GRACE :: Lung Cancer

Small Cell Lung Cancer

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #40 The General Approach to Extensive Stage Small Cell Cancer

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We are pleased to continue this series of informational videos for our Spanish speaking community.  GRACE is pleased to welcome Dr. Rafael Santana-Davila, Assistant Professor with the University of Washington School of Medicine and Seattle Cancer Care Alliance.  In this 40th video for the Spanish lung cancer video library, Dr. Santana-Davila joined GRACE to discuss the general approach to extensive stage small cell lung cancer.  


 

 

 

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TRANSCRIPTS – Spanish and English
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Los Principios de Tratamiento Cuando el Cáncer de Células Pequeñas está en Estadio Extendido

The General Approach to Extensive Stage Small Cell Cancer

 

Rafael Santana-Davila, MD
Assistant Professor of Medicine
University of Washington Seattle Cancer Care Alliance
Seattle, Washington

 

Spanish TRANSCRIPT

Cuando el cáncer de células pequeñas está en estadio extendido es básicamente cuando el cáncer está en otras partes del pulmón o en otras partes del cuerpo. En este tipo de cáncer, el principio no es curar al paciente si no tratar de extender su vida y mejorar la calidad de ésta. En la mayoría de los casos el principio es quimioterapia, hay varios tipos de ésta que se pueden usar pero dependen de la conversación del doctor con el paciente para que conozca los riesgos, beneficios y los efectos adversos de cada tipo de quimioterapia. Se dan regularmente dos ciclos de quimioterapia y después se vuelven a hacer estudios de imágenes para ver cómo está respondiendo el cáncer. Lo más común es dar cuatro ciclos de quimioterapia y después de esto se puede usar radiación para consolidar las ganancias que obtuvo la quimioterapia.


  

English TRANSCRIPT

When small cells lung cancer is in extensive stage is when the cancer cells are in other parts of the lung or even in other parts of the body. In this type of cancer, the goal is not to cure the patient but to try to extend their life and improve their life quality. In most cases the treatment suggested is chemotherapy, which has different types of approaches and they all depend on the conversation the doctor and the patient have in order for the patient to understand the risks, benefits and possible side effects. Regularly, we give two cycles of chemotherapy and then we make again imaging studies to see how the cancer is responding. Four cycles of chemotherapy are the most common treatment to give and then we use radiation to concentrate the good effects chemotherapy had in the cancer cells.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #39 General Approach to Limited Stage SCLC

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GRACE Cancer Video Library - Lung

 

We are pleased to continue this series of informational videos for our Spanish speaking community.  GRACE is pleased to welcome Dr. Rafael Santana-Davila, Assistant Professor with the University of Washington School of Medicine and Seattle Cancer Care Alliance.  In this 39th video for the Spanish lung cancer video library, Dr. Santana-Davila joined GRACE to discuss the general approach to limited stage small cell lung cancer.  


 

 

 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
download transcripts
 

Enfoque General Para El Estadio Limitado de Células Pequeñas de Cancer de Pulmón

General Approach to Limited Stage Small Cells Lung Cancer

 

Rafael Santana-Davila, MD
Assistant Professor of Medicine
University of Washington Seattle Cancer Care Alliance
Seattle, Washington

 

Spanish TRANSCRIPT

Cuando el cancer de células pequeñas se encuentra en estado limitado, el tratamiento es a base de radiación y quimioterapia al mismo tiempo (quimioterapia y radiación concurrente). Regularmente es cuatro a seis semanas de radiación con dos ciclos de quimioterapia al mismo tiempo. Una vez que ha pasado esto lo que esperamos es que se haya erradicado todo el cancer dentro del pulmón y curar a las personas. En algunos casos, también se da radiación al cerebro para prevenir que el cancer lo afecte, a esto se le llama por sus siglas en inglés: PCI.


  

English TRANSCRIPT

When the lung cancer of small cells is in limited stage we use at the same time a radiation and chemotherapy treatment (chemotherapy and radiation concurrent). Regularly, is four to six weeks of radiation with two cycles of chemotherapy at the same time. Once this is over, we hope the cancer is eradicated in the lung and the person is cured. In some cases, we also give PCI which is radiation to the brain to prevent its damage.


GRACE Video

Histology-Specific Recommendations – Large-Cell Neuroendocrine

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GCVL_LU-F07_Histology_Specific_Recommendations_Large-Cell_Neuroendocrine

 

Dr. Jack West, Swedish Cancer Institute, identifies the best choice for first-line chemotherapy for large-cell neuroendocrine histology.

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Transcript

One of the less common subtypes of non-small cell lung cancer is known as large cell neuroendocrine, and it is in the same family as small cell lung cancer — these are all known as neuroendocrine cancers. They originate from cells that are in the middle of the body, in the middle of the chest, that have evolved to have hormone-secreting abilities. Because of that, large cell neuroendocrine and small cell lung cancer really share enough features that they are treated in a very similar way.

The standard approach for most patients with advanced non-small cell lung cancer for metastatic lung cancer, if you do not have a driver mutation like EGFR or ALK, is a two drug combination, a so-called platinum-based doublet with cisplatin or carboplatin in combination with a partner drug. For many subtypes of lung cancer, what that partner is doesn’t matter too much — the various combinations all produce very similar results. However we tend to make a very specific recommendation for patients with a large cell neuroendocrine cancer and in fact we treat it very much like we would a small cell lung cancer.

For decades we’ve known that cisplatin or carboplatin in combination with a drug known as etoposide is a very effective treatment approach for small cell lung cancer and because large cell neuroendocrine is in the same family and has so many similar features, the most common recommended approach in terms of the chemotherapy that we would favor is cisplatin or carboplatin in combination with etoposide. Other options are certainly reasonable, but they are not as commonly recommended.

Unfortunately we don’t have a lot of actual research yet on the best approaches for patients with advanced large cell neuroendocrine cancers, but we’re starting to look into that for the first time in a very meaningful way. Until we have those results, we really do tend to favor a platinum and etoposide approach.


GRACE Video

Is There a Role for PCI in Locally Advanced NSCLC?

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GCVL_LU-E10d_Role_PCI_Locally_Advanced_NSCLC

 

Dr. Nasser Hanna, Indiana University Health, addresses the issue of prophylactic cranial irradiation (PCI) in locally advanced NSCLC.

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Transcript

Unfortunately many people with stage III disease are not cured of their cancer. We’re doing better, but we’re not doing good enough for most people and for those people who are not being cured, oftentimes the cancer will recur in what we call “distant sites.” That may be bones, it may be the liver, it may be the adrenal glands, these two small glands that sit above the kidneys, and sometimes it can be the brain.

When cancer progresses and shows up in the liver or shows up in the adrenal gland, it can certainly be disconcerting, sometimes it can cause symptoms and people don’t feel well, but oftentimes it’s something we just see radiographically. That’s oftentimes not true when cancer recurs in the brain. When it recurs in the brain, oftentimes it’s very unpleasant for somebody. They may have headaches, they may have double vision, they may have unsteadiness or nausea, they may pass out, they may even have seizure activity. So the idea of trying to prevent cancer from spreading to the brain is of paramount importance.

Now in another type of lung cancer, small cell lung cancer, we have utilized a strategy of prophylactically radiating the brain because we know that so many patients with small cell lung cancer eventually develop cancer in the brain. Prophylactically radiating the brain before any signs of cancer have appeared there may do one of two things. Number one is there actually may be microscopic disease in the brain that we really can’t detect on imaging studies for which you’re radiating when you’re doing the so-called prophylactic brain radiation. Secondly, some people believe that when you radiate the brain, it forms sort of an inhospitable environment for cancer to subsequently implant and seed. Either way, we’ve demonstrated that in patients with small cell lung cancer, you can reduce the incidence of brain metastases and in some cases actually help people live longer if you prophylactically radiate the brain.

Now the incidence of brain metastases in those with stage III non-small cell lung cancer is not as high as those with small cell lung cancer. Having said that, about 30-35% of those with stage III disease do eventually develop brain metastases. So the question has come up: should we or could we prophylactically radiate the brain and achieve fewer brain recurrences and perhaps maybe even help people live longer or cure more disease? Well the answer to this question is really unknown — there was one attempt at a carefully conducted clinical trial to test this idea, and unfortunately it was very difficult to accrue to this clinical trial, and it ended up only accruing about a third of the patients that it was meant to accrue.

We got some limited information from this clinical trial and what we learned is yes, we can reduce the incidence of cancer appearing in the brain by prophylactically radiating it. We really weren’t able to demonstrate in this small group of patients an ability to cure more people or help more people live longer, and certainly prophylactically radiating the brain does come with some side effects such as hair loss, fatigue, sometimes headaches, and sometimes nausea.

As of today, it is not standard to prophylactically radiate the brain in patients with non-small cell lung cancer and I’m not sure we’re ever going to get the completion of a clinical trial that will adequately address that, so I suspect for now and probably forever that will not be a standard approach for patients with stage III disease.


GRACE Video

Different Lung Cancer Subtypes – Histology

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GCVL_LU-A07_Different_Lung_Cancer_Subtypes_Histology

 

Dr. Edward S. Kim from the Levine Cancer Institute in Charlotte, NC defines the concept of cancer histology and gives examples of several lung cancer subtypes.

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Transcript

Now we’re talking about histology. When you’ve identified a nodule on a chest x-ray, or a CAT scan, or maybe there’s something in the liver — as you know,  lung cancer likes to leave its home base and go to other places — we get a biopsy, and that biopsy is going to help us two ways. One: it’s going to tell us what the origin of the tissue is, and two is: what subtype of that tumor is it? So, in the case of lung cancer, we try to first, identify whether it’s a non-small cell, or small cell lung cancer, and then within the non-small cell lung cancer grouping, which consists of about 85% of all of lung cancer, there are multiple different histology subtypes. That means a pathologist looks at it under a microscope — is looking at it like you would look at artwork on the wall, and trying to identify whether it’s an impressionist period, or it’s a different period of time — and that’s how they’re doing it.

Sometimes, they’ll run some basic tests that they can do in their pathology lab to help further classify one or the other histology subtypes. The most common subtype is adenocarcinoma — again, this is just the name of a non-small cell lung cancer subtype. There are also subtypes called squamous cell cancer, and then — again, those are the two major types, there are then a whole host of others. You will hear terminology such as: large cell carcinoma, neuroendocrine carcinoma, there’s even a classification called NOS, meaning not otherwise specified, and about 10-15% of the time, we can see this.

What does that mean? Well, it still means it’s a lung cancer, and it usually means it’s non-small cell lung cancer, but there is not enough tissue, or the architecture was not preserved enough during the biopsy procedure, that the pathologist can completely classify this tumor. That’s problematic, because now we have therapies that are specifically tailored for some patients who have adenocarcinoma, or squamous cell carcinoma. There are not as many therapies out there tailored for the large cell or neuroendocrine tumors. Again, these just represent different cell types that exist in the lung, and those are the ones that decide to grow and become misbehaving, and they evolve into a cancer, and that’s why they have their particular names.


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