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FEATURE ARTICLE
Updates in Small Cell
Lung Cancer Treatment
Suzanne Walker, CRNP, MSN, AOCN ®
large trials reported increased
ung cancer is the leadrates of lung cancer in smokers
Lung cancer is divided into two major histologic types:
ing cause of cancer
who received beta carotene
death among men and
small cell lung cancer (SCLC) and non-small cell lung
supplements (Albanes & Heiwomen in the United States. The
cancer. SCLC is rapidly progressive and, without treatnonen, 1994; Omenn et al.,
American Cancer Society estiment, may be fatal in as few as 12 weeks. Fortunately,
1996).
mates that 157,200 people
(88,400 men and 68,800 women)
SCLC is a very chemotherapy- and radiation-sensitive
will die from lung cancer in
disease, and a variety of chemotherapy agents have
Screening
2003, accounting for 28% of all
demonstrated
activity
against
it.
This
article
provides
an
cancer deaths (Jemal et al.,
Presently, no recommended
overview of SCLC, including current treatment strategies
2003). Currently, more Ameriscreening examinations exist
cans die from lung cancer than
for lung cancer. Low-dose spifor limited, extensive, and recurrent disease. By undercolon, breast, and prostate canral computed tomography (CT)
standing the various traditional and emerging treatment
cers combined (Jemal et al.).
scanning can detect pulmonary
modalities, nurses can better assess their patients and
Lung cancer is divided into
nodules at an earlier stage of
help to reduce potential SCLC treatment complications.
two major histologic types:
disease (Henschke et al., 1999).
small cell lung cancer (SCLC)
However, researchers do not
Key Words: carcinoma, small cell; antineoplastic comand non-small cell lung cancer
know whether earlier detection
bined chemotherapy protocols; paraneoplastic syndromes
(NSCLC). SCLC accounts for
results in reductions in mortalabout one-fifth of all lung canity. Additionally, CT scanning
cers (American Cancer Society, 2003). present at diagnosis, life expectancy is, on may result in a high number of invasive
SCLC is one of the most biologically ag- average, just 6 weeks (Kelly, 2000). Only procedures for benign lesions (Diederich et
gressive of all cancers; approximately 70% 20% of patients with SCLC who have lim- al., 2002). The impact that CT scanning
of patients with SCLC already have detect- ited disease and receive chemotherapy and may have on early detection of SCLC also
able metastases at diagnosis (Elias, 1997; radiation therapy live five years (Livingston, is unknown, as this histology is detected
Loehrer, 1995). About one-third of patients 1997). The median duration of survival for infrequently at an early stage regardless of
with SCLC are diagnosed with limited dis- patients with limited disease who receive the particular screening test being used
ease, and two-thirds have extensive disease combination therapy is 21 months (Bonomi, (Ginsberg, Vokes, & Rosenzweig, 2001).
at the time of diagnosis (Hirsch et al., 1998). For patients diagnosed with extensive The National Cancer Institute recently ini1988). These designations are defined in disease, median survival is 8–13 months tiated the National Lung Cancer Screening
(Elias, 1997).
Figure 1.
Trial, with an expected accrual of 50,000
The etiology of SCLC often is apparent at
individuals at risk for developing lung candiagnosis. Cigarette smoking is implicated in
cer (National Cancer Institute, 2003). ParPrevention
a vast majority of cases and accounts for a
ticipants are randomized to receive either
continuing rise in SCLC deaths among
Smoking avoidance and cessation remain spiral CT or chest x-ray lung cancer screenwomen (Splinter, 1997). SCLC also may be the keys to preventing SCLC. Pharmaco- ing.
attributed to exposure to pollutants and sub- logic smoking-cessation strategies include
stances such as asbestos, coal, copper, nickel, nicotine-replacement therapy and the antiand uranium, and these substances may pro- depressant bupropion (Hughes, Stead, &
Submitted May 2002. Accepted for publicaduce an additive risk when combined with Lancaster, 2000; Silagy, Mant, Fowler, &
tion March 20, 2003. (Mention of specific
cigarette smoking (Steenland, Loomis, Shy, Lancaster, 2000). Counseling from healthproducts and opinions related to those prod& Simonson, 1996).
care providers also has been shown to imucts do not indicate or imply endorsement by
The prognosis for patients diagnosed with prove smoking-cessation rates (Rice &
the Clinical Journal of Oncology Nursing or
SCLC generally is poor. Without treatment, Stead, 2000; Silagy, 2000).
the Oncology Nursing Society.)
half of those with initially localized disease
Chemoprevention strategies for lung candie in 12–15 weeks. When metastases are cer thus far have been disappointing. Two Digital Object Identifier: 10.1188/03.CJON.563-568
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CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 7, NUMBER 5 • UPDATES IN SMALL CELL LUNG CANCER TREATMENT
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