Lung cancer, which used to be one of the rarest cancers, has, over the past century, surpassed all other malignancies as the leading cause of death worldwide. Numerous ecological and clinical studies have proven that the increase in lung cancer cases is directly related to rising environmental pollutants and the population's growing smoking habits.
Lung cancer disease is characterized by an abnormal growth of the cells present in the lungs. As a result, the patient experiences basic symptoms such as shortness of breath, chest pain, and heaviness that eventually lead to the cancer cells spreading to other parts of the body. Histologically, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are the two primary subtypes of lung cancer.
Following a small cell lung cancer diagnosis, medical professionals will attempt to determine whether the cancer has spread and, if so, how far. During the staging procedure, doctors determine how much cancer is present in the body. It helps evaluate cancer's severity and the most effective course of small cell lung cancer treatment.
Based on stages, small cell lung cancer is divided into two main stages, i.e., limited stage and extensive stage small cell lung cancer. The effects of various stages of small cell lung cancer on patients' health and its potential treatments are thoroughly discussed in this article.
Limited vs. Extensive Stage Small Cell Lung Cancer
1. Limited stage small cell lung cancer (LS-SCLC): This often comprises lung cancers that have only affected one lung (unless the tumor has migrated to other parts of the lung), which may also have affected nearby lymph nodes in the chest. This indicates that since cancer only affects one side of the chest, just one radiation field is necessary for LS-SCLC treatment.
If the lymph nodes, also known as supraclavicular nodes, are on the same side of the chest as the tumor, cancer may still be regarded to be at a limited stage. Even though they are closer to the opposite side of the chest, some clinicians also include lymph nodes in the middle of the chest (mediastinal lymph nodes).
The tumor must be contained inside a region that is small enough to be treated with radiation therapy in a single "port" or treatment area. When small cell lung cancer was first discovered, only around one in three patients had a limited stage of the disease.
Concurrent chemotherapy and radiation therapy is the recommended treatment for limited stage small cell lung cancer, and clinical trials have shown that this combination has a 25% five-year survival rate. Cisplatin and etoposide are still the conventional chemotherapy drugs, although patients who cannot take cisplatin or who have a contraindication to it frequently receive carboplatin instead.
Through advancements in radiation therapy, survival rates have increased significantly. For eligible individuals, concurrent chemoradiotherapy is the recommended course of treatment.
2. Extensive stage small cell lung cancer: Small cell lung cancer in its advanced stages is described as a condition that cannot be properly confined inside a safe radiation field. Most individuals with small cell lung cancer are given an extensive stage diagnosis because it is one of the most aggressive diseases. Approximately two-thirds of people with small cell lung cancer are in the advanced stage. With a median overall survival of about 8 to 13 months, the disease's prognosis is extremely dismal.
The most frequent cause of lung cancer has been identified as cigarette smoking. Although there is a tumor node metastasis (TNM) staging option for SCLC, the majority of clinical studies and therapy choices rely on the Veterans Administration (VA) staging system.
Chemotherapy has been the usual first-line treatment for small cell lung cancer in its advanced stages. The chemotherapy consists of etoposide and platinum (cisplatin or carboplatin). However, it has become an essential component of the therapy plan since the development of immune checkpoint inhibitors.
Chemotherapy is combined with the administration of immune checkpoint inhibitors. Immune checkpoint drugs have been able to marginally increase the overall survival of patients with extensive stage small cell lung cancer despite the disease's extremely aggressive nature.
The most frequent cause of extensive stage small cell lung cancer diagnosis has been shown to be cigarette smoking, with a median age of diagnosis of 70 years. The frequency of new instances of extensive stage small cell lung cancer has been rising in all the major markets, except for Spain, where it is dropping, even though people are quitting smoking due to the growing awareness of the harmful health effects of smoking. Geographically, the U.S. continues to lead with an estimated prevalence of over 47,000 patients in 2021, followed by the U.K. with over 8,500 patients.
According to the BIS Research report, the prevalence of extensive stage small cell lung cancer is forecasted to grow at a CAGR of 2.61% and 1.61%, respectively, for the U.S. and the U.K. for the period 2022-2032.
With a median age of 70 years at diagnosis, small cell lung cancer at the widespread stage has a poor prognosis. Associated comorbidities make the course of treatment more difficult by the time the patient is diagnosed with extensive stage small cell lung cancer.
In terms of the number of patients, the global extensive stage small cell lung cancer market is quite limited. However, the advent of lung cancer genomic testing, next-generation oncology devices and solutions, and the introduction of immune checkpoint inhibitors make it promising despite the lack of effective diagnostic methods and tools.
Conclusion
Small cell cancer types account for 10%-15% of all lung cancers and are the most aggressive type with the lowest survival rate. In contrast to SCLC in its limited stage, extensive small cell lung cancer spreads across one or both lungs.
Currently, radiation therapy is a viable backup option for small cell lung cancer treatment, with chemotherapy typically employed as the first line of treatment. The goals of small cell lung cancer treatment are to preserve the quality of life, lessen symptoms, and prolong life.
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