High grade and low grade small cell - 1274381

Hi Gill,

Small cell lung cancers belong to a family of tumors known as neuroendocrine cancers, and they are all treated in a similar fashion. Although you wouldn't call a small cell lung cancer "low-grade", there are other subtypes of neuroendocrine cancers that can be classified that way, as Dr. West describes here, stating:

"On one end of the spectrum are carcinoids, which have such a favorable prognosis as tumors that they aren’t historically considered a carcinoma. The term carcinoid suggests just a similarity to carcinomas. In fact, they are on the most favorable end of the neuroendocrine tumor spectrum. A typical carcinoid has a very slow growth rate, very few dividing cells, little to no chance of spread to lymph nodes, and a very high survival rate. An atypical carcinoid still has more dividing cells, a small but higher risk of lymph node involvement, and a generally quite favorable prognosis but not as excellent as for typical carcinoids. Both typical and atypical carcinoids are seen in a pretty even balance of men and women, with a much lower proportion of smokers than other lung cancers, and are often seen in younger patients, an average age in the 50s in many studies. In contrast, LCNEC and SCLC sit at the high grade end of the spectrum, with many rapidly dividing cells and a much less favorable prognosis. They also have a strong majority of men, up to 80-90% in some series, and are almost always seen in smokers."

It may be one of the lower-grade subtypes to which your doctor referred, and it's possible to have cells of more than one subtype.

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As far as symptoms, the problem with lung cancer in general is that patients generally don't have symptoms until the cancer has become advanced. A small tumor often does not cause any symptoms. Add to that the fact that many lung cancer symptoms are non-specific - a variety of health issues can cause a cough, shortness of breath, fatigue or weight loss. On one hand, it would be unusual to have symptoms from a cancer that was not very advanced a year before it was discovered, but if an advanced cancer was producing symptoms, it would likely progress rapidly over the course of a year.

JimC
Forum moderator

Hi Gill,

I'm sorry you've not been feeling well and hope there is no cancer diagnosis. SCLC (small cell lung cancer) tends to grow rapidly so it would be very unlikely to have had it for a year without a diagnosis. There are other reasons to be skeptical of any cancer diagnosis. When weight loss and fatigue happen because of cancer the cancer is pretty well developed in the body causing proteins to form that cause loss of appetite and fatigue. It's pretty common to have these as the first symptoms that something is wrong but highly unlikely that they could last a year without having other more dramatic symptoms.

About tumor grade. The term isn't really used in lung cancer. It refers to how the tumor cells look under microscope. In some cancers like breast and prostate cancer it is used. "Tumor grade is the description of a tumor based on how abnormal the tumor cells and the tumor tissue look under a microscope. It is an indicator of how quickly a tumor is likely to grow and spread. If the cells of the tumor and the organization of the tumor’s tissue are close to those of normal cells and tissue, the tumor is called “well-differentiated .” These tumors tend to grow and spread at a slower rate than tumors that are “undifferentiated” or “poorly differentiated,” which have abnormal-looking cells and may lack normal tissue structures. Based on these and other differences in microscopic appearance, doctors assign a numerical “grade” to most cancers. The factors used to determine tumor grade can vary between different types of cancer." http://www.cancer.gov/about-cancer/diagnosis-staging/prognosis/tumor-gr…
In lung cancers pathologists usually assign the grade as well or un differentiated as described above however it doesn't usually affect treatment so much.

I hope this helps.
All best,
Janine

Hi Gill,

It's really beyond the scope of this site to provide detailed information on such issues, but you may want to start with this page from the NIH: https://www.nlm.nih.gov/medlineplus/malabsorptionsyndromes.html

I would not expect it to be an early sign of SCLC.

JimC
Forum moderator