To Your Good Health

DEAR DR. ROACH: I was diagnosed with small cell lung cancer (SCLC) in June through a yearly wellness check. I had no prior symptoms or issues. The cancer was in the limited stage and did not spread to the brain, nor any other part of the body. (I am 62, exercise three times a week with weights and have generally good health.) I have gone through chemotherapy and radiation therapy (IMRT). All treatment ended at the end of September. I am now waiting for a full PET scan to be done at the end of December. My oncologist believes that since they caught it early, the treatment was curative. However, everything I have read and the people I have spoken to seem to indicate that this type of cancer always comes back and that the prognosis is still not great. Can you share some knowledge and your experience with SCLC, and what the future holds for those going through it? — F.D. ANSWER: The majority of lung cancers are non-small cell lung cancer (80-85%), especially squamous cell and adenocarcinoma, and they behave and are treated very differently from small cell lung cancer (10-15%). Non-small cell lung cancer is treated with surgery if thought to be curable, whereas small cell is usually treated with chemotherapy and radiation. Usually, small cell lung cancer has already spread by the time of diagnosis, and although it initially responds well to treatment most of the time, it does usually recur, as your research has shown. Still, there are people who are cured, and the amount of disease at the time of diagnosis is the most important predictor. For people who have limited disease like you, 15-30% will be alive in five years; among those who present extensive disease, only 1-2% will be alive in five years. Being free from disease at five years usually means a cure. Exercising and being otherwise healthy are other good prognostic signs.