What is the Difference Between Small Cell and Non-Small Cell Lung Cancer?

Lung cancer is divided into two general categories based on its appearance under the microscope: small cell and non-small cell. Non-small cell is the more common type and currently accounts for about 87 percent of lung cancers. Doctors make a distinction between the two types of lung cancers because treatment approaches differ for each.

David Jackman o
David Jackman, MD, is a thoracic oncologist and senior physician in Dana-Farber Cancer Institute’s Lowe Center for Thoracic Oncology

Symptoms
Symptoms of small cell and non-small cell lung cancer can be similar and may include a persistent cough, chest pain, shortness of breath, wheezing, loss of appetite, weight loss, and unusual tiredness. Some patients may also experience swelling of the face and neck.

Risk Factors
Tobacco smoking (cigarettes, pipes, or cigars) remains the number one risk factor for developing either type of lung cancer. Exposure to secondhand smoke, asbestos, and radon may also increase the risk of developing lung cancer. Though tobacco remains a major risk factor, a substantial number of patients diagnosed with lung cancer have no prior history of smoking.

Treatment
Treatment for lung cancer depends on several factors:

  • A patient’s overall health, other medical issues, and preferences
  • The type of lung cancer
  • Whether and where the lung cancer has spread

In addition, for some kinds of lung cancer, doctors look for specific changes in the tumor’s DNA or proteins that might provide further clues on how to best treat that specific patient’s cancer. These tests might be done on cells obtained from prior needle biopsies or surgeries. Sometimes they are done through “liquid biopsies” that tests cancer DNA collected from the patient’s blood.

Whether treatment consists of surgery, radiation, chemotherapy or some combination of those will depend on the factors listed above. Your treatment team, then, may include a thoracic surgeon, a radiation oncologist (someone who specializes in the focused use of radiation to treat your cancer) and/or a medical oncologist (who is specifically trained in the use of chemotherapy, targeted drugs, and immune-targeting therapies). Your treatment team will discuss the best strategy to attack your lung cancer, along with the potential benefits and risks associated with that strategy.

Bruce E. Johnson, M.D. who heads the lung cancer research program. Photographed for POP FW 2008.

There have been many exciting breakthroughs in the treatment of lung cancer over the last decade.. These have included several new targeted medications that hone in on specific proteins that are present in the cancers of some patients. In addition, a newer class of drugs called immunotherapies tries to harness the power of a patient’s own immune system to recognize and attack cancer cells. Through our clinical trials in lung cancer, we continue to look for new and better ways to fight this disease and improve patients’ lives.