Small Cell vs Non-Small Cell Lung Cancer – What’s the Difference?
Sitting at the doctor's, you heard the words "cancer," "type," "small vs non small cell lung cancer," and "treatment plan". Yesterday, you only had a small rash as a symptom, and today everything has changed. Yet, these words matter more than they seem to be right now.
Every cancer, be it lung or cervical, is simply an umbrella term. A lot more goes into planning the treatment, like the type, size, stage, metastasis (how much it has spread), and even how your body copes with medication.
We're here to start at the beginning. The first thing to remember: there are two main types: small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC). They look different under a microscope, and they act differently in the body.
This guide is here to take you through understanding the two types and what it means when you have either, or why it matters to the care you receive.
Major differences between NSCLC vs SCLC
You might be wondering, "Does it really matter what type of lung cancer I have? Isn't cancer just… cancer?"
It's a fair question, especially when everything feels like it's moving too fast. But the type makes a real difference. Your doctors are already planning your treatment based on the type, so it's important you're on the same page so you don't lose any time.
Let's break down why this distinction between small cell vs non small cell lung cancer exists and what it's actually based on.
Why are small cell vs. non-small cell lung cancers differentiated?
Doctors classify lung cancer into different types because each one grows, spreads, and responds to treatment in its own way.
This isn't just about naming; it's about understanding how the disease grows, spreads, and responds to treatment. That distinction helps guide decisions from the very beginning.
On what basis are they classified?
This division between small cell vs. non-small cell lung cancer is based on how the cells look under a microscope, how quickly they multiply, and how likely they are to move beyond the lungs.
SCLC grows and spreads much faster. The good news is that it reacts well to treatment early on, but it can also return more aggressively after remission.
NSCLC is more common and usually grows more slowly. That slower pace gives doctors more options to work with, including surgery, radiation, and targeted therapies that are personalized for cancer in a specific body.
Let's take a look at the side-by-side differences between small cell vs. non-small cell lung cancer:
| Factor | Small Cell Lung Cancer | Non-small Cell Lung Cancer |
|---|---|---|
| Growth rate and spread | Fast-growing, spreads to other organs early | Slower growing, may stay localized longer |
| Diagnosis stages | Staged as Limited (one lung) or Extensive (beyond) | Staged I–IV based on tumour size, lymph nodes, and spread |
| Treatment options | Usually, chemo and radiation and surgery are rarely used | Surgery (early stages), targeted and immunotherapy available, chemo, and radiation |
| Survival and prognosis | High initial response, but often returns, long-term small cell lung cancer survival rate is lower | Depending on the stage and subtype, non small cell lung cancer survival rates are better when caught early |
| Occurrence | 15% of all lung cancers | 85% of all lung cancers |
| Subtypes | Types of small cell lung cancer include: • Small cell carcinoma (most common) • Combined small cell carcinoma (both SCLC and NSCLC) | Types of non small cell lung cancer include: • Adenocarcinoma • Squamous • Large cell types Rare types include: • Salivary gland carcinoma • Carcinoid tumour • Unclassified carcinoma |
| Main cause | Strongly linked to heavy smoking | It can occur in smokers and non-smokers alike |
| Metastasis | Spreads to the brain, liver, and bones early | Tends to spread more gradually, depending on the subtype |
| Treatment timeline | Treatment begins quickly due to aggressiveness | Timing depends on the stage, more room for planning |
Diagnosis and planning: What to expect from testing
The first test you may have already gone through is a biopsy. A small part of your lung tissue will be taken to study the cancer under a microscope and determine between small cell vs non small cell lung cancer.
Doctors look at the cell details and figure out how they behave. This process also includes understanding what treatment the cells might or might not respond to.
If you've been told it's NSCLC, there may be additional molecular testing ahead. These tests look for specific gene mutations or markers that could make you eligible for targeted therapies.
Next, they will determine the stage of cancer (I-IV or limited or extensive) through basic imaging tests like MRI or PET scans. This tells them how advanced the cancer is, and it directly influences your treatment plan, from timing and intensity to which options are on the table.
Treatment strategies
The main reason you should know which type of lung cancer you have is to talk about your treatment with your care team and plan further. So, let's take a look at the different treatments usually recommended for either type:
| Treatment Type | SCLC | NSCLC |
|---|---|---|
| Chemo | Main treatment plan | Used after surgery or when cancer has spread beyond the lungs |
| Radiation | Clubbed with chemo, especially in limited-stage | To shrink tumours or target specific areas (especially if surgery isn't possible) |
| Surgery | Rarely used; cancer is usually already spread at diagnosis | Used in early stages when the tumour is still localized |
| Targeted therapies | Not used | Important for cancers with certain mutations (e.g., EGFR, ALK) |
| Immunotherapy | Clubbed with chemo in extensive-stage | Increasingly common in advanced stages or with high PD-L1 protein |
| Laser therapy (with photodynamic therapy) | Kills small cancer cells blocking airways | Used in case the cancer tissue spreads to the airways |
| Cryotherapy | Not used | Used to destroy locally advanced cancers when re-surgery is not advised |
| Clinical trials | Clinical trials exist for both small and non-small cell lung cancer. You can ask your care team to keep you updated on available trials. | |
Wrapping up: Dealing with lung cancer signs
Knowing whether you have small cell lung cancer vs non small cell lung cancer isn't just a technical detail; it's a part of understanding your path forward. Each type brings its own set of challenges but also its own treatment options, timelines, and possibilities.
As you and your loved one walk through this next chapter, don't hesitate to ask questions. Have honest conversations with your oncologist about your diagnosis, what kind it is, how far it's progressed, and which treatments are best for your situation.
Every year, research brings new therapies: more targeted, more personalised, and often more hopeful. While the journey can feel overwhelming, knowing the type of lung cancer you have is the first step toward a plan.
FAQs on types of lung cancer
How long can you live with small cell lung cancer?
Survival rates vary a lot. Some people respond well to treatment and live for years, while others face a faster progression. The stage at diagnosis and how the cancer responds to therapy both play a big role. Talk to your oncologist to understand your next steps.
Why is there no surgery for small cell lung cancer?
By the time it's found, small cell lung cancer has often already spread. Surgery isn't helpful once it's beyond the lungs, so doctors focus on treatments that reach the whole body, like chemo and radiation.
Can chemo cure non small cell lung cancer?
In the early stages, surgery followed by chemo can lead to long-term remission. In later stages, chemo helps manage the disease, ease symptoms, and extend life, but a complete cure is less common without other treatments.
How successful is radiation for small cell lung cancer?
Radiation can be very effective, especially when the cancer is still in one lung. It's combined with chemotherapy to shrink tumours and relieve symptoms. In some cases, it can even help achieve remission.
Is small cell lung cancer hereditary?
Yes, a study in 2021 found that small cell lung cancer can be hereditary. Gene mutations like BRCA1, BRCA2, and RAD51D passed down in generations are 10% more susceptible to small cell cancer. Patients with these mutations are also more likely than others to respond to therapies that exploit defects in DNA repair pathways.