Differences in Small Cell vs Non-Small Cell Lung Cancer
Edward S. Kim, M.D., FACP, reviews the key differences between small cell and non-small cell lung cancer.
PUBLISHED March 29, 2019
Philippa J. Cheetham, M.D.: Let’s talk about lung cancer in terms of the different types. It’s not a one size fits all. What are the different types of lung cancer?
Edward S. Kim, M.D., FACP: Well historically, there was the biggest breakdown between not being small and small, and that’s how we describe them under a microscope. Now everything is small under a microscope, but particularly when you compare these types of cells. There were the small ones and the not-so-small ones. And thus we got naturally non-small cell and small cell.
Philippa J. Cheetham, M.D.: So talking about size, you’re referring to the microscopic size of the cell; we’re not talking about a small size on a CT [computed tomography] scan or a chest X-ray, correct?
Edward S. Kim, M.D., FACP: Correct, yes. Under the microscope. When a pathologist looks at the actual specimen, they see tiny little hyperpigmented cells, and that’s what denotes a small cell lung cancer.
Philippa J. Cheetham, M.D.: And you’ve already talked about small cell. Do you see that more commonly in people who smoke? We hear about some patients having lung cancers that are not associated typically with smoking. Which ones have the strongest link with cigarette smoking and other environmental factors?
Edward S. Kim, M.D., FACP: It spans the whole process, as you say. There is a strong association with smoking and small cell. If we look at the non–small cell cancers, the squamous cell still has a very strong association with smoking. But also in non–small cell, we still see smoking quite a bit. What we have seen emerge, as you referred to, is that incidence of about between 15 percent and 30 percent of folks who are being diagnosed who did not have a personal tobacco history. Now, could they have had environmental exposures? Did their parents smoke when they were growing up? Did they work in a bar or a bowling alley or maybe they traveled a lot on planes? You know it wasn’t too long ago that on airplanes you could still smoke.
Philippa J. Cheetham, M.D.: Right, and even in hospitals.
Edward S. Kim, M.D., FACP: That’s right. So there is environmental exposure, and so we don’t capture that very well in medical histories.
Philippa J. Cheetham, M.D.: For patients who present with these kind of cancers, obviously some patients are smokers all their lives, and even a diagnosis of lung cancer will not result in somebody stopping. How important is it to the long-term survival? If you’re diagnosed with lung cancer, is it worth stopping at that point or has that ship already sailed?
Edward S. Kim, M.D., FACP: That’s a tough question. I can only speak to personally what I do, and I can speak with what also I believe. I think stopping is always better, but it is very challenging for folks. And certainly if you are diagnosed with an early stage lung cancer, you need to stop. Just like if you…had a heart attack and you were smoking. There are some surgeons out there who will not operate on you if you don’t demonstrate that your behavior can be modified, and tobacco cessation needs to happen at that point.
Philippa J. Cheetham, M.D.: And, of course, never mind the benefits on your cardiac health and other organs in the body that benefit from you quitting smoking. Not easy to do when you’ve probably heard the most stressful diagnosis of your life.
Edward S. Kim, M.D., FACP: That is the other point, that this is the most stressed out they’ve been in a while. And I can empathize with that. You tend to go back to your obsessions and habits when something stressful like that happens.
Philippa J. Cheetham, M.D.: So on CURE Connections® we try and focus on evidence-based medicine, and obviously we’re both practicing doctors and are trained to educate patients about the latest information, the data that’s being reported in the medical literature, and large clinical trials. But let’s talk about Dr. Google. A lot of patients are on the internet doing their own research. Some of it’s out of date, some of it is not necessarily evidence-based. Obviously, patients who may be diagnosed with lung cancer when they get the initial symptoms, whether that be a cough, whatever, that’s where often nowadays patients are going to research their symptoms and signs. A few comments about what people read in terms of making their own diagnosis, misdiagnosis?
Edward S. Kim, M.D., FACP: I think the internet is a source of great information and misinformation. If you’re looking for something, you will find it. If you are looking for an alternative therapy to traditional therapies, you will find it. If you’re looking for cutting-edge therapy, you will find it. So I always tell people to proceed with caution whenever they’re on the internet. Even in these groups that have been formed that have survivors and other health care professionals, one has to be careful because we don’t know who’s on the other end of those conversations.
I always like to encourage patients to seek out information. I think you have to be your champion, or you need to have a friend or a family member who’s going to be that champion for you. On the flipside, it needs to be balanced with discussions with your health care professional, and you need to find that person who is going to be your quarterback or your leader in your health care sphere. We know that now patients are seeing multiple doctors and multiple health care professionals, and they don’t know who’s keeping track of what. So there has to be that person on your team at home, and then there needs to be that person on the health care side that’s helping formulate the plan.