Abstract: Small cell lung cancer (SCLC) is characterized by high aggressiveness, early metastasis, and rapid development of therapeutic resistance, making it one of the lung cancer subtypes with the poorest prognosis and the greatest challenges in clinical management. In recent years, emerging strategies such as chemoimmunotherapy, consolidation immunotherapy, and DLL3-targeted TCE/BiTE have continued to advance. However, the fundamental challenges of limited overall survival improvement and a low proportion of patients achieving long-term benefit remain unresolved. Standardized diagnostic and treatment documents, including the Chinese Anti-Cancer Association (CACA) guidelines, have provided an important foundation for the diagnosis, staging, and comprehensive treatment of SCLC, while the latest Consensus of Chinese Experts on Small Cell Lung Cancer further emphasizes frontier directions such as molecular subtyping, novel therapies, precision stratification, and dynamic management. As understanding of SCLC heterogeneity, plasticity, and microenvironmental complexity continues to deepen, related research is shifting from merely expanding therapeutic regimens toward establishing a precision diagnosis and treatment framework that integrates patient stratification, efficacy prediction, dynamic monitoring, mechanistic investigation, and treatment optimization. In this article, we discuss, in the context of relevant guidelines and the latest expert consensus, the key pathways by which SCLC may progress from therapeutic advances toward precision diagnosis and treatment, with a focus on clinical stratification, dynamic evolution, spatial niches, neuroimmune regulation, and future interventional strategies.