Ryan Gentzler, MD, is a medical oncologist at UVA Cancer Center who specializes in lung cancer.
What is small cell lung cancer?
Small cell lung cancer is a type of cancer that forms from neuroendocrine cells, or specialized cells in the airways that normally function in the lung to release hormones to the blood in response to oxygen levels. These cells tend to exist in the central airways toward the center of the chest where small cell lung cancers commonly start to form. When tissue from small cell lung cancer is viewed under a microscope, the cells are often described as small, round and blue, which is where this disease gets its name.
What is non-small cell lung cancer?
Non-small cell lung cancer is a more common type of lung cancer that forms from different cells in the lung, not neuroendocrine cells. The cells are larger in non-small cell lung cancer and there are several types, including adenocarcinoma, squamous cell carcinoma, large cell carcinoma and other types that are more rare.
Which condition is more common?
Prevalence of each type is difficult to estimate, but in 2011 there were just over 400,000 patients living with all types of lung cancer. In 2014, it is estimated that there will be more than 224,000 new cases of lung cancer diagnosed in the United States. Of these, approximately 13 percent will be small cell lung cancer, and more than 80 percent will be non-small cell lung cancers. Other rare tumors in the lung make up the remainder of new lung cancer diagnoses.
Which condition is more aggressive?
Small cell lung cancer is typically considered to be more aggressive. These tumors tend to grow at a faster rate and spread, or metastasize, to lymph nodes and other organs in a shorter period of time. Because of this, 90 percent of small cell lung cancers are diagnosed when the cancer has already spread to lymph nodes (one third of patients) or to other organs (two thirds of patients).
Is smoking a risk factor for one condition more so than the other?
Smoking is the major risk factor for all types of lung cancer. Nearly all cases of small cell lung cancer are attributed to smoking, and the disease is most common in heavy smokers, both active and former smokers. On the other hand, approximately 10-20 percent of non-small cell lung cancers, particularly adenocarcinomas, can occur in patients who have never smoked.
What are typical symptoms? Do they differ significantly?
Unfortunately, most patients with both types of lung cancer do not have symptoms in early stages of disease. As the cancer grows, symptoms can include cough, shortness of breath and/or weight loss. Sometimes chest pain, hoarseness and coughing up blood occur. If the cancer spreads to the bone, pain in that particular bone may be the only symptom. The symptoms of small cell and non-small cell lung cancer are largely similar. Due to the more rapid growth of small cell lung cancer, fatigue and weight loss may be more common in patients with that disease.
At what stages are these cancers typically diagnosed? Is small cell generally identified at a later stage or vice versa?
Both non-small cell and small cell lung cancer are staged I through IV based on the TNM staging system, which characterizes the size of the tumor, number and location of lymph nodes involved and whether the cancer has spread to other areas of the body. Staging for small cell lung cancer is generally simplified to two distinct stages – limited or extensive. Limited stage is defined as cancer that is contained within one area that could be targeted with radiation therapy. Extensive stage is any amount of uncontained cancer that cannot be targeted with radiation. Unfortunately, most patients have extensive stage when they are diagnosed.
What treatment options for small cell and non-small cell lung cancer are available at UVA Cancer Center?
We offer brachytherapy, stereotactic body radiation therapy, multidetector PET/CT, 4D CT simulation, respiratory gating and more. We also have multiple clinical trials open for small cell and non-small cell lung cancers. For patients with extensive stage small cell lung cancer, we have a trial that combines an oral drug with standard chemotherapy that is designed to increase the effectiveness of the chemotherapy and improve response to therapy.
We also have several clinical trials that involve immunotherapy, which uses the patient’s immune system to help fight lung cancer. Immunotherapy has been very promising in early phase clinical trials and we will open two more of these trials in the next 2-3 months.
Additionally, we recently opened the ALCHEMIST trial, which brings molecularly-targeted oral therapies to patients with earlier stage non-small cell lung cancer who have undergone surgery.
What distinguishes UVA Cancer Center from other regional hospitals in treating lung cancer?
UVA has an established Lung Cancer Program that exceeds the capabilities of other area cancer centers by offering a truly multidisciplinary team of expert thoracic surgeons, medical oncologists, researchers and radiation oncologists along with dedicated radiologists, pathologists and nurse navigators who conduct weekly conferences to discuss new patient care plans and track patient progress. The UVA lung cancer team conducts leading edge clinical trials and offers the latest in screening, diagnostic and treatment technology. We also are unique in that the Society of Thoracic Surgeons oversees our program quality metrics so we can constantly improve our program and level of patient care.
Is the UVA Cancer Center Lung Screening Program helpful in terms of catching lung cancer early?
The Lung Cancer Screening Program at UVA is geared toward detecting lung cancer at earlier stages, when the disease is more treatable. Most lung cancers, particularly small cell lung cancers, are diagnosed at advanced stages because of the time it takes for symptoms to develop. A low-dose CT scan, as part of an organized lung cancer screening program, has been shown in the National Lung Screening Trial (NLST) to detect lung cancers at earlier stages for patients at higher risk of developing lung cancer. Lung screenings can reduce the risk of death from the disease by as much as 20 percent, which is significant.
Learn more about the Lung Cancer Screening Program at UVA.
Additionally, the U.S. Preventative Task Force and the National Comprehensive Cancer Network, among other organizations, have endorsed lung cancer screening. The Centers for Medicare and Medicaid Services (CMS) have recently issued a statement that they are in support of lung cancer screening and will pay for these tests for patients who qualify.