Warning Signs Of Small Cell Lung Cancer

Only 1 in 4 lung cancer patients are diagnosed at an early stage. Learn these early signs of small cell lung cancer.

Most Americans with lung cancer are diagnosed at a later stage with the odds of a cure being low. Only about one-fourth of all lung cancer patients survive for five years.

“Unfortunately, lung cancer is often detected very late,” said Naina Mahngar, MD, medical oncologist and hematologist at Franciscan Health Woodland Cancer Care Center Michigan City. “Only one in four are diagnosed at an early stage, and one-half are diagnosed at a place where it’s not curable anymore.”

In this article you will learn what small cell lung cancer is, what the signs of small cell lung cancer are, and how lung cancer is diagnosed and treated.

What Is Small Cell Lung Cancer?

Small cell lung cancer is a fast-growing lung cancer that develops in the tissues of the lungs. Small cell lung cancer often begins in the nerve cells or hormone-producing cells of the lung. The term “small cell” refers to the size and shape of the cancer cells as seen under a microscope. Small cell lung cancer often metastasizes at a faster pace and earlier stage than non-small cell lung cancer.

"Depending on which cell has overgrown, our pathology doctors, when they look at it under the microscope, they give it a classification. So what cell of origin did it come from?" said Corey Hogue, MD, a radiation oncologist with the Franciscan Health Woodland Cancer Center in Michigan City. "There's two types that happen to be called small cell and non-small cell. For patients, it matters because the treatments between the two types are very different. So whenever doctors come together and decide the best treatment option, we have to consider the cell of origin because they respond to different treatments and it can impact the recommendations that a patient would get."

How Common Is Small Cell Lung Cancer?

The American Cancer Society estimates there will be about 226,650 new cases of lung cancer diagnosed in the United States in 2025. Of those, about 13 percent of people with lung cancer -- nearly 30,000 people, will be diagnosed with small cell lung cancer.

What Are The Signs Of Small Cell Lung Cancer?

"Unfortunately, the most common symptom of lung cancer is really no symptoms at all," Dr Hogue said. "It takes a certain volume or size of tumor before it would cause any symptoms. So that's why screening for people that are high risk can be important. But for some people that present with symptoms, certainly if you had a cough that doesn't get better, if you're coughing up blood, if you're losing weight, if you're short of breath, these are all reasons to go to your primary care doctor and do some additional investigation."

As the lung cancer progresses, a person may experience these signs:

• Persistent, worsening cough that will not go away
• Coughing up small amounts of blood
• Chest pain or discomfort
• Changes in the voice or being hoarse
• Recurrent pneumonia or bronchitis
• Unexplained weight loss or loss of appetite

“A lot of young people ignore symptoms,” Dr. Mahngar said. “If you have a cough that lasts more than a week or two, you need to see a provider. If you have shortness of breath, getting winded doing the things you usually do with ease, see your doctor. If you have unexplained weight loss of 5 to 10 pounds and you’re not trying to lose weight, it’s generally a sign there’s a process in the body happening.”

Other signs of small cell lung cancer may include:

• Swelling of the neck or face
• Fatigue
• Hoarseness
• Swollen neck veins
• Wheezing.
• Coughing up phlegm or mucus

Talk to your Franciscan Health physician if you’re experiencing common lung cancer symptoms.

“Generally, most young people have a lot of reservations about calling the doctor,” Dr. Mahngar said. “Use words like ‘It’s a big change from my baseline’ or ‘I’m concerned something else is going on.’”

How Can I Prevent Small Cell Lung Cancer?

The most important way to prevent small cell lung cancer is to avoid tobacco smoke.

“Quitting smoking is the No. 1 way to increase your life span across the board,” Dr. Mahngar said.

People who never smoke have the lowest risk of small cell lung cancer. People who smoke can reduce their risk of lung cancers by stopping smoking, but their risk of small cell lung cancer will still be higher than people who never smoked.

Other possible risk factors for lung cancer include:

• Family history of lung cancer
• Environmental agents like radon exposure
• Workplace toxins, such as asbestos and arsenic
• Older age

Should I Be Screened For Lung Cancer?

While lung cancer is rare in adults under the age of 45, screening for lung cancer is available and recommended for certain high-risk people such as: adults aged 55 to 80 who are currently heavy smokers or who quit within the past 15 years.

In 2021, the U.S. Preventive Services Task Force began recommending annual lung cancer screening with low-dose computed tomography (CT) for people aged 50 to 80 who smoked at least one pack of cigarettes a day for 20 years, smoked two packs of cigarettes a day for 10 years, currently smoke, or who have quit in the past 15 years. About 14.2 million Americans meet these guidelines. Medicare and most private insurance plans must pay for the screening test in folks who fall into these high-risk categories.

"For less than the price of a nice dinner, you can get a lung scan read by a trained radiologist, and then it will give you the peace of mind or tell you that you need to do some additional testing," Dr. Hogue said.

A study published in the New England Journal of Medicine, followed more than 15,000 adults ages 50 to 74 years old for at least 10 years. Those who had low-dose CT lung scans at a year, three years and 5.5 years had lower death rates than the control group: 24 percent lower for men and 33 percent lower for women. An earlier U.S. trial found a 20 percent drop in lung cancer deaths via screenings with CT in comparison to chest X-rays.

So what we're finding now are little nodules that would otherwise take a year or two, three to develop into a big mass, are diagnosing the cancer early and able to treat it either with surgery or sometimes just five doses of radiation,” said radiation oncologist Michael Eaton, MD, medical director of cancer services at Franciscan Health Cancer Center Indianapolis. “And we're shifting the whole paradigm of lung cancer to earlier disease, which is very highly curable in early stages.”

How Is Lung Cancer Diagnosed?

"For a small percentage of people, they will have a finding from a lung scan that needs to be investigated further," Dr. Hogue said."Our radiologists can categorize things that they see and give it some kind of risk category, and that helps us determine what the next steps would be. So in some cases, a biopsy would be recommended. And a biopsy is where a doctor goes in and gets a sample of the tissue, sends it to a pathology doctor, they look at it under the microscope after they've chopped it up, and they tell us exactly what it is. And that's the best way to find out what's going on."

How Is Lung Cancer Treated?

"For the small percentage of people where we do unfortunately find cancer, we do have many, many treatment options available," Dr. Hogue said. "In general, they fall into three big categories."

1. Surgery: "Surgery used to be quite invasive and require opening up the chest, but now, at many facilities including Franciscan Health, we have robotic surgery options as well," he said.
2. Systemic Therapy: "Systemic therapy, or treatment that goes all throughout the body, would be chemotherapy, immunotherapy these days, other targeted therapies that are very specific for different types of lung cancer," Dr. Hogue said. "It minimizes the side effects if they're very targeted to a patient's individual tumor type."
3. Radiation Therapy: "Radiation therapy has advanced significantly over the years where we can precisely give high dose of radiation to the tumor alone and we can spare all the healthy, normal tissues nearby," Dr. Hogue said.

"Franciscan Health has the whole complement of treatments for every new diagnosis. We discuss it in a multidisciplinary tumor board, so that would include thoracic surgeons, that would include medical oncologists, radiation oncologists, pathologists, radiologists, everybody together puts their head together and comes up with a treatment plan. So, it's not one doctor coming up with something on their own. It's, you know, five, six, seven, eight doctors together. Even if you don't ever even see that doctor, they're providing their input and expertise."

What Is The Survival Rate For Lung Cancer?

The five-year survival rate for lung cancer now 27%,. When diagnosed early, the survival rate for lung cancer at an early stage is much higher. Lung cancer can often be treated surgically if it is diagnosed at an early stage and hasn't spread.

Listen Now: Lung Cancer

Lung cancer is the leading cause of cancer death, but medical technology and treatments are advancing. Earlier detection is possible and provides better lung cancer outcomes. Franciscan Health radiation oncologist Cory Hogue, MD, shares what you need to know about lung cancer, diagnosis and treatment options in the Franciscan Health DocPod podcast..