Large-Cell Lung Carcinoma (LCLC), or Large-Cell Carcinoma (LCC) in short, is a heterogeneous group of undifferentiated malignant neoplasms that lack the cytology and architectural features of small cell carcinoma and glandular or squamous differentiation. LCC is categorized as a type of NSCLC (

non-small-cell lung carcinoma Non-small-cell lung cancer (NSCLC), or non-small-cell lung carcinoma, is any type of epithelial lung cancer other than small-cell lung cancer (SCLC). NSCLC accounts for about 85% of all lung cancers. As a class, NSCLCs are relatively insensitiv ...

) that originates from the epithelial cells of the lung. LCLC is histologically characterized by the presence of large, undifferentiated cells that lack distinctive features of either squamous cell carcinoma or adenocarcinoma (other types of cancers). Typically seen in LCLC, tumor cells have abundant pale-staining cytoplasm and prominent nucleoli.

Presentation

The clinical presentation of LCLC is nonspecific and can include symptoms such as: #Persistent cough #Shortness of breath/pain with breathing #Chest pain #Unintentional weight loss #General fatigue #Coughing up blood (hemoptysis) #Frequent upper respiratory infections (URIs) #Difficulty swallowing #Hoarseness

Diagnosis

LCC is, in effect, a "diagnosis of exclusion", in that the tumor cells lack light microscopic characteristics that would classify the neoplasm as a small-cell carcinoma, squamous-cell carcinoma, adenocarcinoma, or other more specific histologic type of lung cancer. Tools used for diagnosis: Imaging Studies: Chest X-rays, CT scans, PET, or PET-CT scans are the most commonly used imaging modalities to help identify the size, location, and extent of the tumor. Biopsy: Done by obtaining a piece of tissue from the tumor, classically done through bronchoscopy or CT guided needle biopsy, to study the histology of the tissue and confirm diagnosis.

Classification

The newest revisions of the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

(WHO) "Histological Typing of Lung Cancer schema" include several variants of LCC, including: * large cell neuroendocrine carcinoma * basaloid carcinoma * lymphoepithelioma-like carcinoma * clear cell carcinoma * large cell carcinoma with rhabdoid phenotype.

Large-cell neuroendocrine carcinoma (LCNEC)

One clinically significant subtype is "large-cell neuroendocrine carcinoma" (LCNEC), which is believed to derive from

neuroendocrine Neuroendocrine cells are cells that receive neuronal input (through neurotransmitters released by nerve cells or neurosecretory cells) and, as a consequence of this input, release messenger molecules ( hormones) into the blood. In this way they b ...

cells. In addition, a "subvariant", called "combined large-cell neuroendocrine carcinoma" (or c-LCNEC), is recognized under the new system. To be designated a c-LCNEC, the tumor must contain at least 10% LCNEC cells, in combination with at least 10% of other forms of NSCLC.

Pathology images

File:Large cell carcinoma of the lung.jpg File:Large cell carcinoma of the lung .jpg

Incidence

In most series, LCLC's comprise between 3%-9% of all primary

lung cancer Lung cancer, also known as lung carcinoma, is a malignant tumor that begins in the lung. Lung cancer is caused by genetic damage to the DNA of cells in the airways, often caused by cigarette smoking or inhaling damaging chemicals. Damaged ...

s. According to the

Nurses' Health Study The Nurses Health Study is a series of prospective studies that examine epidemiology and the long-term effects of nutrition, hormones, environment, and nurses' work-life on health and disease development. The studies have been among the largest i ...

, the risk of large cell lung carcinoma increases with a previous history of

tobacco smoking Tobacco smoking is the practice of burning tobacco and ingesting the resulting smoke. The smoke may be inhaled, as is done with cigarettes, or released from the mouth, as is generally done with pipes and cigars. The practice is believed to hav ...

, with a previous smoking duration of 30 to 40 years giving a

relative risk The relative risk (RR) or risk ratio is the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group. Together with risk difference and odds ratio, relative risk measures the association bet ...

of approximately 2.3 compared to never-smokers, and a duration of more than 40 years giving a relative risk of approximately 3.6. Another study concluded that cigarette smoking is the predominant cause of large cell lung cancer. It estimated that the

odds ratio An odds ratio (OR) is a statistic that quantifies the strength of the association between two events, A and B. The odds ratio is defined as the ratio of the odds of event A taking place in the presence of B, and the odds of A in the absence of B ...

associated with smoking two or more packs/day for current smokers is 37.0 in men and 72.9 in women. Notable people with the condition include American comedian

Andy Kaufman Andrew Geoffrey Kaufman ( ; January 17, 1949 – May 16, 1984) was an American entertainer and performance artist. He has sometimes been called an "anti-humor, anti-comedian". He disdained telling jokes and engaging in comedy as it was tra ...

, who died from the disease in 1984.

Treatment options

Treatment often requires a multidisciplinary approach, which will vary based on factors such as the extent of the tumor and the condition and comorbidities of the patient. #Surgery: Surgical resection may be considered for local tumors. #Chemotherapy: Standard treatment of LCLC. Often use of platinum-based agents with other cytotoxic drugs are used to target the tumor. Due to overall prognosis chemotherapy often may offer increased chance to improve survival. #Targeted Therapy: A type of treatment that targets specific features of the cell to minimize damaging healthy cells and to reduce side effects of the treatment. #Immunotherapy: A form of treatment that boosts the body's natural immune defense system to apprehend the cancer cells.

References

External links

World Health Organization Histological Classification of Lung and Pleural Tumours. 4th Edition. {{Respiratory and intrathoracic neoplasia Lung cancer