Extensive stage small cell lung cancer (SCLC) is in the stage where it has spread to other parts of the body, such as the other lung or the brain. Without treatment, the average life expectancy for a person with an extensive-stage small cell lung cancer diagnosis is two to four months. With treatment, the expectancy rises to between six and 12 months, with a five-year survival rate of up to 4%. Show The liver, adrenal glands, and bone are also common sites of metastasis. Unlike non-small cell lung cancer (NSCLC), which is divided into four main stages and several substages, extensive-stage is one of only two stages of SCLC (the other being limited stage). eggeeggjiew / Getty ImagesSCLC is less common than NSCLC, accounting for about 10% to 15% of all lung cancers. It tends to be more aggressive, growing rapidly and spreading quickly. Though extensive-stage small cell lung cancer cannot be cured and has a poor prognosis, it may respond to chemotherapy and newer treatments. Symptoms of Extensive-Stage SCLCIn the early, limited-stage of SCLC, you may have no symptoms at all. As the cancer progresses, you might begin to have a persistent cough or recurrent lung infections. These problems will continue to become more severe as the cancer grows and spreads, and you will develop increasingly debilitating symptoms. Symptoms of extensive-stage small cell lung cancer can be categorized by those that affect the lungs, those caused by paraneoplastic syndromes (abnormal immune or hormone activity triggered by the tumor), and those related to metastasis. Symptoms related to the lungs include:
Symptoms of paraneoplastic syndromes include:
Symptoms related to metastasis include:
CausesSCLC is initially caused by exposure to smoke or other toxins. In fact, approximately 95% of people diagnosed with SCLC are current or former smokers. Tobacco use is the biggest risk factor for small cell lung cancer. Researchers believe that the carcinogens in tobacco smoke damage DNA in proto-oncogenes, which regulate cell growth, and tumor suppressor genes, which are involved in repairing or eliminating damaged cells. These mutated cells then grow uncontrollably and unchecked, quickly developing into malignant tumors. Prolonged exposure to secondhand smoke also increases the risk of lung cancer, as does exposure to environmental agents, including asbestos and radon. SCLC is often unnoticed in the early stages, usually progressing beyond the limited stage and transitioning to extensive stage before it's found. DiagnosisHealthcare providers base their diagnosis of small cell lung cancer on several specialized tests, including:
Roughly 60% to 70% of people with small cell lung cancer will have extensive disease at the time of diagnosis. SCLC will be staged at the time of diagnosis. Healthcare providers will identify the cancer as extensive stage SCLC if it meets any of the following criteria:
Sometimes the disease is also be considered extensive if it has spread to the fluid around the lung. TreatmentA combination of chemotherapy and immunotherapy drugs is the preferred regimen for the more advanced stage of small cell lung cancer.
The currently recommended initial treatment regimen for extensive-stage small cell lung cancer is a platinum (carboplatin or cisplatin) combined with VePesid (etoposide) and immunotherapy (Tecentriq (atezolizumab) or durvalumab). As it progresses, treatment options may switch from battling the cancer cells to easing symptoms. Radiation and chemotherapy may be used as palliative therapy at this point to help you manage pain or complications. PrognosisWhile treatments can relieve symptoms and extend life, extensive small cell lung cancer is not curable. Survival rates for small cell lung cancer have improved since the developments of new treatments, but still remain low. Treatment of other fast-growing cancers, such as leukemia, has come a long way, and it is hoped that better treatments for small cell lung cancer will be found in the near future. For now, patients need to prepare for the likelihood that extensive small cell lung cancer will not go into remission, and if it does, it's likely to recur within two years. CopingStudies suggest that learning what you can about your lung cancer can improve your quality of life—and possibly even your outcome. Ask questions. Learn about clinical trials. Consider joining a support group. Many hesitate to talk about end-of-life issues, but discussing these with your healthcare provider and your family—even if all of you are hoping for a cure—is associated with fewer feelings of loneliness and a better quality of life. Never lose hope, even if you have chosen not to pursue further treatment. Hope for quality time with loved ones, with good control of your symptoms. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
By Lynne Eldridge, MD
Thanks for your feedback! How long can you live with immunotherapy lung cancer?Among those who received immunotherapy, the estimated survival rate was 69.2 percent at 12 months. In contrast, the placebo group had an estimated 12-month survival rate of 49.4 percent. Immunotherapy is already changing the treatment landscape for people with lung cancer. However, it's not perfect.
How long can immunotherapy keep you alive?In a study led by UCLA investigators, treatment with the immunotherapy drug pembrolizumab helped more than 15 percent of people with advanced non-small cell lung cancer live for at least five years — and 25 percent of patients whose tumor cells had a specific protein lived at least that long.
Can small cell lung cancer be treated with immunotherapy?For more than three decades, care for small-cell lung cancer (SCLC) remained mostly the same. That's changing now -- doctors have a new option called immunotherapy. This line of treatment uses your body's own immune system to fight cancer.
What is the success rate of immunotherapy for lung cancer?Immunotherapy is helping improve outcomes for people with several types of cancer that typically have a poor diagnosis including advanced bladder, kidney, and lung cancers. The average response rate of cancer patients to immunotherapy drugs is between 20 to 50%.
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