Large cell lung cancer (LCLC) is one of the less common types of non-small cell lung cancer (NSCLC) and is classified as a group of tumors that do not have the clear histological features of the other known types, and the classification of this type has changed significantly as the medical understanding of lung cancer has evolved and the distinction between the different types has become more refined.
Although large cell lung cancer used to be diagnosed at a higher rate in the past, the reliance on more accurate classifications has led to its current low rate, although it remains an important type due to its different characteristics and clinical behavior from other lung cancers.
What is large cell lung cancer?
Large cell lung cancer is a subtype of non-small cell lung cancer, so named because of the large size of the cancer cells when examined under a microscope. These cells do not exhibit the characteristic histologic features of adenocarcinoma or squamous cell lung cancer and differ from small cell lung cancer cells in morphology and size.
Large cell lung cancer can arise in any part of the lung, but it is more commonly seen in the peripheral regions of the lung. It is one of the least common types of non-small cell lung cancer and has been observed in a higher incidence in men than in women.
Causes of large cell lung cancer
There is no one specific cause of large cell lung cancer, but there are a number of risk factors that are associated with an increased likelihood of developing this type of lung cancer. Smoking is the most prominent factor associated with lung cancers in general, with the largest percentage of lung cancer-related deaths attributed to smoking.
In addition to smoking, other risk factors include exposure to radon gas, occupational exposure to irritants or pollutants such as asbestos and certain chemicals, as well as living in areas with high levels of air pollution. Secondhand smoke is a factor for people who live with smokers. Genetic and familial factors also play a potential role. People with a family history of lung cancer may have an increased risk, and it has been suggested that previous exposure to radiation therapy may be associated with an increased risk.
Symptoms of large cell lung cancer
Symptoms of large cell lung cancer are similar to those of other types of non-small cell lung cancer and may not be evident in the early stages, which can lead to delayed detection of the disease.
Common symptoms of large cell lung cancer
- A persistent or worsening cough that may be accompanied by blood or bloody mucus
- Chest pain with hoarseness or difficulty swallowing
- Shortness of breath with wheezing or whistling while breathing
- Loss of appetite with unexplained weight loss
- Persistent fatigue that may be accompanied by fever or night sweats
- Recurrent pneumonia or bronchitis that returns to the same area of the lung
Symptoms of the disease spreading to other organs
- Enlarged lymph nodes or swelling in the face or neck
- Back pain or bone pain
- Headaches or vision changes
- Yellowing of the skin or eyes
- convulsive seizures
It should be noted that many of these symptoms are general and may occur in non-cancerous conditions, so the exact cause can only be determined through a medical evaluation.
What are the symptoms to see a doctor for?
It is advisable to see a doctor for persistent or unexplained respiratory symptoms, especially if they last for a while or get worse over time. Symptoms such as chronic cough, shortness of breath, chest pain, unexplained weight loss, or coughing up blood should not be ignored. Early assessment is even more important for people with risk factors, as early detection of lung cancer improves the chances of managing the disease and choosing appropriate treatment options.
How is large cell lung cancer diagnosed?
Suspicion of large cell lung cancer often begins with chest imaging tests, where the tumor may appear on a chest X-ray as a gray or white area, and other imaging tests are used to determine the exact size, shape, and location of the tumor, and the best way to take a biopsy.
Imaging tests for large cell lung cancer
Tests that may be used include:
- Chest X-ray
- Computed Tomography
- Magnetic Resonance Imaging
- Positron Emission Tomography
- Ultrasound imaging
These tests help assess the extent of the disease and may be used to see if the cancer has spread to other parts of the body.
Biopsy and microscopy for large cell lung cancer
The diagnosis of large cell lung cancer is confirmed by taking a sample of tumor tissue and examining it under a microscope, which is performed by a pathologist to confirm the presence and type of cancer cells. Methods for obtaining a biopsy include:
- Bronchoscopy
- Needle biopsy
- Thoracentesis of fluid from the thoracic cavity
- Mediastinoscopy or lymph node sampling
- Video-assisted thoracoscopy (VATS)
Open surgery may be used as a diagnostic method only in specific cases, often when the tumor is localized or when other methods are insufficient to obtain a suitable specimen.
Additional examinations
In some cases, sputum samples may be examined under a microscope to detect abnormal cells, especially when the tumor is close to the center of the lung. Additional tests may be performed on the tumor tissue from the biopsy to obtain information to help understand the nature of the disease more precisely.
Stages of large cell lung cancer
Large cell lung cancer is staged according to the extent to which the disease has spread within the lungs or to other parts of the body, and staging helps in understanding the progression of the disease and choosing the appropriate treatment plan.
- Stage 0: The cancer is present only in the surface layer lining the lung and has not spread beyond it.
- Stage IA and IB: The cancer is confined to the lung without spreading to the lymph nodes or other parts of the body, and the differentiation between the two sub-stages depends on the size of the tumor and whether it has reached the lining of the lung.
- Stage II (IIA and IIB): The tumor is larger than stage I, and may begin to spread to nearby lymph nodes or adjacent tissues, without reaching distant organs, and the subcategorization varies according to the size, location, and degree of spread of the tumor.
- Stage III (IIIA, IIIB, and IIIC): The cancer is more advanced and may be more difficult to surgically remove, and the subdivision of the stages depends on the size, location, and extent of the tumor within the chest.
- Stage IV: The cancer has spread to other areas of the body outside of the lungs and is considered metastatic at this stage.
Treatment options for large cell lung cancer
Treatments for large cell lung cancer are similar to treatments for other types of non-small cell lung cancer, and the treatment plan is usually individualized for each patient. Treatment may involve the use of a single modality or a combination of several modalities.
Large cell lung cancer surgery
Surgery is one of the most effective options when the disease is detected in its early stages. Surgical options may include
- Sphenoidectomy, in which the tumor is removed along with a portion of the surrounding tissue
- Lobectomy, in which an entire lobe of the lung is removed
- Complete pneumonectomy, in which the entire lung is removed
Chemotherapy and radiation therapy for large cell lung cancer
Chemotherapy or radiation therapy may be used separately or in combination to:
- Shrink the tumor before surgery
- Elimination of residual cancer cells after surgery
Radiation therapy relies on the use of high doses of radiation to destroy cancer cells, while chemotherapy uses drugs that target rapidly dividing cells, including cancer cells.
Targeted therapy for large cell lung cancer
Targeted therapy relies on targeting specific characteristics or features of cancer cells, such as certain changes or biomarkers, to disrupt the functioning of these cells while minimizing the impact on healthy cells, and several targeted drugs are used to treat NSCLC depending on the characteristics of the tumor.
Immunotherapy for large cell lung cancer
Immunotherapy works by boosting the immune system’s response to attack cancer cells. A number of immunotherapy drugs are currently used to treat non-small cell lung cancer, and this type of treatment has improved outcomes and quality of life for some patients.
The difference between large cell lung cancer and non-small cell lung cancer
There are several main types of non-small cell lung cancer (NSCLC), and each type differs in the shape of the cells and where the tumor originates within the lung, as shown in the following table:
| Comparison | Large cell lung cancer | Lung adenocarcinoma | Squamous cell lung cancer |
|---|---|---|---|
| Definition | Large cancer cells that don’t look like glandular or squamous cells | Starts in mucus-producing glandular cells | Starts in the flat cells that line the airways |
| Appearance of cells | Large cells without clear distinguishing features | Cells with clear glandular characteristics | Cells with clear squamous characteristics |
| Tumor location | It can occur in any part of the lung, most often in the peripheral parts | Often in the outer parts of the lungs | Often in the airways |
| Relative popularity | Less common than other types | The most common | Common among smokers |
Living with large cell lung cancer
Living with large cell lung cancer requires dealing with the physical and psychological aspects of the disease, along with adherence to the treatment plan and regular medical follow-up. Understanding the nature of the disease and communicating with the medical team are key factors that help patients adapt to changes in their daily lives.
Psychosocial support plays an important role in improving quality of life, whether through family and friends or by taking advantage of specialized support programs. Medical sources have shown that emotional support helps patients deal with the anxiety and stress associated with the disease and treatment, and promotes a sense of resilience.
It is also recommended to pay attention to lifestyle as much as possible, including balanced nutrition and physical activity appropriate to the state of health, as this can contribute to reducing fatigue and improving overall well-being during the different stages of the disease, and reporting symptoms or side effects of treatment to the doctor in a timely manner is an essential part of safe living with the disease.
In general, living with large cell lung cancer depends on a balance of medical treatment, psychosocial support, and working together with the health team to maintain the best possible quality of life throughout the course of the disease.
In conclusion, large cell lung cancer is a type of lung cancer that requires a thorough understanding of its nature, symptoms, diagnosis, and treatment, and knowledge of these aspects helps raise awareness of the disease and pay attention to symptoms that may require early medical evaluation. Timely diagnosis, adherence to the treatment plan, regular medical follow-up, as well as psychosocial support, are all essential elements in dealing with the disease and improving the quality of life, and continuous communication with the medical team remains a pivotal step to make appropriate decisions at every stage of the disease.
Sources:
- Lung Cancer Foundation of America. (n.d.). Large cell carcinomas.
- Healthline Editorial Team. (n.d.). Large cell carcinoma.
- Tampa General Hospital. (n.d.). Large cell carcinoma.