Large Cell Carcinoma of the Lung

What Is It?

Large cell carcinoma is the uncontrolled growth of abnormal cells in the lungs. This cancer is a type of non-small cell lung cancer that represents 10% to 20% of all tumors that start in the bronchi, which are the main branches of the windpipe (trachea) that lead to the lungs. This type of lung cancer is associated strongly with smoking.

Large cell tumors are usually large at the time of diagnosis. They tend to be accompanied by extensive bleeding and tissue damage. They often are called undifferentiated tumors because the cells lack the specific architecture found in other types of cancer cells. Large cell carcinoma tends to grow quickly and spread (metastasize) at an earlier stage than other forms of non-small cell lung cancer.

The constant flow of fluids through the lungs can carry cancer cells to nearby parts of the body, such as the chest wall or the diaphragm. These fluids consist of blood and lymph (a protein filled fluid). Unless large cell carcinoma is diagnosed and treated early, it can spread to organs outside of the chest area.

Symptoms

Although some cancers don't have any symptoms at first, others can cause any of the following:

• A persistent cough
• Coughing up blood (hemoptysis)
• Shortness of breath or wheezing
• Fatigue
• Recurrent pneumonias in the same place
• Unexplained weight loss or loss of appetite
• Difficulty swallowing
• Pain in the chest, shoulder or arm
• Bone pain
• Hoarseness
• Headaches or seizures
• Swelling of the face, neck or upper extremities
• Enlargement of the ends of fingers and toes (digital clubbing), in particular the skin around the fingernails

Diagnosis

Large cell carcinoma often is discovered on a chest X-ray, where it appears as a gray or whitish area. Other imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, can be used to further determine the size, shape and location of the tumor. This helps to find the best place to obtain a sample of the tumor to differentiate large cell carcinoma from other types of lung cancer such as small cell carcinoma or adenocarcinoma of the lung. The type of cancer affects the type of treatment you should get.

Another way to diagnose the tumor type is with sputum cytology, in which mucus from the lungs (sputum) is examined under a microscope to check for abnormal cells. However, this technique is most effective when the cancer is located near the center of the lung. It isn't as accurate for detecting small tumors near the edges of the lung.

Other tests that can be used to diagnose this type of cancer include:

• Thoracentesis A needle is used to remove pleural fluid, the fluid between the lung and the chest wall. This fluid is examined for cancer cells.
• Mediastinoscopy This is a surgical procedure that lets the doctor remove lymph nodes from the lungs through very small incisions to test them for cancer.
• Needle biopsy or fine-needle aspiration In this procedure, a needle is used to remove (aspirate) fluid or tissue for testing from lymph nodes, a lung mass or from an area in the bone marrow or other organ where the tumor may have spread.
• Bronchoscopy A flexible, fiber-optic viewing instrument is passed through the airway into the lung. The instrument allows the doctor to examine the tumor directly and to remove cells for examination.

Occasionally, surgery is done to remove the tumor first and then the diagnosis is made.

Your doctor will choose a therapy based on the size and location of the tumor, which define the cancer's stage. Stage I tumors are small and have not invaded the surrounding tissue or organs. Stage II and III tumors invade surrounding tissue and/or organs and have spread to lymph nodes. Stages I through III are further divided into two categories A and B. Stage IV tumors have spread outside the chest area.

Expected Duration

Without treatment, cancer will continue to grow. As with any cancer, even if large cell carcinoma seems to have disappeared (gone into remission) after treatment, there is a chance the cancer can return.

Prevention

Quit smoking and avoid secondhand smoke. Tobacco smoke is the main risk factor for most types of lung cancer, including large cell. Although studies are looking for ways to diagnose lung cancer earlier, no test has been proven effective yet.

Treatment

Surgery is the primary treatment for large cell carcinoma that has not spread. For small, localized tumors, it might be possible to remove only a small section of the lung. More extensive cancer might require removing one lobe of the lung or the entire lung. Radiation therapy and chemotherapy may be combined with surgery to help prevent the cancer from coming back.

People with severe medical problems that make it difficult for them to withstand surgery may receive radiation therapy to shrink the tumor or a combination of radiation and chemotherapy.

When there is significant tumor spread, chemotherapy drugs may be recommended to slow cancer growth even if it cannot be cured. Chemotherapy has been used to decrease symptoms and prolong life in advanced cases of lung cancer. Unfortunately, large cell carcinoma does not respond to chemotherapy and radiation therapy as well as other types of tumors.

When To Call A Professional

If you experience any of symptoms of lung cancer, make an appointment to see your health care professional as soon as possible.

Prognosis

Large cell carcinoma usually is diagnosed after the disease has spread. The overall prognosis for large cell carcinoma and other non-small cell lung cancers is poor, with a five-year survival rate of about 16%. The survival rate is higher (closer to 50%) when cancers are detected and treated early. The five-year survival rate after surgery is approximately 47% for those with stage I disease. For those with more advanced, stage III disease, the five-year survival rate is approximately 8%.

Even when surgery and other therapies are initially successful, there is a high risk of cancer returning. This is because large cell carcinoma and other non-small cell lung cancers readily spread to other parts of the body.

Additional Info

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: (301) 435-3848

Toll-Free: (800) 422-6237

TTY: (800) 332-8615

E-Mail: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: (800) 227-2345

http://www.cancer.org/

American Lung Association

61 Broadway, 6th Floor

New York, NY 10006br />Phone: (212) 315-8700

Toll-Free: (800) 548-8252E-Mail: info@lungusa.org

http://www.lungusa.org/

National Heart, Lung, and Blood Institute (NHLBI)

P.O. Box 30105

Bethesda, MD 20824-0105

Phone: (301) 592-8573

TTY: (240) 629-3255

Fax: (301) 592-8563

E-Mail: nhlbiinfo@rover.nhlbi.nih.gov

http://www.nhlbi.nih.gov/

U.S. Environmental Protection Agency (EPA)

Ariel Rios Building

1200 Pennsylvania Ave., N.W.

Washington, DC 20460

Phone: (202) 272-0167

http://www.epa.gov/

U.S. Department of Labor's Occupational Safety & Health Administration (OSHA)

200 Constitution Ave.

Washington, D.C. 20210

Phone: (202) 693-1999

Toll-Free: (800) 321-6742

TTY: (877) 889-5627

http://www.osha.gov/