Small cell lung cancer (SCLC) is a fast-growing cancer that forms in the lung. It's one of two types of lung cancer. The other type is non-small cell lung cancer (NSCLC). SCLC is less common than NSCLC, accounting for about 15 percent of all lung cancers.

This cancer is named for the size of the cells, which look smaller under a microscope than healthy lung cells or NSCLC cells. Smoking is the biggest risk factor for SCLC, but even never-smokers can develop SCLC.

SCLC grows quickly. By the time it is diagnosed, the cancer has often spread from the lung to other parts of the body.

Even so, it can be curable when the cancer has barely spread or not spread at all. Even when SCLC has spread, there are treatments available to slow cancer growth and alleviate some symptoms.

Causes and Risk Factors of Small Cell Lung Cancer (SCLC)

Smoking is the main cause of small cell lung cancer (SCLC). Most people who are diagnosed with this cancer are current or former smokers. The longer someone has smoked and the more cigarettes, cigars, or pipes they have smoked, the greater their risk. Regular exposure to secondhand smoke can also increase the likelihood of SCLC.

Exposure to these substances increases the risk for SCLC:

Radon gas, which sometimes leaches into basements from soil surrounding your home
Asbestos, found in work environments, such as mines or textile plants
Chemicals like arsenic, cadmium, silica, vinyl chloride, coal products, and beryllium (mainly found in certain industrial workplaces)
Air pollution, such as from diesel fumes
Radiation to the chest from other cancer treatments or imaging scans

Exposure to these substances can damage DNA in ways that allow lung cells to grow uncontrollably and become cancer.

Some gene changes pass down through families, which is why people who have a family history of SCLC are at increased risk for this cancer themselves.

Once you’ve had lung cancer you’re more likely to develop it again.

How Is Small Cell Lung Cancer (SCLC) Diagnosed?

The diagnosis of small cell lung cancer usually starts with a discussion of symptoms and a physical exam. If the doctor suspects cancer, these imaging tests can show whether there are any abnormal growths in the chest or other parts of the body.

Chest X-Ray This test uses a small amount of radiation to create pictures of the lungs.
Computed Tomography (CT) In a CT scan, a computer combines X-ray images taken of the chest from multiple angles into one cross-sectional and highly detailed image. A CT scan can also show swelling in lymph nodes, if the cancer has spread there.
Magnetic Resonance Imaging (MRI) An MRI uses strong magnets and radio waves to take detailed images from inside the body.
Positron Emission Tomography (PET) In a PET scan, a small amount of radioactive sugar is injected into a vein, and then a scan is done with a special camera. Because cancer cells take up more sugar than healthy ones, areas with cancer show up on the scan. PET and CT are sometimes combined into one test.

Imaging tests can show areas of abnormal growths, but the only way to confirm the diagnosis is by taking a sample of cells or tissue and testing it in a laboratory. This is called a biopsy, and it can be done in a few ways.

Needle Biopsy The doctor uses a thin (fine needle biopsy) or thicker (core biopsy) needle to remove cells and fluid. A CT or ultrasound helps guide the needle to the suspicious area.
Bronchoscopy A bronchoscope is a thin, flexible tube with a light and camera. The doctor places the scope through the nose or mouth and passes it into the airways. Instruments threaded through the scope remove biopsy samples.
Endobronchial Ultrasound (EBUS) This technique combines bronchoscopy with ultrasound imaging to find and biopsy lymph nodes that might contain cancer.
Electromagnetic Navigation Bronchoscopy Using a technology that's similar to the GPS in cars, this procedure enables doctors to find small, hard-to-reach tumors that aren't accessible with bronchoscopy alone.

Stages of Small Cell Lung Cancer (SCLC)

The stage is based on the cancer’s size and location, information which was gathered from the diagnostic imaging tests and biopsies. Knowing the stage helps doctors choose the treatment that's most likely to be effective. SCLC has two stages:

Limited stage is only in the lung, and possibly lymph nodes, on one side of the chest.
Extensive stage has spread to the other lung, to distant lymph nodes, or to organs like the bones or brain.

Treatment and Medication Options for Small Cell Lung Cancer (SCLC)

Treatment for small cell lung cancer (SCLC) depends on the stage. Limited-stage SCLC can be treated with surgery, radiotherapy, chemotherapy, or immunotherapy. For extensive-stage SCLC, treatments like chemotherapy and immunotherapy can slow the cancer and relieve symptoms. Surgery is often ruled out for SCLC that has spread.

Chemotherapy

Chemotherapy is strong medicine, often injected into a vein, that travels throughout the bloodstream to kill cancer cells wherever they are in the body. In limited-stage SCLC, chemotherapy given along with radiation kills any remaining cancer cells. For extensive-stage SCLC, chemotherapy is often the main treatment, sometimes along with immunotherapy.

When chemotherapy is combined with radiation, the treatment is called concurrent chemoradiation.

The two treatments work together to kill and prevent the spreading of cancer cells.

The chemotherapy combinations that are most often used to treat SCLC are:

Cisplatin and etoposide
Carboplatin and etoposide

Radiation Therapy

In this treatment, a machine delivers high energy radiation to the tumor. The radiation kills cancer cells and stops them from dividing. For limited-stage SCLC, radiation therapy is given with chemotherapy to eliminate the cancer. In extensive-stage SCLC, it's given to shrink tumors and relieve symptoms like pain, bleeding, and shortness of breath that happen as the cancer grows and spreads.

Immunotherapy

This treatment works differently. Instead of killing cancer cells, it helps the immune system more effectively fight the cancer. The most common immunotherapy drugs used to treat SCLC are checkpoint inhibitors. By blocking the protein PD-L1 or PD-1, they "turn on" immune cells to attack cancer cells. Immunotherapy can also be combined with chemotherapy, especially to treat extensive-stage SCLC.

Immune checkpoint inhibitors used for SCLC are:

Atezolizumab (Tecentriq)
Durvalumab (Imfinzi)

Tarlatamab-dlle (Imdelltra) is another type of immunotherapy drug called a bispecific T-cell engager (BiTE). This drug has two "arms." One attaches to an immune cell called a T cell. The other attaches to a protein on the surface of SCLC cells. BiTE brings the immune cell to the cancer cell to kill it. It's a treatment for extensive-stage cancer that is no longer responding to chemotherapy.

Targeted Therapies

There are not as many targeted therapies available for SCLC as NSCLC, but new research looks promising. Tyrosine kinase inhibitors (TKIs), such as apatinib (Rivoceranib), block an enzyme used in cell growth and division, which can limit tumor growth.

While these targeted therapies are not yet fully approved, newer therapies might be an option through a clinical trial. Speak with your doctor about what clinical trials you might be eligible for, or look at ClinicalTrials.gov.

Surgery

Surgery isn't a common treatment for SCLC. Less than 5 percent of people qualify for this therapy because they have limited-stage cancer with a small tumor that hasn't spread to any lymph nodes.

Depending on the size and location of the cancer, the surgeon may remove one lobe of the lung (lobectomy). Chemotherapy and/or radiation therapy is given after surgery to ensure that all the cancer cells have been eradicated and to reduce the risk of a recurrence.

Complementary and Integrative Therapies

Complementary therapies work alongside conventional treatments like chemotherapy and radiation. Treatments like these don't slow the cancer, but they can help people with SCLC feel better:

Acupuncture helps with pain and relieves nausea from chemotherapy.
Yoga reduces fatigue and improves sleep.
Massage therapy is helpful for pain and anxiety.
Meditation has a calming effect that eases anxiety and stress.
Music therapy is useful for relieving anxiety.

Prevention of Small Cell Lung Cancer (SCLC)

Because the number one cause of SCLC is smoking, quitting all tobacco products — including cigars and pipes — is the best way to prevent this cancer. Even if you've been smoking for years, quitting will help prevent further damage before lung cancer can develop.

Ask your doctor about medications or other smoking cessation methods to reduce your urge to smoke. Also try to avoid secondhand smoke.

Radon is another major cause of SCLC. It seeps into homes through the ground. If you're not sure whether you're being exposed to radon, have your home tested. Treating your home or installing a radon mitigation system can reduce levels. Also try to avoid lung cancer-causing substances, like asbestos, cadmium, and coal products, in the workplace, and use appropriate personal protective equipment when necessary.

Detecting SCLC early can improve survival. The United States Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography (CT) screening for people ages 50 to 80 who currently smoke or have quit within the past 15 years and who have a 20 pack-year smoking history. That's equal to smoking one pack of cigarettes per day for 20 years, or two packs a day for 10 years.

However, the National Comprehensive Cancer Network (NCCN) takes a broader approach and recommends screening over age 50 with at least a 20 pack-year history of smoking.

Lifestyle Changes for Small Cell Lung Cancer (SCLC)

During treatment, take good care of your health to keep up your strength, manage side effects, and improve your emotional well-being. Here are a few lifestyle changes your doctor might recommend.

Stop Smoking

Even if you've already been diagnosed with lung cancer, it's not too late to quit smoking. Quitting can improve your lung function, prevent your cancer from progressing, lower the odds of it coming back, and help you live longer.

Eat a Nutritious Diet

Good nutrition is always important, but it's especially crucial to eat well during lung cancer treatment. Your body needs a mix of vitamins, minerals, carbohydrates, protein, and healthy fats for energy and to preserve your strength.

If treatment has reduced your appetite or caused nausea, a dietitian at your cancer hospital can create an eating plan that you can tolerate to give you the calories and nutrients you need to stay healthy.

Get Regular Exercise

Cancer-related fatigue can make it difficult to exercise, but staying active will give you more energy. Even a slow walk, yoga or tai chi session, or other low-intensity activity is helpful. Exercise improves mood, reduces stress, and helps with shortness of breath and other breathing problems caused by lung cancer. Check with your doctor before you start any new exercise program, to make sure it's safe for you.

It’s generally recommended that most adults get 150 minutes of moderate aerobic activity each week.

Small Cell Lung Cancer (SCLC) Prognosis

In general, the less the cancer has spread, the higher the survival rate. SCLC tends to have a lower survival rate than NSCLC because it has often spread to distant lymph nodes or organs when it is diagnosed.

The likelihood of surviving for at least five years after an SCLC diagnosis are:

30 percent when the cancer has not spread outside the lung
18 percent when the cancer has spread regionally, to nearby lymph nodes or tissues
3 percent when the cancer has spread to distant parts of the body, such as the brain

It's important to remember that these statistics don't take into account newer treatments, and they can't predict how long you'll live. Your outcome depends on which treatments you get, and how well your cancer responds to those treatments. Also, this data is based on initial diagnoses and doesn't apply to lung cancers that come back (recur) after treatment.

Complications of Small Cell Lung Cancer (SCLC)

Some complications of small cell lung cancer happen as the cancer grows and spreads. When a tumor blocks the airways or fluid builds up in the lungs, it can cause shortness of breath. Pain can be a result of the cancer spreading to bones or other organs.

Additional potential complications include paraneoplastic syndromes, which happen when lung cancer cells release substances that act on certain organs and tissues. These syndromes include:

Cushing’s syndrome, which results in elevated levels of the hormone cortisol
Syndrome of inappropriate antidiuretic hormone secretion (SIADH), which can affect your sense of taste and cause weakness
Lambert-Eaton myasthenic syndrome, which causes weakness of the arms and legs

Chemotherapy and other treatments can cause nerve or kidney damage. You and your doctor should discuss these potential side effects and complications before deciding which treatment plan is best for you.

Disparities and Inequities in Small Cell Lung Cancer (SCLC)

Thanks to treatment advances like immunotherapy, SCLC survival rates are improving. Certain groups, though, are less likely to get the recommended treatments, including Black and Hispanic Americans, older adults, and people of lower incomes.

In some cases, those disparities have resulted in lower survival rates.

Black Americans and Small Cell Lung Cancer (SCLC)

Black Americans have the highest rate of lung cancer diagnoses of any other racial and ethnic group. They are also less likely to get lung cancer screening than other groups. Once diagnosed, Black Americans with SCLC are less likely to have curative treatment, even if they have insurance coverage.

But despite all these disparities, their survival rates aren't lower than those of other groups.

Research shows that Black people are less likely to get the recommended treatment — chemotherapy — than white people. Even so, they have better survival rates than white people.

Another study that looked at people with limited-stage SCLC also found a survival advantage among Black Americans.

Hispanic and Latinx Americans and Small Cell Lung Cancer (SCLC)

This population has the lowest risk of lung cancer among all ethnic and racial groups, but when they do get diagnosed, their cancer is more likely to be at a later stage. Hispanic and Latinx Americans are 28 percent more likely to not receive any treatment and 12 percent less likely to survive five years than non-Hispanic white Americans.

Their access to clinical trials is also lacking. Only 1 percent of Hispanic and Latinx Americans enroll in lung cancer studies. Without having new treatments tested on this group, it's hard for doctors to know whether, or how well these therapies will work.

American Indian/Alaska Native Americans and Small Cell Lung Cancer (SCLC)

This group has the second highest rate of lung cancer diagnoses, and the highest smoking rate in the country. Yet only 23 percent of American Indian/Alaska Native Americans are diagnosed early, and 22 percent of those who are diagnosed don't receive treatment. Likely due to the lack of treatment, people in this group are 13 percent less likely to survive for five years than non-Hispanic white Americans.

Asian and Pacific Islanders and Small Cell Lung Cancer (SCLC)

People within these ethnic groups are not diagnosed with lung cancer as often as those in other groups. But when they do develop lung cancer, it's 16 percent less likely to be caught early than it is with non-Hispanic white Americans. But when it comes to survival rates, Asian and Pacific Islander Americans do just as well as white Americans.

Income and Small Cell Lung Cancer (SCLC)

As for income, higher earners have a better survival advantage. That may have to do with health insurance coverage, which is also associated with better outcomes — especially when people have private insurance. Some studies also link education level to better outcomes, but the data remains unclear. Higher income is often associated with a higher level of education.

Related Conditions to Small Cell Lung Cancer (SCLC)

A few conditions can happen alongside small cell lung cancer and can potentially affect its outcome.

Chronic obstructive pulmonary disease (COPD) is a lung disease that progressively gets worse and causes difficulty breathing. COPD includes two conditions: emphysema and chronic bronchitis.
COPD and SCLC share some of the same risk factors, including tobacco smoking. COPD may cause lung cancer to develop faster, and it can speed up cancer progression, leading to worse survival.
Cardiovascular disease and lung cancer share many of the same risk factors, including smoking, high blood pressure, age, and diabetes. Having cardiovascular disease increases the risk of dying from lung cancer.
Heart complications can be a side effect of chemotherapy treatment, so if you have a history of cardiovascular disease, your doctor may tailor your treatments in an attempt to avoid further heart complications.

Support for Small Cell Lung Cancer (SCLC)

LUNGevity Foundation

This nonprofit organization's support communities are available 24 hours a day, seven days a week. LUNGevity offers face-to-face meetups, an online forum, and a Facebook group where people with SCLC can share information and advice. The organization also offers resources to help lung cancer patients navigate their diagnosis.

GO2 for Lung Cancer

This lung cancer organization, which was founded by patients and survivors, is dedicated to prolonging survival and improving quality of life. It offers a variety of support services for lung cancer patients and their families, including a HelpLine, treatment navigation, and a peer-to-peer phone network.

CancerCare

This national organization offers free treatment information, support services, and other resources for people affected by lung cancer. CancerCare also provides counseling from oncology social workers, as well as financial assistance and support groups.

The Takeaway

Small cell lung cancer (SCLC) is the less-common type of lung cancer, accounting for about 15 percent of lung cancer cases. SCLC is the most aggressive and fastest spreading form of all lung cancers.
Smoking is by far the leading cause of SCLC.
Chemotherapy is usually part of the treatment. Surgery is an option for limited-stage cancers, and immunotherapy and radiation may be used for all stages of SCLC.
SCLC often isn't diagnosed until it has already spread, but new treatments are helping to improve survival.

Common Questions & Answers

What is the life expectancy of someone with SCLC?

Life expectancy depends on the stage at diagnosis. The five-year relative survival rate for SCLC that is only on one side of the chest is 30 percent. Survival drops to 3 percent once the cancer has spread to distant sites.

Can small cell lung cancer be cured?

Yes, it depends on the stage. A limited-stage SCLC may be cured with surgery, chemotherapy, radiation, and immunotherapy.

Is small cell lung cancer considered terminal?

No, but because this cancer has often spread by the time it is diagnosed, the survival rates tend to be lower than for non-small cell lung cancer (NSCLC). Treatments can prolong survival, however, even when the cancer has spread.

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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Tawee Tanvetyanon

Medical Reviewer

Tawee Tanvetyanon, MD, MPH, is a professor of oncologic sciences and senior member at H. Lee Moffitt Cancer Center and Morsani College of Medicine at the University of South Florida in Tampa. He is a practicing medical oncologist specializing in lung cancer, thymic malignancy, and mesothelioma.

A physician manager of lung cancer screening program, he also serves as a faculty panelist for NCCN (National Comprehensive Cancer Network) guidelines in non-small cell lung cancer, mesothelioma, thymoma, and smoking cessation. To date, he has authored or coauthored over 100 biomedical publications indexed by Pubmed.

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Stephanie Watson

Author

Stephanie Watson is a freelance health writer who has contributed to WebMD, AARP.org, BabyCenter, Forbes Health, Fortune Well, Time, Self, Arthritis Today, Greatist, Healthgrades, and HealthCentral. Previously, she was the executive editor of Harvard Women’s Health Watch and Mount Sinai’s Focus on Healthy Aging. She has also written more than 30 young adult books on subjects ranging from celebrity biographies to brain injuries in football.

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Lung Cancer

What Is Small Cell Lung Cancer (SCLC)?

Types of Small Cell Lung Cancer (SCLC)

Signs and Symptoms of Small Cell Lung Cancer (SCLC)