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Wake Forest Baptist Approach Thoracic Oncology Program View Lung Cancer Video The Thoracic Oncology Program, the region’s only multidisciplinary thoracic oncology clinic, consolidates the services of a team of physicians and other health care professionals involved in care of patients with malignancies of the chest, including lung cancer, mesothelioma, carcinoid tumor and thymoma.  The Program’s primary goal is to facilitate communication between physicians to provide the highest level of care for patients with these common and uncommon chest malignancies.  Evaluating treatment options and determining a course of action as quickly as possible is of great importance.  The team includes cancer specialists in pulmonary medicine, medical oncology, cardiothoracic surgery, radiation oncology, radiology and pathology.  The members of the team meet weekly to discuss new cases and develop the most effective treatment plan for each patient.  As a comprehensive cancer center, we offer our patients access to the best diagnostic tools and the latest advances in treatment, including interventional pulmonary procedures, surgical techniques, radiation techniques and chemotherapy. The team is involved in clinical trials testing novel therapies including combinations of surgery, radiation and chemotherapy.  Research protocols are available to study new approaches in each of these areas.  Wake Forest Baptist is the lead site for a clinical trial evaluating the use of dose-dense chemotherapy as front-line treatment for patients with advanced non-small cell lung cancer. This clinical trial involves intensive chemotherapy with the support of growth factors to stimulate the production of red blood cells and white blood cells which should minimize symptoms such as fatigue, weakness, fever, and infections. Half of the patients will also be assigned to receive an investigational medicine that may reduce side-effects on the peripheral nervous system such as numbness and tingling in the hands and feet.  This research study is sponsored by the Cancer and Leukemia Group B (CALGB), a national cooperative cancer research group. Making cutting-edge research and treatments available to lung cancer patients is the only way real progress will be made in improving both quantity and quality of life. 3D Conformal and Intensity Modulated Radiation Therapy Among the newer treatment options for cancer of the prostate, brain, lung, and head and neck are two methods of focusing radiation on the tumor and surrounding at-risk tissues while optimally sparing nearby normal tissues, 3-dimensional (3D) conformal radiation therapy, and intensity modulated radiation therapy (IMRT).  This approach uses anatomic computed tomogrphic and/or magnetic resonance images of the patient, computer-generated radiation dose calculations, and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. The linear accelerator radiation beam intensity is varied, or modulated, over space and time during the patient’s treatment, hence the term “Intensity Modulated” radiation therapy. In combination with advanced imaging techniques like magnetic resonance spectroscopy and positron emission tomography that image both tumor anatomy and biology, IMRT holds great promise for improving local tumor control and survival, even in the most resistant and aggressive human cancers.   Lung cancer - small cell Lungs Lung cancer, lateral chest X-ray Lung cancer - chemotherapy treatment Small cell carcinoma   Secondhand smoke and lung cancer Normal lungs and alveoli Smoking hazards Bronchoscope   Definition: Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It spreads much more quickly than non-small cell lung cancer. There are three different types of small cell lung cancer: Small cell carcinoma (oat cell cancer) Mixed small cell/large cell carcinoma Combined small cell carcinoma Most small cell lung cancers are the oat cell type. Alternative Names: Cancer - lung - small cell; Small cell lung cancer; SCLC Causes, incidence, and risk factors: About 15% of all lung cancer cases are small cell lung cancer. Small cell lung cancer is slightly more common in men than women. Almost all cases of SCLC are due to cigarette smoking. SCLC is rare in those who have never smoked. SCLC is the most aggressive form of lung cancer. It usually starts in the breathing tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow very quickly and create large tumors. These tumors often spread rapidly (metastasize) to other parts of the body, including the brain, liver, and bone. Symptoms: Bloody sputum (phlegm) Chest pain Cough Loss of appetite Shortness of breath Weight loss Wheezing Other symptoms that may occur with this disease: Facial swelling Fever Hoarseness or changing voice Swallowing difficulty Weakness Signs and tests: Your health care provider will perform a physical exam and ask questions about your medical history. You will be asked whether you smoke, and if so, how much and for how long you have smoked. When listening to your chest with a stethoscope, your health care provider can sometimes hear fluid around the lungs or areas of partial lung collapse. Each of these findings could (but does not always) suggest cancer. Small cell lung cancer has usually spread to other parts of your body by the time it is diagnosed. Tests that may be performed include: Bone scan Chest x-ray Complete blood count (CBC) CT scan Liver function tests MRI Positron emission tomography (PET) scan Sputum test (cytology, looking for cancer cells) Thoracentesis (removal of fluid from the chest cavity around the lungs) In some cases, your health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this: Bronchoscopy combined with biopsy CT scan-directed needle biopsy Endoscopic esophageal ultrasound (EUS) with biopsy Mediastinoscopy with biopsy Open lung biopsy Pleural biopsy Usually, if a biopsy reveals cancer, more imaging tests are done to find out the stage of the cancer. (Stage means how big the tumor is and how far it has spread.) However, the traditional staging system, which uses numbers to tell how advanced the cancer is, is usually not used for patients with SCLC. Instead, SCLC is classified as either: Limited (cancer is only in the chest and can be treated with radiation therapy) Extensive (cancer has spread outside the chest) The majority of cases are extensive. Treatment: Because SCLC spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Chemotherapy may be combined with radiation therapy of the lungs in people who have limited disease. The most commonly used drugs in the U.S. are etoposide with either cisplatin or carboplatin. Because the disease has usually spread by the time it is diagnosed, very few patients with SCLC are helped by having surgery. Surgery is only considered when there is only one tumor that has not spread. Chemotherapy or radiation will be needed after surgery. Combination chemotherapy and radiation treatment is given to people with extensive SCLC. However, the treatment only helps relieve symptoms. It does not cure the disease. Often, SCLC may have already spread to the brain, even when there are no symptoms or other signs of cancer in the brain. As a result, radiation therapy to the brain may be given to some patients with smaller cancers, or to those who had a good response in the first round of chemotherapy. This method is called prophylactic cranial irradiation (PCI). Support Groups: For additional information and resources, see cancer support group. Expectations (prognosis): How well you do depends on how much the lung cancer has spread. Without treatment, the average survival is 2 -4 months. Treatment can often prolong life to 6 - 12 months in patients with extensive disease. About 10% of patients with limited spread will show no evidence of cancer at 2 years. This type of cancer is very deadly. Only about 6% of people with this type of cancer are still alive 5 years after diagnosis. Complications: Cancer spreads to other parts of the body Side effects of surgery, chemotherapy, or radiation therapy Calling your health care provider: Call your health care provider if you have symptoms of lung cancer (particularly if you smoke). Prevention: If you smoke, stop smoking. It's never too late to quit. In addition, you should try to avoid secondhand smoke. Routine screening for lung cancer is not recommended. Many studies have been done to look at this idea, but physicians have concluded that, at this time, screening would not help improve a person's chance for a cure. References: Ettinger DS. Lung cancer and other pulmonary neoplasms. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 201. National Cancer Institute. Small cell lung cancer treatment PDQ. Updated February 13, 2009. U.S. Preventive Services Task Force. Lung cancer screening. Ann Int Med. 2004;140:738-739.

Review Date:8/9/2009 Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.