A relative was diagnosed with small cell lung cancer, and will be getting chemotherapy and radiation therapy but no surgery.
From reading on the Web I gather that radiation therapy isn’t usually applied to this disease because it spreads so rapidly, and that if it is known not to have spread they might try surgery, but this is rare.
I hear my relative has “oat cell” lung cancer and that it is “in the blood”, and also that it is “inoperable” (not clear she’s distinguishing this from “surgery not indicated”).
Web sites say the prognosis is poor because this cancer has almost always spread by the time patients present with symptoms - but she says this was detected during a PAP smear and she has no symptoms.
She’s in her early 70s and is a long-term smoker.
I’d like to know if her prognosis is very gloomy, as is typical with this disease, or whether to infer her prognosis may be unusually good because it was spotted before symptoms appeared and the radiation therapy is a sign of this early, pre-matastasis stage.
I’m not seeking medical advice for her - she’s under a doctor’s care. I just wonder what the family will be experiencing.
I am certainly no expert in this, but my understanding is that radiation therapy in small cell carcinoma (aka “oat cell carcinoma”) is used when there is “limited disease” present. In that setting, a cure is possible but still rare with the combined use of chemotherapy and radiotherapy. The chemo is, of course, of systemic benefit whereas the radiation is applied to the chest in an effort to hit the primary site.
In people who respond to the above combined therapy, the next step is usually prophylactic radiation treatment to the brain. This evolved when it became apparent that relapse in patients previoulsy in remission tended to occur in the brain.
I am afraid that even when the disease appears limited at the outset, the prognosis for small cell carcinoma of the lung is still pretty bleak - about 10 percent at five years.
Here is a brief excerpt from a very reliable source:
I neglected to mention that there is no role for surgery in this disease since:
It is quite sensitive to chemo (at least initially)
This cancer will have always spread by the time of diagnosis even in asymptomatic individuals. Hence, surgery can never be curative and would merely subject the person to surgery while leaving behind cancer cells (somewhere). OTOH, chemotherapy reaches every ‘nook and cranny’ and, in theory at least, can eliminate all the cancer - that at the primary site as well as that which has spread elsewhere.
The prognosis is somewhat better when small cell carcinoma is detected at an “early” stage. From Medline Plus:
*The treatment depends upon the stage of the cancer.
For small cell cancer, chemotherapy and radiation are usually used in limited stage disease (when the disease is confined to the chest ). Studies have shown that giving chemotherapy and radiation therapy at the same time is better than giving one after the other. Chemotherapy alone is used for extensive stage disease.
In some cases where a patient with limited stage disease has only one small tumor, the tumor will be surgically removed, followed by chemotherapy. However, very few patients with small cell lung cancer are candidates for surgery.
Some patients with limited stage disease may need radiation to the entire brain after they have completed chemotherapy and radiation to the chest. This is known as prophylactic cranial irradiation (PCI)…The overall survival depends on the stage of the disease. For limited stage small cell cancer, cure rates may be as high as 25%, while cure rates for extensive stage disease are less than 5%.*
Most of the time, treatment is offered with the understanding that the cancer will respond for a time (months to possibly a year or more) but usually return.
What this probably means is that the tumor was detected cytologically (from a smear prepared from sputum or a specimen like a bronchial washing) and stained in the same way as a cervical Pap smear. Finding tumor in this way is independent of the stage of disease. An asymptomatic patient may or may not have advanced-stage cancer.
I do apologize for this multiple post, but I now realize that I never answered your question explicitly as to whether ‘radiation therapy implies that small cell lung cancer has not spread’.
To be clear, the use of radiation therapy in this condition implies that the cancer appears to be confined to the lung and the associated lymph nodes. This is so-called “limited disease” which is not quite synonymous with no spread, however. It just means that any overt spread is confined to the chest.
“Extensive disease” is everything else.
As described above, “limited disease” is more likely to be curable than “extensive disease”, but is still most likely to prove fatal.
I wasn’t aware that anyone honestly spoke of lung cancer cures. It’s a matter of stretching things out. A “good” outcome invovles getting someone past 18 months or so.
It’s hard to tell whether lung cancer has spread, one approach might involve checking adjacent lymph nodes?
Surgery and/or focused Radiotherapy is best used when the cancer is local, and has not obviously spread: the lack of obvious metastatic masses does not rule out metastasis. Resection of, or Irradiation of the primary mass may well forestall metastasis by killing cells that would otherwise leave or later produce metastatic cells.
As for use of radiotherapy intracranially … newer approaches invovle the gamma knife, which employs exquisitely controlled and targeted beams. There might also be approaches involving vaccines.
If you check out [url=www.clinicaltrials.gov]this place, you might find something in a clinical trial. It is not unusual to encourage advanced cancer patients into clinical trial research.
This isn’t really relevant to the prophylactic radiation given to the whole brain in small cell carcinoma where there’s no specific target. Indeed, in small cell cancer, the purpose of the radiation is to more or less cover the entire brain. Hopefully, in this way, any small deposits of cancer cells within the brain will be zapped before they cause trouble (and before they become large enough or significant enough to be identified as a cancerous spot).
Phrased differently, things like the gamma knife are used and useful only when there’s a well-defined target, and not when the entire brain is the target.
But it is relevant when the issue is a localised metastatic brain lesion. Use of gamma knife prophylactically can be of use when such a lesion threatens important local functions, or is near a critical nerve center.
Vaccine therapy is also of potential use in preventing or delaying the onset or progression of brain tumors.
>For small cell cancer, chemotherapy and radiation are usually used in limited stage disease (when the disease is confined to the chest ). Studies have shown that giving chemotherapy and radiation therapy at the same time is better than giving one after the other. Chemotherapy alone is used for extensive stage disease.
Well, this is a hopeful sign. This suggests she has “limited stage” disease. I wonder what it means that she says the doctor told her it is “in the blood”? These things taken together seem to mean the cancer cells are circulating but none of them have taken root anywhere - but how would they be able to tell that??? Maybe these things are just contradictory (from the info I have).
In re the PAP smear, what she said was that she had a routine PAP smear done “and they picked it up then”. Again, she has no symptoms, so I don’t know why they’d have done a test like a PAP smear that wasn’t one.
Still hard to tell what’s going on - but it sounds like I’m trying to tell whether it’s one year or two, not whether she’ll “survive”.
She’s still smoking - damn cigarettes. A thousand Americans a day. Why aren’t we at war with that?!?
A PAP smear detects atypical or dysplastic or malignant cervical cells from the transition area of the cervix.
Imagine the cevix as an iced donut, icing side facing out towards the vaginal opening, the cake/nekkid side facing inwards up towards the uterus’n’stuff.
The transitional layer where icing meets cake in the inner ring of the donut hole … that’s what gets sampled in a PAP smear.
PAP screens detect varying degrees of cervical cell atypia/dysplasia/malignancy: cervical cancer.
I can’t imagine what a PAP screen has to do with lung cancer, unless the PAP screen was part of a multi-organ cancer safari.
Also, I thought that cancer cells tended to metastize through the lymph system, rather than the vascular system. Although certain cancers of the blood or immune systems may present in the blood: lieukemia, lymphoma…
Although you can have a small cell lung cancer that spreads to the cervix, and although you can even have a primary small cell cancer of the cervix (i.e. having nothing to do with the lung), I think that Jackmannii had it right when he said this about the Pap smear in this case:
In other words, we’re not talking about a cervical Pap smear here, just the same cell-staining technique that’s used in a Pap smear but, in this case, applied to the lungs and tissue from the lungs.
Generally, this is true and you are right. However, note your (appropriate) use of the word ‘tended’. Even though the tendency is for cancers to spread via the lymphatic system, they can also spread through the bloodstream itself. Indeed, kidney cancers preferentially spread via the bloodstream. It’s also worth noting that when, on microscopic examination of a biopsy specimen of a cancer, there is “vascular invasion” by the tumor, the prognosis is worse than if there wasn’t such invasion. For completeness sake, in addition to spreading via the bloodstream and spreading via the lymphatic system, I’ll point out that cancer can also be spread via aerosolisation! Specifically, some lung cancers spread from the affected lung to the unaffected, cancer-free lung, by having the cancer cells coughed up from side and breathed back in the other.
>In other words, we’re not talking about a cervical Pap smear here, just the same cell-staining technique that’s used in a Pap smear but, in this case, applied to the lungs and tissue from the lungs.
Hmm. This is not a very technically sophisticated patient we’re discussing here. But it’s a stretch to think she’s going to confuse these tests, because the samples would be collected very differently. Maybe she had a checkup that included a PAP smear and other, less intrusive tests - she’d probably think of it as a “PAP smear appointment”. And something else they did that day, whatever it was, triggered the lung cancer investigation.
I still don’t know what “it’s in the blood” means, but perhaps only that the doctor explained that this cancer metastisizes rapidly (which is certainly true).
Thanks, everybody, for the information. I appreciate it.