Small-cell lung cancer (SCLC) starts in the lungs but often spreads to other parts of the body. The brain is one of the most common places where lung cancer travels.
Lung cancer in the brain is not primary brain cancer. Doctors call it metastatic lung cancer.
It can be very hard to hear that your cancer has spread. Remember that you have many people to support you, including your treatment team. Metastatic SCLC in the brain is treatable, although your treatment will change.
It helps to know what to expect moving forward, how to prepare for the changes ahead, and where to find support.
How Brain Metastasis Happens
Lung cancer spreads when cancer cells break away from the tumor and enter blood vessels or lymph nodes near the lungs. From there, cancer cells travel through the bloodstream or lymphatic system to the brain and other organs.
SCLC in the brain
SCLC spreads faster than non-small-cell lung cancer (NSCLC). How long it takes to reach the brain varies from person to person. About 15% of SCLCs have already spread to the brain by the time of diagnosis. Others spread there later. Most people with SCLC will eventually have brain metastasis.
As cancer spreads in the brain, the tumors press on nerve cells that help you think, see, and talk. Damage to these structures causes the symptoms of brain metastasis.
Changes in Symptoms
A cough, shortness of breath, and a hoarse voice are the usual lung cancer symptoms. Once cancer is in your brain, you'll have new symptoms.
Look for signs such as:
- Confusion
- Severe headaches
- Nausea or vomiting
- Weakness in an arm or leg
- Loss of balance
- Slurred speech or trouble finding the right words
- Blurry or double vision
- Changes in mood or personality
- Memory problems
These are serious symptoms. Call your doctor if you notice them.
Treatment for Brain Metastasis
Surgery, chemotherapy, immunotherapy, and radiation therapy are the main treatments for SCLC. When the cancer spreads to your brain, treatment changes.
Your next steps depend on:
- Your symptoms
- The size of your tumors
- If you were already on a treatment before your cancer spread
Whole-brain radiation therapy
Whole-brain radiation therapy (WBRT) delivers radiation to your entire brain to kill cancer cells and shrink tumors. You get this treatment in a few sessions spaced days or weeks apart.
The problem is that WBRT causes side effects such as hair loss, tiredness, memory loss, and thinking problems. That's why this treatment isn't used as much today. But it may still be an option if you have a lot of tumors in your brain. Your doctor will take special care to avoid side effects.
A newer type of radiation is safer and more precise than WBRT.
Stereotactic radiosurgery
One of the main treatments for SCLC brain metastasis today is stereotactic radiosurgery (SRS). Despite the name, this isn't surgery. "It's radiation. It's precise, and it's very well tolerated," says Laura Alder, MD, an assistant professor of medicine in thoracic medical oncology at Duke Cancer Center in Durham, North Carolina.
Your doctor uses 3D imaging to aim a beam of radiation at the cancer in your brain. The radiation is targeted to avoid healthy tissue around the cancer. Radiation damages the DNA of cancer cells so they can't grow or multiply. Research shows that SRS increases survival time in people with brain metastasis.
One SRS treatment may be enough to treat small tumors. For large tumors, you may need two or more radiation sessions spaced about one month apart.
Whole-body treatments
Another important treatment is medicine that kills lung cancer cells all over your body. "It's usually a blend of chemotherapy and an immune checkpoint inhibitor, which is a drug that works with your immune system to help fight and kill the cancer," Alder says.
Checkpoints are proteins that stop your immune cells from attacking the cancer. Immune checkpoint inhibitors "turn off" these proteins to boost your immune response.
These medicines come as an infusion or an injection beneath the skin. You get them at a doctor's office, hospital, or clinic.
During treatment, your doctor will order MRI scans about once every six weeks. This test shows whether your cancer has gotten smaller, which means treatment has worked.
If you were already on immunotherapy and then SCLC spread to your brain, you'll likely stay on your current treatment if SRS is possible. "We want to use a good treatment for as long as we possibly can before switching to another treatment," Alder says.
Clinical trials
Every new SCLC treatment starts in a clinical trial. When you join a study, you get access to a treatment that might work better than approved drugs. Ask the doctor who treats your cancer whether you're a good candidate for any SCLC clinical trials.
Cognitive and Emotional Changes
Your brain controls your thoughts, memories, and emotions. Cancer that spreads to your brain can affect all of these functions.
You may notice that:
- It's hard to remember things.
- You can't concentrate.
- You have trouble reasoning or solving problems.
- You can't find the right words.
- You can't follow a conversation or understand what people say.
- Your personality has changed.
- You're anxious or depressed.
- Your moods change often.
There are ways to manage these changes. A psychiatrist or other mental health care provider treats mood changes with medicines and therapy. Speech-language pathologists have tools to improve your speech and understanding of language. You can also use reminders like your computer's calendar or alarm to help you remember.
Planning and Support
Your doctor will create a treatment plan for you based on your cancer stage, tumor size, and gene changes. Factors like your health and symptoms also go into the decision.
You're also an important part of your treatment team. Make sure you understand all your options. Let your doctor know your goals. What do you want to get out of treatment? How will the treatment slow your cancer and improve your quality of life?
Support groups
The right support can help you deal with your diagnosis and its effects on your life. Family and friends are one support system. Your loved ones can build you up and bring you joy during this difficult time.
Also, look to your medical team. Your doctor, nurse, social worker, and other members can support your emotional and physical health.
A lung cancer support group is another good resource. You'll meet people with similar experiences. Lean on them or ask for advice.
Your cancer center may also offer lung cancer support groups. If not, try one of these groups, which meet in person and online:
- LUNGevity is a nonprofit organization for people with lung cancer. It offers an online forum, virtual meetups, and a Facebook group called "Small Cell SMASHERS" for people with SCLC.
- Lung Cancer Initiative connects you to research and education resources. It also hosts a variety of programs to support people with lung cancer.
- GO2 for Lung Cancer is an advocacy organization founded by patients and survivors. It offers a phone buddy program, online support, and community social groups.
- The American Lung Association offers a free online support community called Inspire.com and lung cancer support groups across the country.
- Lung Cancer Research Foundation funds research, but it also has a lung cancer support phone line.
Ways to Improve Quality of Life
The news that your cancer has spread to your brain can be hard to hear. Once SCLC spreads, it's not curable. But it is treatable.
Your medical team will use every possible treatment to shrink your cancer and slow its growth. They'll also help you manage symptoms and treatment side effects.
Palliative care is a key part of lung cancer treatment. People often mistake it for hospice or end-of-life care, but they aren't the same. Palliative care helps manage symptoms such as pain, reduced appetite, seizures, and tiredness.
Metastatic lung cancer takes a lot of the control out of your life. But there are still things you can control to help yourself feel better and improve your quality of life.
Don't stop living. Continue to do the things you want to do. Your medical team will help make it possible. They'll adjust your treatment schedule so that you can go on the vacation you've dreamed about or attend your child's graduation.
"Our job as a medical team is to support you by emphasizing quality of life," Alder says. "We can all work together to make sure that you and your family feel supported and you can do the things that are really important to you."
