An Overview Large Cell Carcinoma of the Lungs

Symptoms, Treatments, and Prognosis of Large Cell Lung Cancer

Large cell carcinoma
PEIR Digital Library/Wikimedia Commons/Public Domain

Large cell carcinoma of the lungs is a form of non-small cell lung cancer. Non-small cell lung cancers account for 80 percent of lung cancers, and of these, roughly 10 percent are large cell carcinoma of the lung. Unlike some lung cancers that more commonly present with a cough or lung infections, early symptoms often include a vague sense of shortness of breath and fatigue.

Large cell carcinomas are also called large cell lung cancers. They are named for the appearance of large round cells when examined under the microscope, although the tumors themselves tend to be large as well when diagnosed. Large cell carcinomas often occur in the outer regions of the lungs, and tend to grow rapidly and spread more quickly than some other forms of non-small cell lung cancer.

Symptoms

Because large cell carcinomas often begin in the outer parts of the lungs, well-known symptoms of lung cancer, such as a chronic cough and coughing up blood, may be less common until later in the disease. Early of large cell carcinomas that may be overlooked may include fatigue, mild shortness of breath, or achiness in your back, shoulder, or chest. Many people note that these initial symptoms are subtle and vague, for example, they believe that their symptoms of shortness of breath with climbing stairs are related to gaining a few pounds or being a few years older, rather than being a sign of lung cancer.

Since large cell carcinomas are often found in the outer regions of the lungs, they can cause fluid to develop in the space between the tissues that line the lung (pleural effusions) and invade the chest wall. This can cause pain in your chest or side that worsens with a deep breath.

Large cell carcinomas can also secrete hormone-like substances that cause symptoms referred to as paraneoplastic syndrome. In men, these substances may cause enlargement of the breasts, something known as gynecomastia.

Causes and Risk Factors

We aren't certain exactly what causes large cell carcinoma of the lungs, but sevearl risk factors have been identified. Smoking is the greatest risk factor, and plays a larger role in large cell lung cancers than other forms of non-small cell lung cancer such as lung adenocarcinoma. Exposure to radon in the home is the second leading risk factor for lung cancer, and nearly anyone can be at risk. Other factors such as air pollution, secondhand smoke, and  genetics can all play a role. On-the-job exposures are an important risk factor, and it's thought that up to 17 percent of lung cancers in men may be related to occupational exposure to chemicals and other substances such as asbestos.

Diagnosis

Large cell carcinoma of the lungs is often first suspected when abnormalities are seen in an X-ray. That said, a chest x-ray isn't sufficient to rule out the disease, and it's not uncommon for a lung cancer to be missed on a chest x-ray. If any symptoms are present, further testing is needed even if a chest x-ray is perfectly normal. Further evaluation may include:

  • Chest CT scan
  • MRI
  • Bronchoscopy (a test that uses a lighted scope that is inserted through the mouth and down into the large airways)
  • PET Scan (a test designed to look for actively growing tumors and can be helpful in distinguishing cancer from scar tissue)

Depending upon the results, your doctor will usually want to obtain a sample of tissue to confirm the diagnosis and will order further tests to check to see if your cancer has spread. A lung biopsy to detect lung cancer may be done in one of several ways ranging from a fine needle biopsy, to an endobronchial ultrasound guided biopsy during a bronchoscopy, to an open lung biopsy.

Stages

Large cell carcinoma is broken down into 4 stages:

  • Stage 1: The cancer is localized within the lung and has not spread to any lymph nodes.
  • Stage 2: The cancer has spread to lymph nodes or the lining of the lungs, or is in a certain area of the main bronchus.
  • Stage 3: The cancer has spread to tissue near the lungs.
  • Stage 4: The cancer has spread (metastasized) to another part of the body.

Treatments

Depending upon the stage, treatments for large cell carcinomas of the lung may include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, or a combination of these. Many clinical trials are in progress looking for new ways to treat lung cancer, and to help decide which treatments are most effective.

Surgery

Lung cancer surgery offers a chance for a cure when large cell carcinomas are caught in the early stagesof the disease. Procedures may include removal of the tumor alone with a wedge of surrounding tissue (wedge resection), removal of a lobe of the lung (lobectomy), or removal of entire lung (pneumonectomy). Newer, minimally invasive procedures are no available at some cancer centers, that are associated with a shorter recovery time. This technique, called video-assisted thoracoscopic surrgery involves a surgeon making several small incisions in the chest, and then using instruments to remove the lung tissue without needing to remove or separate ribs.

Chemotherapy

Chemotherapy may be used alone, prior to surgery to reduce the size of the tumor (neoadjuvant chemotherapy), or following surgery to help ensure that no cancer cells are left behind (adjuvant chemotherapy). It may be used with or without radiation therapy. Examples of chemotherapy medications used with large cell carcinomas include Altima (pemetrexed) and Platinol (cisplatin).

Targeted Therapies

Targeted therapies are medications that are designed to attack cancer specifically. Because they work by targeting proteins on cancer cells, or normal cells that have been “hijacked” by a tumor in its attempt to grow, they may have fewer side effects than traditional chemotherapy. Molecular profiling is done to look for any "targetable" mutations in lung cancer cells that might respond to these medications. At the current time it's felt that everyone with advanced non-small cell lung cancer, such as large cell lung cancer, should have molecular profiling done on their tumor. When a treatable mutation is found, there is a good likelihood that one of the targeted drugs will be able to control the tumor for some time. While targeted drugs do not cure lung cancer, they can keep it in check until resistance occurs. And, when resistance occurs, there are now second and third generation drugs, in some cases, that can be used.

Radiation Therapy

Radiation Therapy may be used in a number of different ways with lung cancer. It can be used before surgery to reduce the size of a tumor. It can be used after surgery to "clean up" any left over cancer cells. With small cancers it may be used alone to treat the cancer via a specialized form of radiation called stereotactic body radiotherapy (SBRT). SBRT delivers a very high dose of radiation to a localized area of tissue with a curative attempt. SBRT may also be used to treat isolated brain metastases (or other metastases) due to lung cancer. Commonly, radiation therapy is used as a palliative treatment with advanced lung cancer, not with the intent to cure the disease, but to control symptoms such as airway obstruction, bleeding, and bone pain due to bone metastases.

Immunotherapy

Immunotherapy is an exciting new field of lung cancer treatment that has resulted in long-term control of the disease for some people, even those with stage 4 disease. At the current time there are four immunotherapy drugs that have been approved for lung cancer. These drugs work, simplistically, by harnessing the body's own immune system in the fight against cancer. To place some perspective on how fast the treatment of lung cancer is evolving, the first drug in this category was approved for lung cancer in 2015.

Clinical Trials

There are currently many clinical trials in process evaluating newer treatments for lung cancer (or treatments that have fewer side effects). The National Cancer Institute advises that everyone with lung cancer should consider participating in a clinical trial. While some people feel anxious about taking part in a medical study, it's helpful to keep in mind that every treatment we currently have, including those that have been approved in the past few years and are making a difference in survival, was once evaluated as part of a clinical trial.

Prognosis

The 5-year survival rate for lung cancer overall is sadly only about 18 percent. For those diagnosed in the early stages of the disease, the prognosis is much better. One variant of large cell carcinoma, large cell neuroendocrine carcinoma, has a poorer prognosis than large cell carcinoma.

Coping

A diagnosis of lung cancer is frightening and you may feel very alone. Allow your loved ones to support you. Many people have no idea how to react towards someone who is diagnosed with cancer. Letting people know specific things they can do to help may ease their anxiety, as well as fill your need for extra support at this time.

Ask questions. Learn as much as you can. Consider joining a lung cancer support group either through your cancer center or online. And be true to yourself. No matter what others have experienced or recommend, only you know what is best for you.

A Word From Verywell

Though lung cancer has historically had a poor prognosis, the treatment for, and survival from, lung cancer is improving. This improvement has developed rapidly, and it can be difficult for even a lung cancer specialist to stay on top of the most recent advances. Many physicians recommend getting a second opinion at one of the larger National Cancer Institute designated cancer centers, centers that often have several oncologists focused on lung cancer alone, and involved in the most current research.

View Article Sources