stages and small cell

• By RiaRia
• Posted March 14, 2009 at 5:35 pm
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i was wondering the same thing - i only know of small cell being limited or extensive.
maria

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• By jmichelle
• Posted March 14, 2009 at 5:45 pm
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I noticed that as well. I just figured that they were typos or someone was mistaken.

From everything I have have learned you are correct:

SCLC is either limited or extensive
and
NSCLC has the various stages.

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• By pattyp1
• Posted March 14, 2009 at 6:21 pm
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hey, Robin,
you are correct - the oncology community has only two groupings for SCLC - limited and extensive - limited indicates no spread beyond the primary site - extensive would correspond to stage 4 - there is a reason for this - SCLC tends to travel through the lymphatic system early in its development - its favorite destinations are the brain, the liver, one adrenal gland, the spot between the lungs, and the skeleton. It's almost like it sneezes or spreads like a dandelion. Limited stage SCLC is rarely found, and by the time extensive stage has been found, it's already taken hold somewhere remote to the primary site.

hope this helps
hugs
Pat

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• By Chum
• Posted March 14, 2009 at 6:49 pm
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I think that the above posts are probably correct - but there are instances when people have both small cell and non-small cell - bad stuff, but I remember seeing at least two people with that "blend." Could be that they were both extensive and stage 4.

Courage

Chum

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• By rmhayes
• Posted March 14, 2009 at 7:36 pm
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I know about blended diagnosis..i am extensive sclc and also have nsclc and mixed cell. all 3 are a distinctive different cancer...however, way i was explained why the sclc is the one they went with as far as treatment was: the sclc is more agressive on where it attacks next. that nsclc doesnt respond as well to chemo etc....but my mixed cell and nsclc i do not even know what stages they were because the focus in my case layed strictly with the sclc. but even with a "blended" diagnosis...sclc still only has 2 stages...period. limited and extended and since both the prognosis and treatment are vastly different it worries me when someone refers to sclc as stage 3b or stage 4 only because are they dealing with sclc or nsclc u should know these things so u know what to demand for treatment. what made it bad for me is my oncologist did not tell me bout the fact that there were 2 different other cancers going on seperate and by themselves while i was fighting sclc. im not sure if i explained why it bothers me about using stages with a cancer that doesnt have stages...so i'll try to put it like this..u should know what your dealing with so you know how to deal with it. lol nope dont think that did the trick either
robin

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• By Daughter816
• Posted March 14, 2009 at 8:16 pm
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I have posted that my dad has sclc,extensive but he dr said anytime cancer spreads it is considered a stage IV.

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• By robinwd
• Posted March 15, 2009 at 8:36 pm
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I pointed out this discrepancy a couple of weeks ago.
For just plain ol' SCLC, it is limited or extensive, period.

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• By Outrider1
• Posted March 16, 2009 at 3:08 am
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They do not stage SCLC like other cancers as it does not grow like the other cancers in a uniform shape. SCLC is also referred to as "oat cell" cancer because it looks like a pile of dried oatmeal. If you pile up oat meal, it does not stay in a uniform shape or size for any amount of time. Since the size and shape is never uniform it is difficult to to assign a number on a scale to it, therefore, when it is small and contained in one lung and no spread out side the lung (with exception of the few lymph nodes nearest the tumor) it is consider non-extensive. Once it spreads outside the lung it is considered extensive.
Staging for other cancers are based of several criteria such as
1. Size
2. Location
3. Lymph involvement
4. Spread or metastasis.
I hope that helps.
Dawn

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• By Outrider1
• Posted March 16, 2009 at 3:10 am
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Sorry,
I should have used the correct term of limited instead of non-extensive. My chemo brain just could not come up with the right term until I re-read the other posts.
Dawn

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• By Mamadx2
• Posted March 16, 2009 at 10:59 am
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I have also been confused by the different stages mentioned for SCLC.
Would love to hear from some "limited" survivors; don't see many posts from that diagnosis.

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• By Barbell
• Posted March 16, 2009 at 11:11 am
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That is strange. I was dx'd with Small Cell, Stage 3A. I certainly will ask my Oncologist when I go back to explain exactly what I have. Thanks, y'all. Barbell

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• By debra1
• Posted March 16, 2009 at 4:01 pm
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When I was first diagnosed, I asked if I was stage IV?
My Doc said yes, it is called extensive SCLC. The only confusion I have with some of the posts of newbies, is I wonder if it is really SCLC when they have a stage with it.

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• By Tricia_D
• Posted March 16, 2009 at 7:10 pm
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My boyfriend was told he has Stage IV Small Cell Carcinoma of the Lung, but I believe this diagnosis was based on the fact that his SCLC is a metastasis from the Primary tumor which was located in the Prostate (very rare) over a year ago. I believe that once the cancer travels from the Primary site, it is considered Stage IV. I'm still learning a lot myself. This all came down two weeks ago and he is just being released from the hospital today. I'll keep you posted on anything I learn. Thank you all for sharing your wisdom and insight.

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• By rmhayes
• Posted March 16, 2009 at 8:29 pm
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mine traveled from my lungs to wrap around the bronchia and my aorta...and that just makes it extensive sclc

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• By TAVZ
• Posted March 16, 2009 at 9:48 pm
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My husband has cancer! (SCLC) I'm his caregiver..
not be be unknowledgeable but I have never heard of stages for (SCLC) small cell lung cancer? I have read on this website, those who have expressed their own personal journeys dealing with this beast cancer only (NSCLC) non small cell lung cancer has stages! I have never heard the Oncology Dr. speak-any different. so end lighton me! please..

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• By rmhayes
• Posted March 17, 2009 at 12:38 am
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talking to my dr on this subject..wanted more info. This is what my oncologist says: if your diagnosed with sclc and it has not gone anywhere...its limited. if it has grown outside of original into another area it is extensive sclc. ok his nurse also sent me to a site..sponsored by the gov. and here is there info:
The following stages are used for small cell lung cancer:

Limited-Stage Small Cell Lung Cancer

In limited-stage, cancer is found in one lung, the tissues between the lungs, and nearby lymph nodes only.

Extensive-Stage Small Cell Lung Cancer

In extensive-stage, cancer has spread outside of the lung in which it began or to other parts of the body.
this is all out there who like me wonder where the stages come from...either they are thinking because there are mets it makes it a stage or their dr..well actually has it wrong or just compared it to.
makes ya go hmmm
robin

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• By robinwd
• Posted March 17, 2009 at 10:56 am
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Mamadx2....I am an almost 4 yr. survivor of limited SCLC!

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• By LTLCS
• Posted March 17, 2009 at 12:04 pm
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Staging is the process of finding out if cancer is localized or widespread. It will show if the cancer has spread to other body structures and, if so, how far. The treatment and prognosis (outlook for survival) for a patient with lung cancer depends, to a large extent, on the cancer's stage.

Staging of Non-Small Cell Lung Cancer (NSCLC)

The system most often used to describe the growth and spread of non-small cell lung cancer (NSCLC) is the TNM staging system, also known as the American Joint Committee on Cancer (AJCC) system. T stands for tumor (its size and how far it has spread within the lung and to nearby organs), N stands for spread to lymph nodes and M is for metastasis (spread to distant organs). In TNM staging, information about the tumor, lymph nodes, and metastasis is combined and a stage is assigned to specific TNM groupings. The grouped stages are described using Roman numerals from 0 to IV.

Non-small cell lung cancer T stages

Tis: Cancer is found only in the layer of cells lining the air passages. It has not invaded other lung tissues. This stage is also known as carcinoma in situ.

T1: The cancer is no larger than 3 centimeters (slightly less than 1¼ inches), has not spread to the visceral pleura (membranes that surround the lungs) and does not affect the main branches of the bronchi.

T2: The cancer has one or more of the following features:

it is larger than 3 cm
it involves a main bronchus, but is not closer than 2 cm (about ¾ inch) to the point where the trachea (windpipe) branches into the left and right main bronchi
it has spread to the visceral pleura
the cancer may partially clog the airways, but this has not caused the entire lung to collapse or develop pneumonia
T3: The cancer has one or more of the following features:

it has spread to the chest wall, the diaphragm (breathing muscle that separates the chest from the abdomen), the mediastinal pleura (membranes surrounding the space between the two lungs), or parietal pericardium (membranes of the sac surrounding the heart).
it involves a main bronchus and is closer than 2 cm (about ¾ inch) to the point where the trachea (windpipe) branches into the left and right main bronchi, but does not involve this area
it has grown into the airways enough to cause one lung to entirely collapse or to cause pneumonia of the entire lung
T4: The cancer has one or more of the following features:

it has spread to the mediastinum (space behind the chest bone and in front of the heart), the heart, the trachea (windpipe), the esophagus (tube connecting the throat to the stomach), the backbone or the point where the windpipe branches into the left and right main bronchi
two or more separate tumor nodules are present in the same lobe
there is a malignant pleural effusion (fluid containing cancer cells in the space surrounding the lung)
Non-small cell lung cancer N stages

N0: No spread to lymph nodes

N1: Spread to lymph nodes within the lung, hilar lymph nodes (located around the area where the bronchus enters the lung). Metastases affect lymph nodes only on the same sides as the cancerous lung.

N2: Spread to lymph nodes around the point where the windpipe branches into the left and right bronchi or to lymph nodes in the medistinum (space behind the chest bone and in front of the heart). Affected lymph nodes are on the same side of the cancerous lung.

N3: Spread to lymph nodes near the collarbone on either side, to hilar or mediastinal lymph nodes on the side opposite the cancerous lung.

Non-small cell lung cancer M stages

M0: No distant spread

M1: Distant spread is present. Sites considered distant include other lobes of the lungs, lymph nodes further than those mentioned in N stages, and other organs or tissues such as the liver, bones, or brain.

Stage grouping for non-small cell lung cancer

Once the T, N and M categories have been assigned, this information is combined (stage grouping) to assign an overall stage of 0, I, II, III or IV.

Overall Stage T Stage N Stage M Stage Treatment
Stage 0 Tis (In situ) N0 M0 treatment
Stage IA T1 N0 M0 treatment
Stage IB T2 N0 M0 treatment
Stage IIA T1 N1 M0 treatment
Stage IIB T2 N1 M0 treatment
T3 N0 M0
Stage IIIA T1 N2 M0 treatment
T2 N2 M0
T3 N1 M0
T3 N2 M0
Stage IIIB Any T N3 M0 treatment
T4 Any N M0
Stage IV Any T Any N M1 treatment

Staging of Small Cell Lung Cancer

For small cell lung cancers, a two-stage system is most often used. These are "limited stage" and "extensive stage". Limited stage usually means that the cancer is only in one lung and in lymph nodes on the same side of the chest.

Spread of the cancer to the other lung, to lymph nodes on the other side of the chest, or to distant organs indicates extensive disease. Many doctors consider small cell lung cancer that has spread to the fluid around the lung to be an extensive stage.

Small cell lung cancer is staged in this way because it helps separate tumors that can be treated more effectively with radiation therapy from those which cannot. About two-thirds of the people with small cell lung cancer will have extensive disease when their cancer is first found.

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• By prathergirl
• Posted May 2, 2009 at 4:49 pm
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In our case, we got no meaningful communication from the Dr's except discrepencies. To me , there are 2 kinds of cancer to certain Dr.'s, " treatable " , and " we could care less at this point ". An RN told me to request the Dr's notes at every appt. from now on because it's the only way we get information. When I checked in to going for a second opinion, or even a different team, we were told there are no others in his insurance's network.

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• By rmhayes
• Posted May 2, 2009 at 6:44 pm
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Check with your state attorneys office. I do not think legally insurance company can deny you a chance for a 2nd opinion and or another Dr. altogether. Insurance companies try to bully us into whatever they can that will cost them less..by means that are not always legal. Right now I am on medicaid and they have denied every single bill thats been submitted by saying they were not filed right. I contacted my lawyer and he informed me this was a common practice of medicaid to delay payments as long as possible. He will contact them and hopefully get the ball started.
good luck
robin

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