Small cell vs. non-small cell lung cancer: What’s the difference?

Hearing the words “lung cancer” can be overwhelming. On top of the emotions that come with a diagnosis, you’re suddenly learning medical terms you may have never heard before. One of the first things your care team may explain is whether your cancer is small cell vs. non-small cell lung cancer.

These two major types of lung cancer behave very differently, and understanding those differences can help you feel more prepared as you talk with your doctor about next steps, lung cancer treatment options and how to navigate your diagnosis.

Let’s break down everything you need to know about these two main types of lung cancer.

What is small cell lung cancer?

Small cell lung cancer, often shortened to SCLC, is a fast-growing form of lung cancer that accounts for only about 10-15% of cases. Under a microscope, the cells look small, round and crowded—hence the name. Most people diagnosed with SCLC have a history of smoking.

But what really sets small cell lung cancer apart is how quickly it can spread. SCLC tends to grow rapidly and can move beyond the lungs early, which is why it’s usually found at a more advanced stage. SCLC can move to lymph nodes, the brain, liver or bones sooner than other lung cancers.

These cancer cells respond well to certain treatments, especially chemotherapy, so your doctor may recommend starting treatment soon after diagnosis. Surgery is typically not the first-line treatment for this type of lung cancer.

Small cell lung cancer is typically divided into two stages:

• Limited-stage: Cancer is confined to one side of the chest and can be treated in one radiation field.
• Extensive-stage: Cancer has spread throughout the chest or to other parts of the body.

Even though small cell lung cancer can grow aggressively, treatment is still very possible—and often effective in controlling the disease. Many people respond well to a combination of therapies, especially early on.

What is non-small cell lung cancer?

Non-small cell lung cancer, or NSCLC, is the most common type of lung cancer, making up about 80-85% of cases. Unlike SCLC, it generally grows more slowly and may be found before it spreads far beyond the lung, especially through regular lung cancer screening.

There are three main subtypes of NSCLC:

• Adenocarcinoma: The most common form, often found in people who smoke and in nonsmokers.
• Squamous cell carcinoma: Usually linked to smoking and forms in the airway lining.
• Large cell carcinoma: A less common type that can appear anywhere in the lung.

While non-small cell lung cancer grows more gradually, it can still spread if not caught early. Because of this slower progression, people with early-stage non-small cell lung cancer may benefit from surgery to remove the tumor—an option that’s less common with SCLC.

With non-small cell lung cancer, there’s a wide variety of treatment options. Surgery, radiation therapy, chemotherapy, immunotherapy and targeted treatments are all used depending on the stage and tumor characteristics.

Tumors may have changes in genes like EGFR, ALK or KRAS, allowing for more personalized treatment approaches.

Small cell vs. non-small cell lung cancer

Now that you know the basics, how do the two types of lung cancer compare? Let’s break down the key differences between small cell vs. non-small cell lung cancer.

The most significant difference between the two is the rate of growth. Small cell lung cancer is fast-moving. It grows and spreads quickly, making early detection less common. Treatment often starts right away and usually involves chemotherapy and immunotherapy.

Non-small cell lung cancer is slower growing. It may be found earlier and has more treatment options, including surgery, targeted therapy and immunotherapy.

Here’s a side-by-side breakdown:

Understanding the differences between small cell vs. non-small cell lung cancer can help guide decisions about treatment and conversations with your care team. Each type has its own treatment path and outlook, and your doctor will tailor your care to your exact diagnosis.

Lung cancer treatment options

If you or a loved one has been diagnosed with lung cancer, you’re likely looking ahead to treatment options. No two cases of lung cancer are the same, which is why treatment plans look different for everyone.

When making recommendations for lung cancer treatment, your care team will consider the type of lung cancer and stage, your overall health and whether the cancer has specific genetic markers.

Here are the main treatment approaches for lung cancer:

• Surgery: Surgery is most common in early-stage NSCLC. A surgeon may remove the tumor, part of the lung or, in some cases, an entire lung. Surgery is rarely used for small cell lung cancer because it’s usually found after it has already spread.
• Radiation therapy: Radiation uses high-energy beams to kill cancer cells. It can be used after surgery to target remaining cancer cells, alongside chemotherapy or as a primary treatment if surgery isn’t an option. In small cell lung cancer, radiation is often paired with chemotherapy for limited-stage disease and may also be used to reduce the risk of spread to the brain.
• Chemotherapy: Chemotherapy is a standard treatment for both SCLC and NSCLC, especially when cancer has spread. Small cell lung cancer responds particularly well to chemotherapy early on.
• Immunotherapy: Immunotherapy helps your immune system recognize and fight cancer cells. It’s now a common treatment for both small cell and non-small cell lung cancer and may be used alone or with chemo.
• Targeted therapy: Targeted drugs focus on specific genetic mutations within cancer cells. These treatments are especially important for NSCLC, where genetic testing often guides care. If tumors have mutations like EGFR, ALK, ROS1 or KRAS, targeted therapies may significantly improve outcomes.

Your doctor may recommend one treatment or several, depending on what will be most effective for your specific cancer.

Navigating a lung cancer diagnosis

Facing a lung cancer diagnosis isn’t easy. It’s normal to feel overwhelmed, scared or unsure about what comes next. But you don’t have to navigate this alone.

Lean on your care team, ask questions as they come up and take things one step at a time. Your care team can also connect you with helpful resources and support services, such as nurse navigators, social workers, nutritionists and counseling, to guide you and your family.

Lung cancer treatment has advanced rapidly in recent years, and there are more effective options than ever before, allowing many people to live longer, fuller lives after lung cancer.

Explore lung cancer treatment options today.