Treatment options for small cell lung cancer (SCLC)

A team of health professionals decides what treatment you might need. They also decide what treatment options you have.

The most common treatments for small cell lung cancer are:

• chemotherapy
• radiotherapy
• surgery
• chemotherapy with radiotherapy (chemoradiotherapy)
• radiotherapy to the brain (prophylactic cranial irradiation – also called PCI)
• chemotherapy with or without immunotherapy

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a lung cancer MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team usually includes:

• a respiratory physician
• a specialist surgeon
• cancer specialists (oncologists) who specialise in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)
• a specialist cancer nurse (also called clinical nurse specialist)
• a pathologist (an expert who examines any cancer or tissue the surgeon removes)
• a pharmacist
• a radiologist (who looks at your scans and x-rays)
• a dietician (who offers support and advice about eating and drinking)

The MDT may also include health professionals who look after people with metastatic (advanced) lung cancer. They can help with symptom control. They include:

• the palliative care team
• a clinical nurse specialist for palliative care

Your treatment depends on:

• the type of lung cancer
• where your cancer is
• how far it has grown or spread (the stage)
• your general health and level of fitness

If you’ve been diagnosed with metastatic cancer

Deciding about treatment can be difficult when you have metastatic cancer.

It helps to understand:

• what treatment can do for you
• how it might affect your quality of life
• what side effects does it have

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Treatment overview

The main treatments are:

• chemotherapy
• radiotherapy
• surgery
• chemoradiotherapy (chemotherapy with radiotherapy)
• radiotherapy to the brain (prophylactic cranial irradiation – also called PCI)
• chemotherapy with or without immunotherapy

You have one or more of these treatments. This depends on the stage of your cancer and also how well the treatment works.

Treatment for limited disease

Limited disease means your cancer is only in one lung. It might be in lymph nodes nearby. 

The main treatment for limited disease small cell lung cancer is chemotherapy. You usually then have radiotherapy to the chest.

If you are fit enough, you might have chemoradiotherapy. This means that you have chemotherapy at the same time as radiotherapy.

If your cancer is at a very early stage, you might be able to have surgery to remove the part of the lung containing the cancer. This is called a lobectomy. But surgery isn’t used very often for small cell lung cancer. If you do have surgery, you usually have chemotherapy afterwards and might also have radiotherapy.

After treatment

After you finish treatment, you might have radiotherapy to your head if the cancer in your lung has stopped growing and you are well enough. Radiotherapy to the head is called prophylactic cranial radiotherapy (PCR) and it aims to kill any cancer cells that might have spread to the brain but are too small to see on scans.

Treatment for extensive disease

Extensive disease means your cancer has spread outside your lung, either within your chest or to other parts of your body. Cancer that has spread to other parts of the body is also called metastatic (advanced) cancer.

Treatment aims to control the cancer for as long as possible and help with symptoms.

You usually have chemotherapy with or without immunotherapy. If the chemotherapy works well, you might have radiotherapy to your lungs afterwards.

After treatment

After treatment you might also have radiotherapy to your head if the cancer has stopped growing and you are well enough. Radiotherapy to the head is called prophylactic cranial radiotherapy (PCR). It aims to kill any cancer cells that might have spread to the brain but are too small to see on scans.

Symptom control

To control symptoms, you might also have other treatments such as:

• radiotherapy
• internal radiotherapy (brachytherapy)
• laser treatment
• freezing the tumour (cryotherapy)
• a rigid tube called a stent  to keep the airway open
• stereotactic ablative body radiotherapy (SABR) for cancer that has spread to one or a few distant sites, also called oligometastatic disease
• a rigid tube (called a stent) to keep a big vein called the superior vena cava open

Clinical trials

Doctors are always trying to improve treatments, and reduce side effects. Your doctor might ask you to participate in a clinical trial as part of your treatment. This might be to test a new treatment or to look at different combinations of existing treatments.

Your doctor will tell you if there are any trials that you can enter.