What Is It?

Large-cell carcinoma is a type of non-small-cell lung cancer that represents 10 percent to 20 percent of all tumors that originate 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 referred to as 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 adjoining structures, 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.

Although some cancers initially have no symptoms, 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

Large-cell carcinoma often is discovered on a chest X-ray, on which 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 centrally located. It isn’t as accurate for detecting small, peripheral tumors. Cancer cells also can be found in fluid between the lung and the chest wall (requiring a thoracentesis procedure using a needle to remove pleural fluid) or in lymph nodes next to the lung (requiring a mediastinoscopy surgical procedure).

Another diagnostic technique is by a needle biopsy or fine-needle aspiration using the guidance of a CT scan. In this procedure, fluid or tissue is removed (aspirated) from lymph nodes, a lung mass or from an area in the bone marrow or other organ where the tumor may have spread. Cells also can be removed during bronchoscopy, in which a 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 (thoracotomy) is performed 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.

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 recur.

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

Surgery is the primary treatment for large-cell carcinoma that is localized. The five-year survival rate after surgery is approximately 47 percent for those with stage I disease. For those with more advanced, stage III disease, the five-year survival rate is approximately 8 percent. For small, localized tumors, it might be possible to remove only a small section of the lung. More extensive carcinoma might require removing one lobe of the lung or the entire lung. Radiation therapy and chemotherapy (the use of strong medications) may be combined with surgery to help prevent cancer recurrence.

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 tumor types. Studies of new drugs may offer improved survival rates.

If you experience any of the symptoms listed above, make an appointment to see your health-care provider as soon as possible.

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 percent. The survival rate is higher (closer to 50 percent) when cancers are detected and treated early.

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

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.