchoscopy, ultrasonography(Ultrasound) abdominal cavity, bone scintigraphy, CT scan (CT) brain, sternal puncture, and, if indicated, use other methods for determining the prevalence of the tumor process, including surgical (parasternal mediastinotomy, mediastinoscopy, thoracoscopy, etc.).

Until recently, most publications were devoted to assessing the effectiveness different methods conservative treatment - chemotherapy and its combination with radiation therapy.

Many domestic and foreign oncologists previously believed that due to the high malignancy of small cell cancer, the nature of metastasis and a poor prognosis, the diagnosis of this disease is a contraindication to surgical treatment.

Small cell carcinoma was considered "therapeutic", which was facilitated by the idea of ​​its relatively higher sensitivity to radiation exposure and the effect of anticancer drugs.

However, for total regression of the tumor in the locoregional zone, it is necessary to administer high total doses. Even with an increase in the dose to 60-64 Gy, complete tumor regression can be achieved only in 65% of patients. This is due to the fact that in small cell cancer, the tumor population is heterogeneous.

It contains a pool of cells resistant to ionizing radiation and chemotherapeutic effects and retaining the ability to repopulate even after summing up the so-called carcinicidal doses.

All this necessitates a critical rethinking of traditional attitudes towards antitumor therapy of small cell lung cancer with an assessment of the feasibility of using methods of local exposure and determining the indications for their use.

With the "common" form of the disease, they are usually used conservative treatment -

Small cell lung cancer is one of the most malignant tumors according to histological classification, which is very aggressive and gives extensive metastases. This form of cancer accounts for about 25% of other types of lung cancer and, if not detected at an early stage and properly treated, is fatal.

For the most part, this disease affects men, but in Lately there was an increase in the incidence among women. Due to the absence of signs of the disease in the early stages, as well as the rapid growth of the tumor and the spread of metastases, in most patients the disease takes neglected form and is difficult to heal.

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• Health to you and your loved ones! Do not give up

Causes

Smoking is the first and foremost cause of lung cancer. The age of the person who smokes, the number of cigarettes per day and the duration of the addiction affect the likelihood of developing small cell lung cancer.

A good prevention is avoiding cigarettes, which will significantly reduce the possibility of illness, however, a person who has ever smoked will always be at risk.

Smokers are statistically diagnosed with lung cancer 16 times more often than non-smokers and 32 times more likely to be diagnosed with lung cancer in those who started smoking in adolescence.

Nicotine addiction is not the only factor that can trigger illness, so there is a possibility that non-smokers may also be among the lung cancer patients.

Heredity is the second leading cause of increased risk of disease. The presence of a special gene in the blood increases the likelihood of developing small cell lung cancer, so there are fears that those people whose relatives suffered from this type of cancer may also get sick.

Ecology is a cause that has a significant impact on the development of lung cancer. Exhaust gases and industrial waste poison the air and enter the human lungs with it. Also at risk are people who have frequent contact with nickel, asbestos, arsenic or chromium in the form of professional activities.

Severe lung diseases are prerequisites for the development of lung cancer. If a person has suffered from tuberculosis or chronic obstructive pulmonary disease during his life, this can cause the development of lung cancer.

Symptoms

Lung cancer, like most other organs, does not bother the patient at the initial stage and does not have pronounced symptoms. You can notice it with timely fluorography.

Depending on the stage of the disease, the following symptoms are distinguished:

• the most common symptom is a lingering cough. However, it is not the only accurate sign, since people who smoke (namely, they have a malignant tumor diagnosed more often than non-smokers) have a chronic cough even before the illness. At a later stage of cancer, the nature of the cough changes: it intensifies, accompanied by pain and expectoration of bloody fluid
• in small cell lung cancer, a person often has shortness of breath, which is associated with the obstructed flow of air through the bronchi, which disrupts the proper functioning of the lung;
• at 2 and 3 stages of the course of the disease, sudden fevers or a periodic increase in temperature are not uncommon. Pneumonia, which smokers often suffer from, can also be a sign of lung cancer;
• systematic chest pain when coughing or trying to take a deep breath;
• a great danger are bleeding of the lungs, which are caused by the invasion of the tumor into the pulmonary vessels. This symptom speaks of neglect of the disease;
• when the tumor increases in size, it is capable of oppressing neighboring organs, which can result in pain in the shoulders and limbs, swelling of the face and hands, difficulty swallowing, hoarseness in the voice, prolonged hiccups;
• at an advanced stage of cancer, the tumor seriously affects other organs, which further aggravates the unfavorable picture. Metastases that have reached the liver can provoke jaundice, pain under the ribs, metastases to the brain lead to paralysis, loss of consciousness and disorders of the speech center of the brain, bone metastases cause pain and aches in them;

All of the above symptoms can be accompanied by sudden weight loss, loss of appetite, chronic weakness and rapid fatigue.

Based on how intensely the symptoms manifest themselves and how timely a person seeks help from a doctor, it is possible to predict the chances of his recovery.

Find out more about early stage lung cancer symptoms here.

Diagnostics

Adults, especially smokers, should be screened periodically for lung cancer.

Diagnosis of a tumor in the lung consists of the following procedures:

1. Fluorography to detect any changes in the lungs. This procedure is carried out during a medical examination, after which the doctor prescribes other examinations that will help in making the correct diagnosis.
2. Clinical and biochemical blood test.
3. Bronchoscopy is a diagnostic method in which the degree of damage to the lung is studied.
4. A biopsy is the removal of a sample of a tumor by surgery to determine the type of tumor.
5. Radiation diagnostics, which includes X-ray examination, magnetic resonance imaging (MRI) and positive emission tomography (PET), which can determine the location of tumor foci and clarify the stage of the disease.

Video: On the early diagnosis of lung cancer

Treatment

The tactics of treating small cell lung cancer are developed based on clinical picture disease and general well-being of the patient.

There are three main methods of treating lung cancer, which are often used in combination:

1. surgical removal of the tumor;
2. radiation therapy;
3. chemotherapy.

Surgical removal of the tumor makes sense early in the disease. Its purpose is to remove a tumor or part of an affected lung. This method is not always possible with small cell lung cancer due to its rapid development and late detection, therefore, more radical methods are used to treat it.

The possibility of surgery is also excluded if the tumor affects the trachea or adjacent organs. In such cases, immediately resort to chemotherapy and radiation therapy.

Chemotherapy for small cell lung cancer can give good results if it is used promptly. Its essence lies in taking special medications that destroy tumor cells or significantly slow down their growth and reproduction.

The patient is prescribed the following drugs:

The drugs are taken at intervals of 3-6 weeks, and for the onset of remission, at least 7 courses must be completed. Chemotherapy helps to shrink the tumor, but it cannot guarantee complete recovery. However, she is able to prolong a person's life even at the fourth stage of the disease.

Radiation therapy or radiotherapy is a method of treating a malignant tumor using gamma radiation or X-rays, which can kill or slow down the growth of cancer cells.

It is used for inoperable lung tumors, when a tumor of the lymph nodes is affected, or when surgery is not possible due to the patient's unstable condition (for example, serious illness other internal organs).

With radiation therapy, the affected lung and all areas of metastasis are subject to radiation. To be more effective, radiation therapy is combined with chemotherapy if the patient is able to tolerate such a combination therapy.

One of possible options Palliative care is the treatment of lung cancer patients. It is applicable when all possible methods to stop the development of the tumor did not give a result, or when lung cancer was detected at a very late stage.

Palliative care is designed to ease last days the patient, providing him with psychological assistance and pain relief severe symptoms cancer. The methods of such treatment depend on the condition of the person and are highly individual for each.

There are various alternative treatments for small cell lung cancer that are popular in narrow circles. In no case should you rely on them and self-medicate.

For successful outcome every minute counts, and people often waste precious time. At the slightest sign of lung cancer, you should immediately consult a doctor, otherwise a lethal outcome is inevitable.

The choice of a patient's treatment method is an important stage on which he depends. future life... This method should take into account the stage of the disease and the psycho-physical condition of the patient.

The article will tell you about what radiation diagnostics of central lung cancer is.

You can learn more about the methods of treating peripheral lung cancer in this article.

How long (life expectancy) live with small cell lung cancer

Despite the rapid progression of small cell lung cancer, it is more sensitive to chemotherapy and radiotherapy than other forms of cancer, therefore, with timely treatment, the prognosis can be favorable.

The most favorable outcome is observed when cancer is detected at stages 1 and 2. Patients who start treatment on time manage to achieve complete remission. Their life expectancy has already exceeded three years and the number of those cured is about 80%.

At stages 3 and 4, the prognosis worsens significantly. At complex treatment the patient's life can be extended by 4-5 years, and the survival rate is only 10%. If untreated, the patient dies within 2 years from the date of diagnosis.

Lung cancer is one of the most common oncological diseases, which is very difficult to treat, but there are many ways to prevent its occurrence. First of all, it is necessary to cope with nicotine addiction, to avoid contact with harmful substances and undergo regular medical examinations.

Early detection of small cell lung cancer significantly increases the chances of defeating the disease.

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Do not self-medicate. Please consult your healthcare professional.

Small cell lung cancer stage 3

Small cell carcinoma is an extremely malignant tumor with an aggressive clinical course and widespread metastasis. This form accounts for 20-25% of all types of lung cancer. Some researchers regard it as a systemic disease, in which there are almost always metastases in the regional and extrathoracic lymph nodes already in the initial stages. The majority of patients are men, but the percentage of affected women is increasing. The etiological relationship of this cancer with smoking is emphasized. Due to rapid tumor growth and widespread metastases, most patients suffer from severe disease.

Symptoms

Re-emerging cough or a change in the cough that is usual for a patient who is a smoker.

Fatigue, lack of appetite.

Shortness of breath, chest pain.

Pain in the bones, spine (with metastases to the bone tissue).

Epileptic seizure, headaches, weakness in the limbs, speech disorders - possible symptoms brain metastases in stage 4 lung cancer.

Forecast

Small cell lung cancer is one of the most aggressive forms. How long such patients live depends on the treatment. In the absence of therapy, death occurs in 2-4 months, and the survival rate reaches only 50 percent. With the use of treatment, the life expectancy of cancer patients can increase several times - up to 4-5. The prognosis is even worse after a 5-year period of illness - only 5-10 percent of patients remain alive.

Stage 4

Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs and systems, which causes symptoms such as:

headaches, etc.

Treatment

Chemotherapy plays an important role in the treatment of small cell lung cancer. In the absence of treatment, half of patients die within 6-17 weeks after diagnosis. Polychemotherapy allows you to increase this indicator of donated. It is used both as an independent method and in combination with surgery or radiation therapy.

The goal of treatment is to achieve complete remission, which must be confirmed by bronchoscopic methods, including biopsy and bronchoalveolar lavage. The effectiveness of treatment is assessed 6-12 weeks after its initiation. From these results, it is already possible to predict the likelihood of cure and the life expectancy of the patient. The most favorable prognosis is in those patients who have achieved complete remission during this time. All patients, whose life expectancy exceeds 3 years, belong to this group. If the tumor mass has decreased by more than 50% and there are no metastases, one speaks of partial remission. The life expectancy of such patients is shorter than in the first group. If the tumor does not respond to treatment or progresses, the prognosis is poor.

After the stage of the disease has been determined (early or late, see "Lung cancer: stages of the disease"), the general condition of the patient is assessed in order to find out whether he is able to undergo induction chemotherapy (including as part of a combination treatment). It is carried out only if neither radiation therapy nor chemotherapy has been previously carried out, if the patient's working capacity is preserved, there are no serious concomitant diseases, cardiac, hepatic and renal failure, the function of the bone marrow is preserved, PaO2 when breathing atmospheric air exceeds 50 mm Hg. Art. and no hypercapnia. However, even in such patients, the mortality rate during induction chemotherapy reaches 5%, which is comparable to the mortality rate during radical surgical treatment.

If the patient's condition does not meet the specified criteria, in order to avoid severe side effects, the dose of antineoplastic agents is reduced.

Induction chemotherapy should be performed by a specialist oncologist; special attention is required in the first 6. 12 weeks. In the course of treatment, infectious, hemorrhagic and other serious complications are possible.

Treatment of localized small cell lung cancer (SCLC)

the effectiveness of treatment is 65-90%;

The 5-year survival rate is about 10%, while for patients who started treatment in good general condition, this figure is about 25%.

The basis in the treatment of a localized form of SCLC is chemotherapy (2-4 courses) according to one of the schemes indicated in the table in combination with radiation therapy of the primary focus, mediastinum and lung root in the total focal dose of Gy. It is advisable to start radiation therapy against the background of chemotherapy (during or after 1-2 courses). If the patient is in complete remission, it is also advisable to irradiate the brain with a total dose of 30 Gy, since SCLC is characterized by a high probability (about 70%) of brain metastasis.

Patients with advanced MDR are shown to be treated with combined chemotherapy (see table), while irradiation is advisable only if there are special indications: with metastatic lesions of bones, brain, adrenal glands, mediastinal lymph nodes with compression syndrome of the superior genital vein, etc.

In some cases of metastatic brain lesions, it is advisable to consider treatment with a gamma knife.

According to statistics, the effectiveness of chemotherapy in the treatment of advanced SCLC is about 70%, while in 20% of cases a complete regression is achieved, which gives survival rates close to those of patients with a localized form.

Chemotherapy

At this stage, the tumor is located within one lung, it is also possible to involve nearby lymph nodes. The following treatments are possible:

Combined chemotherapy / radiation therapy followed by prophylactic cranial irradiation (PCR) in remission.

Chemotherapy with / without PCO for patients with impaired respiratory function.

Surgical resection with adjuvant therapy for stage I patients.

The combined use of chemotherapy and thoracic radiation therapy is the standard approach for patients with limited stage small cell lung cancer. According to statistics from various clinical trials, combination therapy compared with chemotherapy without radiation increases the 3-year prognosis of survival by 5%. Platinum and etoposide are more commonly used drugs.

The average prognostic indicators are life expectancy and the prognosis of 2-year survival in the range of 40-50%. The following ways to improve the prognosis were ineffective: increasing the dose of drugs, the effect of additional types of chemotherapy drugs. The optimal duration of the course has not been determined, but should not exceed 6 months.

Also, the question of the optimal use of radiation remains open. Several clinical studies show the benefits of early radiation therapy (during 1-2 cycles of chemotherapy). The duration of the course of irradiation should not exceed days. It is possible to use both a standard irradiation regimen (1 time per day for 5 weeks) and hyperfractionated (2 or more times a day for 3 weeks). Hyperfractionated thoracic radiation therapy is considered preferred and contributes to a better prognosis.

Age over 70 years significantly worsens the prognosis of treatment. Elderly patients respond much worse to radiochemotherapy, which manifests itself in low efficiency and manifestation of complications. Currently, the optimal therapeutic approach to elderly patients with small cell lung cancer has not been developed.

In rare cases, with good respiratory function and limited tumor process within the lung, it is possible to conduct surgical resection with / without subsequent adjuvant chemotherapy.

Patients for whom it was possible to achieve remission of the tumor process are candidates for prophylactic cranial irradiation (PCR). The research results indicate a significant reduction in the risk of metastases in the brain, which is 60% without the use of PCO. PCO improves the prognosis of 3-year survival rate from 15% to 21%. Often, neurophysiological impairments are observed in patients who have survived non-small cell lung cancer, but these impairments are not associated with the passage of PCO.

The tumor has spread beyond the lung in which it originally appeared. Standard treatment approaches include the following:

Combined chemotherapy with / without prophylactic cranial radiation.

etoposide + cisplatin or etoposide + carboplatin is the most common approach and has been clinically proven to be effective. The rest of the approaches have not yet shown a significant advantage.

cyclophosphamide + doxorubicin + etoposide

Ifosfamide + Cisplatin + Etoposide

cyclophosphamide + doxorubicin + etoposide + vincristine

cyclophosphamide + etoposide + vincristine

Radiation therapy - is used in case of a negative response to chemotherapy, especially with metastases in the head and spinal cord or bones.

The standard approach (cystplatin and etoposide) gives a positive response in 60-70% of patients and leads to remission in 10-20%. Clinical studies show the benefit of platinum-based combination chemotherapy. However, cisplatin is often accompanied by severe side effects, which can lead to serious consequences in patients suffering from cardiovascular diseases. Carboplatin is less toxic than cisplatin. The feasibility of using higher doses of chemotherapy drugs remains an open question.

As with the limited stage, prophylactic cranial radiation is indicated in the case of a positive response to chemotherapy for advanced stage small cell lung cancer. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. There was no significant deterioration in health after PCO.

Often, patients diagnosed with advanced SCLC have poor health conditions that complicate aggressive therapy. However, the conducted clinical studies did not reveal an improvement in the prognosis of survival with a decrease in drug doses or with a switch to monotherapy. However, the intensity in this case should be calculated from an individual assessment of the patient's health.

Life span

How many people live with lung cancer and how can you determine how long you live with lung cancer? It is sad, but with such a terrifying diagnosis, patients without surgery are always fatal. About 90% of people die in the first 2 years of life, after the diagnosis of the disease. But you should never give up. It all depends on at what stage you have a disease and what type it belongs to. First of all, there are two main types of lung cancer - small cell and non-small cell.

Small cell, mainly smokers are susceptible, it is less common, but spreads very quickly, forming metastases and invading other organs. It is more sensitive to chemical and radiation therapy.

How many live

The prognosis for lung cancer depends on many factors, but primarily on the type of disease. The most disappointing is small cell carcinoma. Within 2-4 months after the diagnosis, every second patient dies. The use of chemotherapy treatment increases life expectancy by 4-5 times. The prognosis for non-small cell cancer is better, but it also leaves a lot to be desired. With timely started treatment, the survival rate within 5 years is 25%. How long they live with lung cancer - there is no definite answer, the size and location of the tumor, its histological structure, the presence of concomitant diseases, etc., affect life expectancy.

Small cell lung cancer

In the structure of oncological diseases, lung cancer is one of the most common pathologies. It is based on a malignant degeneration of the epithelium of the lung tissue, a violation of air exchange. The disease is characterized by high mortality. The main risk group is age-old men who smoke. A feature of modern pathogenesis is a decrease in age primary diagnosis increasing the likelihood of lung cancer in women.

Small cell carcinoma is a malignant tumor that has the most aggressive course and widespread metastasis. This form accounts for about 20-25% of all types of lung cancer. Many scientific experts regard this type of tumor as systemic disease, in the early stages of which, there are almost always metastases in the regional lymph nodes. Men suffer from this type of tumor most often, but the percentage of women who become ill is growing significantly. Almost all patients have a fairly severe form of cancer, this is due to the rapid growth of the tumor and wide metastasis.

The reasons for the development of small cell lung cancer

In nature, there are many reasons for the development of a malignant neoplasm in the lungs, but there are main ones that we face almost every day:

• smoking;
• exposure to radon;
• asbestosis of the lungs;
• viral damage;
• dust exposure.

Clinical manifestations of small cell lung cancer

Small cell lung cancer symptoms:

Fatigue and feeling of weakness

• a cough of a prolonged nature, or a reappearing cough with changes usual for the patient;
• lack of appetite;
• weight loss;
• general malaise, fatigue;
• shortness of breath, pain in the chest and lungs;
• change in voice, hoarseness (dysphonia);
• pain in the spine with bones (occurs with bone metastases);
• epileptic seizures;
• lung cancer, stage 4 - speech impairment occurs and severe headaches appear.

Small cell lung cancer grades

1. Stage 1 - the size of the tumor is up to 3 cm in diameter, the tumor has affected one lung. There is no metastasis.
2. Stage 2 - the size of the tumor in the lung is from 3 to 6 cm, it blocks the bronchus and grows into the pleura, causing atelectasis;
3. Stage 3 - the tumor rapidly passes, its size increased from 6 to 7 cm to neighboring organs, atelectasis of the entire lung occurs. Metastases in adjacent lymph nodes.
4. Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs of the human body, which in turn causes symptoms such as:

• headache;
• hoarseness or loss of voice at all;
• general malaise;
• loss of appetite and a sharp decrease in weight;
• back pain, etc.

Diagnosis of small cell lung cancer

Despite all clinical examinations, taking anamnesis and listening to the lungs, you also need a high-quality diagnosis of the disease, which is carried out using methods such as:

• skeletal scintigraphy;
• chest x-ray;
• detailed, clinical blood test;
• computed tomography (CT);
• liver function tests;
• magnetic resonance imaging (MRI)
• positron emission tomography (PET);
• sputum analysis (cytological examination to detect cancer cells);
• pleurocentesis (taking fluid from the chest cavity around the lungs);
• biopsy is the most frequent method diagnosing a malignant neoplasm. It is carried out in the form of removing a particle of a fragment of the affected tissue for further examination under a microscope.

There are several ways to conduct a biopsy:

• bronchoscopy combined with biopsy;
• puncture biopsy is performed using CT;
• endoscopic ultrasound with biopsy;
• mediastinoscopy in combination with biopsy;
• open lung biopsy;
• pleural biopsy;
• video thoracoscopy.

Small cell lung cancer treatment

The most important place in the treatment of small cell lung cancer is chemotherapy. In the absence of appropriate treatment for lung cancer, the patient dies 5-18 weeks after diagnosis. Polychemotherapy helps to increase the mortality rate to 45 - 70 weeks. They use it, both as an independent method of therapy, and in combination with surgical intervention or radiation therapy.

The purpose this treatment, is complete remission, which must be confirmed by bronchoscopic methods, biopsy and bronchoalveolar lavage. As a rule, the effectiveness of treatment is assessed 6-12 weeks after the start of therapy, and, according to these results, the likelihood of cure and the patient's life expectancy can be assessed. The most favorable prognosis is in those patients who have achieved complete remission. This group includes all patients whose life expectancy exceeds 3 years. If the tumor has decreased by 50%, while there is no metastasis, it is possible to speak of partial remission. Life expectancy is correspondingly less than in the first group. With a tumor that does not respond to treatment and active progression, the prognosis is poor.

After determining the stage of lung cancer disease, it is necessary to assess the patient's state of health in terms of whether he is able to undergo induction chemotherapy in combination with a combination treatment. It is carried out in the absence of previously chemotherapy and radiation therapy, also with the patient's ability to work, there are no severe concomitant diseases, heart, liver failure, the function of the bone marrow PaO2 is preserved when breathing atmospheric air exceeds 50 mm Hg. Art. and no hypercapnia. But, it is also worth noting that mortality from induction chemotherapy is present and reaches 5%, which is comparable to mortality from radical surgical treatment.

If the patient's state of health does not meet the specified standards and criteria, in order to avoid complications and severe side effects, the dose of anticancer drugs is reduced. Induction chemotherapy should be performed by an oncologist. The patient needs special attention in the first 4 months. Also, in the course of treatment, infectious, hemorrhagic and other serious complications are possible.

Localized small cell lung cancer (SCLC) and its treatment

Treatment statistics for this form of SCLC have good indicators:

1. the effectiveness of treatment is 65-90%;
2. tumor regression is observed in 45-75% of cases;
3. the median survival rate reaches months;
4. 2-year survival rate is 40-50%;
5. The 5-year survival rate is 10% and reaches 25% for patients who start treatment in good general health.

Chemotherapy (2-4 courses) in combination with radiation therapy in a total focal dose of Gy is fundamental in the treatment of localized forms of SCLC. It is considered correct to start radiation therapy against the background of chemotherapy during or after 1-2 courses. When observing remission, it is advisable to irradiate the brain in a total dose of 30 Gy, since SCLC is characterized by rapid and aggressive metastasis to the brain.

Treating advanced small cell lung cancer (SCLC)

With the common form of SCLC, combined treatment is indicated, while irradiation is advisable to carry out in the presence of special indicators:

• the presence of bone metastasis;
• metastasis to the brain;
• metastasis in the adrenal glands;
• metastasis in the lymph nodes, mediastinum with compression syndrome of the superior vena cava.

Note! In case of metastasis to the brain, treatment with a gamma knife is possible.

After conducting a statistical study, it was revealed that the effectiveness of chemotherapy in the treatment of advanced SCLC is about 70%, while in 20% of cases, complete remission is achieved, which gives survival rates close to those of patients with a localized form.

Chemotherapy

Limited stage

At this stage, the tumor is located within one lung, it is also possible to involve nearby lymph nodes.

The applied methods of treatment:

• combined: chemotherapy + radiation therapy followed by prophylactic cranial irradiation (PCR) in remission;
• chemotherapy with or without PCO, for patients who have deterioration in respiratory function;
• surgical resection with adjuvant therapy for stage 1 patients;
• the combined use of chemotherapy and thoracic radiation therapy is the standard approach for patients with limited stage, small cell lung cancer.

According to statistics from clinical trials, combination treatment compared with chemotherapy without radiation therapy increases the 3-year prognosis of survival by 5%. The drugs used are platinum and etoposide. The prognostic indicators for life expectancy are months and the prognosis of 2-year survival is 50%.

Ineffective ways to increase your forecast:

1. increasing the dose of drugs;
2. the action of additional types of chemotherapy drugs.

The duration of the chemotherapy course has not been determined, but, nevertheless, the duration of the course should not exceed 6 months.

The question of radiation therapy: many studies show its benefits during the 1-2 cycle of chemotherapy. The duration of the course of radiation therapy should not exceed days.

It is possible to use standard radiation courses:

1. Once a day for 5 weeks;
2. 2 or more times a day for 3 weeks.

Hyperfractionated thoracic radiation therapy is considered preferred and contributes to a better prognosis.

Patients of an older age (65-70 years old) tolerate treatment significantly worse, the prognosis of treatment is much worse, since they react rather poorly to radiochemotherapy, which in turn manifests itself in low efficiency and large complications. Currently, the optimal therapeutic approach to elderly patients with small cell lung cancer has not been developed.

Patients who have achieved remission of the tumor process are candidates for prophylactic cranial irradiation (PCR). Research results indicate a significant reduction in the risk of metastases in the brain, which is 60% without the use of PCO. PCO improves the prognosis of 3-year survival rate from 15% to 21%. Often, patients who survived non-small cell lung cancer have impairments in neurophysiological function, but these impairments are not associated with the passage of PCR.

Extensive stage

The spread of the tumor occurs outside the lung in which it originally appeared.

Standard therapies:

• combined chemotherapy with or without prophylactic cranial radiation;
• etoposide + cisplatin or etoposide + carboplatin is the most common approach with proven efficacy. The rest of the approaches have not yet shown significant advantages;
• cyclophosphamide + doxorubicin + etoposide;
• Ifosfamide + Cisplatin + Etoposide;
• cisplatin + irinotecan;
• cyclophosphamide + doxorubicin + etoposide + vincristine;
• cyclophosphamide + etoposide + vincristine.

Radiation is given if the response to chemotherapy is negative, especially for metastases in the brain, spinal cord, or bones.

A fairly positive response is 10-20% of remission, given by cystplatin and etoposide. Clinical studies show the benefit of combination chemotherapy with platinum. But, despite this, cisplatin is often accompanied by severe side effects that can lead to serious consequences in patients suffering from cardiovascular diseases. Carboplatin is less toxic than cisplatin.

Note! The use of higher doses of chemotherapy drugs remains an open question.

For a limited stage, in the case of a positive response to chemotherapy, an extensive stage of small cell lung cancer, prophylactic cranial irradiation is indicated. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. There was no significant deterioration in health after PCO.

Combined radiochemotherapy does not improve the prognosis compared to chemotherapy, however, thoracic radiation is advisable for palliative care remote metastases.

Patients diagnosed with advanced SCLC have poor health conditions that complicate aggressive therapy. The conducted clinical studies did not reveal an improvement in the prognosis of survival with a decrease in doses of drugs or with a transition to monotherapy, but, nevertheless, the intensity in this case should be calculated from an individual assessment of the patient's health.

Disease prognosis

As mentioned earlier, small cell lung cancer is one of the most aggressive forms of all cancers. What is the prognosis of the disease and how long the patients live depends directly on the treatment of oncology in the lungs. Much depends on the stage of the disease, and what type it belongs to. There are two main types of lung cancer - small cell and non-small cell.

SCLC, smokers are susceptible, it is less common, but spreads very quickly, forming metastases and invading other organs. It is more sensitive to chemical and radiation therapy.

Small cell lung cancer, life expectancy in the absence of appropriate treatment is from 6 to 18 weeks, but the survival rate reaches 50%. With appropriate therapy, life expectancy increases from 5 to 6 months. The worst prognosis is in patients with a 5-year illness. Approximately 5-10% of patients survive.

Informative video on the topic: Smoking and lung cancer

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In the structure of oncological diseases, lung cancer is one of the most common pathologies. It is based on a malignant degeneration of the epithelium of the lung tissue, a violation of air exchange. The disease is characterized by high mortality. The main risk group is male smokers aged 50-80 years. A feature of modern pathogenesis is a decrease in the age of primary diagnosis, an increase in the likelihood of lung cancer in women.

Small cell carcinoma is a malignant tumor that has the most aggressive course and widespread metastasis. This form accounts for about 20-25% of all types. Many scientific experts regard this type of tumor as a systemic disease, in the early stages of which it is almost always present in the regional lymph nodes. , suffer from this type of tumor most often, but the percentage of cases increases significantly. Almost all patients have a fairly severe form of cancer, this is due to the rapid growth of the tumor and wide metastasis.

Small cell lung cancer

The reasons for the development of small cell lung cancer

In nature, there are many reasons for the development of a malignant neoplasm in the lungs, but there are main ones that we face almost every day:

• smoking;
• exposure to radon;
• asbestosis of the lungs;
• viral damage;
• dust exposure.

Clinical manifestations of small cell lung cancer

Small cell lung cancer symptoms:

• a cough of a prolonged nature, or a reappearing cough with changes usual for the patient;
• lack of appetite;
• weight loss;
• general malaise, fatigue;
• shortness of breath, pain in the chest and lungs;
• change in voice, hoarseness (dysphonia);
• pain in the spine with bones (occurs with bone metastases);
• epileptic seizures;
• lung cancer, stage 4 - speech impairment occurs and severe headaches appear.

Small cell lung cancer grades

• Stage 1 - the size of the tumor is up to 3 cm in diameter, the tumor has affected one lung. There is no metastasis.
• Stage 2 - the size of the tumor in the lung is from 3 to 6 cm, it blocks the bronchus and grows into the pleura, causing atelectasis;
• Stage 3 - the tumor rapidly passes into neighboring organs, its size has increased from 6 to 7 cm, atelectasis of the entire lung occurs. Metastases in adjacent lymph nodes.
• Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs of the human body and causes symptoms such as:

1. headache;
2. hoarseness or loss of voice at all;
3. general malaise;
4. loss of appetite and a sharp decrease in weight;
5. back pain, etc.

Diagnosis of small cell lung cancer

Despite all clinical examinations, history taking and listening to the lungs, a high-quality one is also needed, which is carried out using methods such as:

• skeletal scintigraphy;
• chest x-ray;
• detailed, clinical blood test;
• computed tomography (CT);
• liver function tests;
• magnetic resonance imaging (MRI)
• positron emission tomography (PET);
• sputum analysis (cytological examination to detect cancer cells);
• pleurocentesis (taking fluid from the chest cavity around the lungs);
• - the most common method for diagnosing a malignant neoplasm. It is carried out in the form of removing a particle of a fragment of the affected tissue for further examination under a microscope.

There are several ways to conduct a biopsy:

• bronchoscopy combined with biopsy;
• performed with CT;
• endoscopic ultrasound with biopsy;
• mediastinoscopy in combination with biopsy;
• open lung biopsy;
• pleural biopsy;
• video thoracoscopy.

Small cell lung cancer treatment

The most important place in the treatment of small cell is chemotherapy. In the absence of appropriate treatment for lung cancer, the patient dies 5-18 weeks after diagnosis. Polychemotherapy helps to increase the mortality rate to 45 - 70 weeks. It is used both as an independent method of therapy and in combination with surgery or radiation therapy.

The goal of this treatment is complete remission, which must be confirmed by bronchoscopic methods, biopsy and bronchoalveolar lavage. As a rule, the effectiveness of treatment is assessed 6-12 weeks after the start of therapy, and, according to these results, the likelihood of cure and the patient's life expectancy can be assessed. The most favorable prognosis is in those patients who have achieved complete remission. This group includes all patients whose life expectancy exceeds 3 years. If the tumor has decreased by 50%, while there is no metastasis, it is possible to speak of partial remission. Life expectancy is correspondingly less than in the first group. With a tumor that does not respond to treatment and active progression, the prognosis is poor.

After conducting a statistical study, the effectiveness of chemotherapy was revealed and it is about 70%, while in 20% of cases complete remission is achieved, which gives survival rates close to those of patients with a localized form.

Limited stage

At this stage, the tumor is located within one lung, it is also possible to involve nearby lymph nodes.

The applied methods of treatment:

• combined: chemotherapy + radiation therapy followed by prophylactic cranial irradiation (PCR) in remission;
• chemotherapy with or without PCO, for patients who have deterioration in respiratory function;
• surgical resection with adjuvant therapy for stage 1 patients;
• the combined use of chemotherapy and thoracic radiation therapy is the standard approach for patients with limited stage, small cell lung cancer.

According to statistics from clinical trials, combination treatment compared with chemotherapy without radiation therapy increases the 3-year prognosis of survival by 5%. The drugs used are platinum and etoposide. The prognostic indicators for life expectancy are 20-26 months and the prognosis for 2-year survival is 50%.

Ineffective ways to increase your forecast:

• increasing the dose of drugs;
• the action of additional types of chemotherapy drugs.

The duration of the chemotherapy course has not been determined, but, nevertheless, the duration of the course should not exceed 6 months.

The question of radiation therapy: many studies show its benefits during the 1-2 cycle of chemotherapy. The duration of the course of radiation therapy should not exceed 30-40 days.

Maybeapplication of standard courses of exposure:

• Once a day for 5 weeks;
• 2 or more times a day for 3 weeks.

Hyperfractionated thoracic radiation therapy is considered preferred and contributes to a better prognosis.

Patients of an older age (65-70 years old) tolerate treatment significantly worse, the prognosis of treatment is much worse, since they react rather poorly to radiochemotherapy, which in turn manifests itself in low efficiency and large complications. Currently, the optimal therapeutic approach for elderly patients with small cell carcinoma has not been developed.

Patients who have achieved remission of the tumor process are candidates for prophylactic cranial irradiation (PCR). Research results indicate a significant reduction in the risk of metastases in the brain, which is 60% without the use of PCO. PCO improves the prognosis of 3-year survival rate from 15% to 21%. Often, survivors have impairments in neurophysiologic function, but these impairments are not associated with the passage of POC.

Extensive stage

The spread of the tumor occurs outside the lung in which it originally appeared.

Standard therapies:

• combined chemotherapy with or without prophylactic cranial radiation;
• +

  Note! The use of higher doses of chemotherapy drugs remains an open question.

  For a limited stage, in the case of a positive response to chemotherapy, an extensive stage of small cell lung cancer, prophylactic cranial irradiation is indicated. The risk of metastases in the central nervous system within 1 year is reduced from 40% to 15%. There was no significant deterioration in health after PCO.

  Combined radiochemotherapy does not improve the prognosis compared to chemotherapy, however, thoracic irradiation is advisable for palliative therapy of distant metastases.

  Patients diagnosed with advanced stage have deteriorated health conditions that complicate aggressive therapy. The conducted clinical studies did not reveal an improvement in the prognosis of survival with a decrease in doses of drugs or with a transition to monotherapy, but, nevertheless, the intensity in this case should be calculated from an individual assessment of the patient's health.

  Disease prognosis

  As mentioned earlier, small cell lung cancer is one of the most aggressive forms of all. What is the prognosis of the disease and how long the patients live depends directly on the treatment of oncology in the lungs. Much depends on the stage of the disease, and what type it belongs to. There are two main types of lung cancer - small cell and non-small cell.

  Small cell lung cancer affects smokers, it is less common, but spreads very quickly, forming metastases and invading other organs. It is more sensitive to chemical and radiation therapy.

  Life expectancy in the absence of appropriate treatment is from 6 to 18 weeks, but the survival rate reaches 50%. With appropriate therapy, life expectancy increases from 5 to 6 months. The worst prognosis is in patients with a 5-year illness. Approximately 5-10% of patients survive.

  Informative video

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  Previously, this type of disease was considered a male disease, but with environmental pollution, increased nervous stress, cases of smoking among women, it has spread to the female part of the population. The main risk group falls on people aged 44-67 years.

  

  Small cell lung cancer: life expectancy

  When diagnosed with small cell, it is impossible to say exactly how long patients live. Because this is determined by several factors: the age of the sick person, good immunity, the body's susceptibility to drugs, the timeliness of the initiated therapy.

  There are four degrees of development of the disease:

  1. Malignant formation is 3cm. Metastasis to other areas is not observed.
  2. Blastoma from 3 to 6 cm. Infected particles enter the pleura, pinch the bronchi, there is a possibility of atelectasis.
  3. The neoplasm grows up to 7cm. Malignant cells grow into nearby lymph nodes. Spread to other organs begins.
  4. Formations are created from harmful cells, covering the heart, kidneys and liver. Incurable.

  In the first stage, characterized by a small tumor in the lung, recovery occurs with a 75-85% probability.

  But this should be preceded by a timely surgical operation, which will remove the malignant formation in time, and a properly selected drug treatment.

  If your body copes with this difficult task without complications, then the probability of relapse after five years will be 6-9%.

  At the second stage, where, in addition to the tumor, there are already small formations in the lymphatic system, the possibility of complete regression is 50-60%.

  Due to the likelihood of relapse and weakening of the body, the survival rate for 4-6 years is no more than 25%.

  However, predominantly this type of malignant formation is detected at the 3rd (approximately 65%) or 4th stage according to the totality of all symptoms that have appeared by this time. By this time, the malignant lung tumor progresses and gives complications to other organs, therefore, the life span, even with treatment, is reduced to 5-7 years.

  It is worth noting that if, as a result of therapeutic actions, the tumor begins to shrink, then doctors regard this as a sign that increases the success of recovery. With partial remission, the chances are about 52%, and with complete remission, the chances are 75-90%.

  3rd stage cancerous tumor is distinguished by the manifestation persistent cough with the release of red-brown sputum due to metastases in the blood vessels. Chest pains, previously attributed to neuralgia, become constant and unbearable. The heartbeat is disturbed, the patency of the esophagus becomes difficult, constant shortness of breath suffers, symptoms appear that characterize the initial damage to other organs.

  When diagnosed with a malignant lung tumor in the 3rd phase, the prognosis is disappointing. Without drug assistance life expectancy ranges from a few weeks to 4-6 months.

  

  However, this type of tumor has increased sensitivity to radiation and chemotherapy, therefore, the combined treatment of small cell cancer in correct dosage cytotoxic drugs can increase the lifespan up to 5-7 years.

  Predictions for stage 4 small cell lung cancer

  On the the final stage malignant cells infect liver and kidney tissue, bones, and penetrate the brain. This causes severe pain that analgesics cannot cope with. Absolute recovery (without relapses) during the described stage occurs very rarely. The lifespan of cancer patients with malignant formations that have spread to the heart or liver is no more than 2 months. With a diagnosis of stage 4 sarcoma, the prognosis does not exceed 8-10% of the life expectancy of people within 4-6 years.

  In terms of the total set of factors, the prognosis of re-manifestation at stage 4 is positive. In comparison with other species, when this form of tumor is affected, the life expectancy after surgery is very short.