Appropriate Treatment
per Disease Stage

Once diagnosed with SCLC, the initial approach to treatment varies substantially by disease stage.1 The Veterans Administration Lung Study Group’s (VALSG) 2-stage classification is used to define the extent of the disease.2

To learn more about SCLC stage classifications, click on the limited-stage and extensive-stage tabs below.

Limited- and Extensive-Stage SCLC

DEFINITION

Cancer is only on 1 side of the chest/lung/lymph nodes and can be treated with a single radiation field3

Disease may involve the mediastinal and hilar nodes1

TNM STAGING

Includes TNM Stages I to III (T any, N any, M0)4

DEFINITION

Cancer has spread widely throughout the lung, to the other lung, to lymph nodes on the other side of the chest, or to other parts of the body (including bone marrow and fluid around the lung)3

TNM STAGING

Includes TNM Stage IV (T any, N any, M1a/b/c)4

  • Patients diagnosed with LS-SCLC have a better prognosis than those with ES-SCLC5
  • The distant metastases associated with ES-SCLC make it difficult to achieve lasting remission5,6
  • Approximately 10% of patients present with brain metastases at initial diagnosis.7 Another 40%-50% subsequently develop brain metastases with disease progression; therefore, CT/MRI of the brain should be part of the work-up1

  • Uses of TNM Staging

    TNM staging provides anatomic discrimination for the measurement of outcome, prognostic information, and more precise lymph nodal staging.1 It can also identify the <5% of patients for whom resection may be beneficial, as well as radiation planning.7,8

    • T describes the original (primary) tumor8
    • N tells whether the cancer has spread to the nearby lymph nodes8
    • M tells whether the cancer has metastasized to distant parts of the body8

STAGING WORK-UP

  • A diagnostic and staging work-up should be performed as quickly as possible after symptom presentation1

Clinical Testing and Work-Up7

Medical History and Physical Examination Drawing

Medical history and physical examination

CT Scan Drawing

Chest/abdomen/
pelvis CT with contrast, and/or positron emission tomography (PET)/CT scan (skull to thigh) if needed to clarify stagec,d

Medical History and Physical Examination Drawing

Medical history and physical examination

Telescope Pathology Review Drawing

Pathology reviewa

Telescope Pathology Review Drawing

Pathology reviewa

Counseling Message Bubbles Drawing

Smoking cessation counseling

Blood Count Drawing

Complete blood cell count (CBC)

Brain Drawing

Brain MRI (preferred) or CT with contrastb,c

Blood Count Drawing

Complete blood cell count (CBC)

Liver Drawing

Electrolytes, liver function tests (LFTs), blood urea nitrogen (BUN), creatinine

CT Scan Drawing

Chest/abdomen/
pelvis CT with contrast, and/or positron emission tomography (PET)/CT scan (skull to thigh) if needed to clarify stagec,d

Counseling Message Bubbles Drawing

Smoking cessation counseling

Brain Drawing

Brain MRI (preferred) or CT with contrastb,c

DNA Molecular Profiling Drawing

Molecular profilinge

Liver Drawing

Electrolytes, liver function tests (LFTs), blood urea nitrogen (BUN), creatinine

DNA Molecular Profiling Drawing

Molecular profilinge

aTo determine the histological classification of lung tumors and relevant staging parameters.

bBrain MRI is more sensitive than CT for identifying brain metastases and is preferred over CT.

cIf extensive stage is established, further staging evaluation is optional and dependent on the clinical situation. However, bran imaging MRI (preferred), or CT with contrast is recommended.

dIf PET/CT is not available, bone scan may be used to identify metastases. Pathologic confirmation is recommended for isolated or equivocal lesions if their involvement would change clinical management.

eComprehensive molecular profiling via blood, tissue, or both can be considered in rare cases—particularly for patients with extensive stage/relapsed SCLC who do not smoke tobacco, lightly smoke, have remote smoking history, or have diagnostic or therapeutic dilemma, or at time of relapse—if not previously done, because this may change management.

  • Because of the neuroendocrine origin of SCLC, it can have a significantly rapid doubling time9
    • Therefore, timely diagnosis and treatment are essential as delays can lead to missed opportunities for both curative and life-prolonging therapies10

LIMITED STAGE (LS) SCLC

Disease Progression in LS-SCLC

DIAGNOSIS3

One in Three Patients Drawing

~1 of 3

PATIENTS HAVE LS-SCLC AT TIME
OF DIAGNOSIS

PATIENTS HAVE LS-SCLC AT TIME OF DIAGNOSIS

RELAPSE1

75 Percent of Patients Drawing

~75%

OF PATIENTS WITH LOCALLY
ADVANCED DISEASE RELAPSE
WITHIN 2 YEARS OF TREATMENT

OF PATIENTS WITH LOCALLY ADVANCED DISEASE RELAPSE WITHIN 2 YEARS OF TREATMENT

SURVIVAL5

16 to 24 Months Calendar Drawing

PATIENTS TYPICALLY SURVIVE

16-24
MONTHS AFTER DIAGNOSIS

PATIENTS
TYPICALLY
SURVIVE
16-24
MONTHS AFTER DIAGNOSIS

EXTENSIVE-STAGE (ES) SCLC

Disease Progression in ES-SCLC

DIAGNOSIS3

Two In Three Patients Drawing

~2 of 3

PATIENTS HAVE ES-SCLC AT TIME OF DIAGNOSIS

RELAPSE1

90 Percent People Drawing

>90%

OF PATIENTS WITH METASTATIC DISEASE
RELAPSE WITHIN 2 YEARS OF TREATMENT

SURVIVAL5

6 to 12 Months Calendar Drawing

PATIENTS TYPICALLY SURVIVE

6-12

MONTHS AFTER DIAGNOSIS

PATIENTS
TYPICALLY
SURVIVE
6-12 MONTHS AFTER DIAGNOSIS

NCCN=National Comprehensive Cancer Network® (NCCN®).

    REFERENCES:
  1. Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021;7(1):3. doi:10.1038/s41572-020-00235-0
  2. Carter BW, Glisson BS, Truong MT, Erasmus JJ. Small cell lung carcinoma: staging, imaging, and treatment considerations. RadioGraphics. 2014;34(6):1707-1721.
  3. Small cell lung cancer stages. American Cancer Society. https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/staging-sclc.html. Accessed March 25, 2025.
  4. Rami-Porta R, Asamura H, Travis WD, Rusch VW. Lung. In: Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. Springer International Publishing; 2017:431-456.
  5. Small Cell Lung Cancer Treatment (PDQ®)–Health Professional Version. National Cancer Institute. https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq. Accessed March 25, 2025.
  6. Huber RM, Tufman A. Update on small cell lung cancer management. Breathe. 2012;8(4): 315-330.
  7. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.4.2025. © National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed March 25, 2025. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  8. Cancer staging. American Cancer Society. https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html. Accessed March 25, 2025.
  9. Harris K, Khachaturova I, Azab B, et al. Small cell lung cancer doubling time and its effect on clinical presentation: a concise review. Clin Med Insights: Oncol. 2012;6:199-203.
  10. Vidaver RM, Shreshneva MB, Hetzel SJ, Holden TR, Campbell TC. Typical time to treatment of patients with lung cancer in a multisite, US-based study. J Clin Oncol. 2016;12(6):e643-e653.