Small cell lung cancer: symptoms, diagnosis, stages and treatment

Macmillan Cancer Support explains that small cell lung cancer (SCLC) is one of the two common types of lung cancer, the other being non-small cell lung cancer (NSCLC), which is the most common. It gets its name from how the cancer cells look under a microscope, and is usually found in the main airways, called bronchi, in the centre of the lungs.

Cancer Research UK says small cell lung cancers are also classed as neuroendocrine tumours, which develop in cells of the neuroendocrine system. They tend to spread quite early on. Macmillan says it has often spread outside the lungs by the time it is diagnosed.

The NHS lists the common symptoms of lung cancer, and says you may not notice any symptoms in the early stages. Macmillan says small cell lung cancer might sometimes be found during tests to investigate another condition.

• a cough that is not going away

• shortness of breath

• coughing up blood

• chest or shoulder pain

• often having chest infections, or a chest infection that is not getting better

• losing weight without trying and loss of appetite

• feeling tired all the time

The NHS says less common symptoms of lung cancer may include swelling of the face or neck, difficulty swallowing, a hoarse voice that does not go away, and changes in the way the fingers look (clubbing), where fingertips look wider than usual or curve downwards. Macmillan notes that lung cancer can cause blocked airways, superior vena cava obstruction (swelling of the face and neck from a blocked vein) or fluid between the lung and its lining (pleural effusion).

The NHS says to see a GP if you have had a cough for longer than 3 weeks or have any other symptoms of lung cancer. Ask for an urgent GP appointment or get help from NHS 111 if you have coughed up blood or noticed blood on a tissue you have coughed into. Call 999 or go to A&E if you are struggling to breathe (choking, gasping and unable to speak) or you have pain in your chest or upper back.

Some of these symptoms are very common and can be caused by other conditions. Having them does not definitely mean you have lung cancer, but it is important to get checked, because if the symptoms are caused by cancer, finding it early may mean it is easier to treat.

Macmillan says smoking tobacco is the cause of most lung cancers and the biggest risk factor, including cigarettes, cigars and pipes. Some people who have never smoked develop lung cancer, and it is more common in older people. Cancer Research UK says SCLC is usually caused by smoking.

The NHS lists other things that make lung cancer more likely: passive smoking, having COPD, a close relative who has had lung cancer, working with asbestos, long-term exposure to air pollution and long-term exposure to radon. It advises that to lower your risk you should quit smoking, stay active and eat a healthy diet including at least 5 portions of fruit and vegetables a day.

Macmillan says you usually begin by seeing your GP, who will examine you and may arrange a chest X-ray or refer you to a chest doctor urgently. At the hospital a specialist nurse or doctor will talk to you about the tests you need.

Cancer Research UK says doctors may use limited and extensive stages to stage small cell lung cancer. Limited disease means the cancer is only in one lung, and might be in lymph nodes nearby. Extensive disease means the cancer has spread outside the lung, either within the chest or to other parts of the body, which is also called metastatic or advanced cancer.

A multidisciplinary team (MDT) of specialists meets to discuss the best treatment. Macmillan says the treatment depends on the stage, your general health, how able you are to do everyday things (performance status) and your own preferences. Cancer Research UK says treatment depends on whether you have limited or extensive disease.

Cancer Research UK says you can decide not to have cancer treatments such as chemotherapy and still have medicines to help control symptoms such as sickness or pain, and can be referred to a symptom control team for support at home. The NHS says if cancer cannot be cured, you will be referred to a symptom control or palliative care team, who help you manage symptoms and can also help your loved ones get support.

Macmillan and Cancer Research UK both offer nurse helplines and information, and your clinical nurse specialist is a key contact. Many people also find it helps to talk things through with a relative, friend or counsellor.

Macmillan notes that sometimes lung cancer is diagnosed through lung cancer screening, which aims to find people at risk of lung cancer at an early stage. Ask your GP whether you are eligible for screening in your area.

On the NHS, a GP can arrange a chest X-ray or make an urgent referral, and your case is discussed by a lung cancer MDT. Cancer Research UK notes you might go to a different hospital if there is no specialist MDT at your local hospital. Some people choose private consultations for faster scans, but the treatment recommended by a lung cancer MDT is based on the same factors.