Small cell, big difference

Small cell lung cancer (SCLC) is rare and difficult-to-treat, which presents a challenge for oncologists like Dr Liu. His SCLC patients often present very poorly at the time of diagnosis, and with symptoms such as difficulty breathing, coughing, fatigue and weight loss, there is a need to act fast. “This is a disease that progresses very quickly, and patients can decline rapidly, meaning that fast responses are crucial to avoid delays in diagnosis and treatment,” explains Dr. Stephen Liu, Associate Professor of Medicine at Georgetown University.

Lung cancer is the most common cancer in the world, resulting in 1.76 million deaths per year. SCLC is a form of lung cancer representing 15-20% of cases, but there is a poor prognosis at diagnosis and only around 2% of people with extensive-stage SCLC, the advanced form of this disease, will be alive after five years.

When looking at recent advances made in the treatment and management of lung cancer over the past number of years, there has been limited impact on SCLC. And while the staging of SCLC may be similar to that of non-small cell lung cancer (NSCLC), current treatment options couldn’t be more different. Oncologists, such as Dr Liu, only have traditional chemotherapy to offer – surgery isn’t a common option – and while initial immediate improvements are seen, for nearly all patients it is known that benefit will be short lived.

The short-lived nature of the treatment available, is one of the most difficult parts of the job, explains Dr. Liu. Patients need to understand that their responses to treatment can be transient; there are limitations to the current standard of therapy.

Dr Liu explains: “we have been seeing patients in our follow-up clinics who have had their lung cancer, non-small cell lung cancer, under control and have been living well for many years. This is, unfortunately, not something we typically see with SCLC patients on chemotherapy.”

Researching a novel approach

After over 20 years of limited progress, it would be easy to view the challenge of SCLC as insurmountable. But the lung cancer community is continuing to research and develop different treatment approaches to help improve the lives of patients, and hope to find the barriers that prevent all patients from seeing more positive outcomes.

In dealing with challenging cancers, Dr Liu emphasises the importance of not giving up hope. “Each patient visit motivates me to improve the way we can manage this challenging disease. It is nothing short of a privilege to help guide patients through their disease, and it is this honour which fuels my motivation in advancing the fight against SCLC.”


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