Large Cell Lung Cancer Metastatic

Large cell lung cancer metastatic is a rare and aggressive form of lung cancer that has spread beyond the lungs to other parts of the body. While challenging to treat, advances in therapy have improved outcomes for many patients.

Table of contents

• What Is Large Cell Lung Cancer?
• Understanding Metastatic Cancer
• Where Large Cell Lung Cancer Spreads
• Stages of Large Cell Lung Cancer
• Signs and Symptoms
• How It Is Diagnosed
• Treatment Approaches
• Outlook and Survival
• Living With Metastatic Large Cell Lung Cancer

What Is Large Cell Lung Cancer?

Large cell lung cancer, also known as large cell carcinoma, is one of the rarest types of lung cancer. It accounts for about 1 in 10 cases of all lung cancers, making it the least common type among the major forms of the disease.^[1] This cancer belongs to a broader category called non-small cell lung cancer (NSCLC), which is different from small cell lung cancer.^[1]

There are two main types of lung cancer: small cell lung cancer and non-small cell lung cancer. Non-small cell lung cancer is further divided into three types. The first is adenocarcinoma, in which the cancer begins in glandular cells on the outer part of the lungs. The second is squamous cell carcinoma, in which the cancer begins in the thin, flat cells that line the airways. The third is large cell carcinoma, which begins in the cells that make up the outer lining of the lungs.^[1]

Under a microscope, the difference between small cell and non-small cell lung cancer is their size. Small cell lung cancer cells appear small and round, while non-small cell lung cancer cells appear larger. Small cell lung cancer tends to be more aggressive and more difficult to treat than non-small cell lung cancer.^[1]

Understanding Metastatic Cancer

Metastatic lung cancer means that the cancer has spread from where it started in the lung to other parts of the body. It is also called advanced or secondary cancer.^[2] A cancer might be advanced when it is first diagnosed, or it may come back some time after you were first treated. This is called recurrent cancer.^[2]

When large cell lung cancer reaches stage IV, it has spread, or metastasized, to other areas beyond the lungs.^[1] This is different from locally advanced lung cancer, which is cancer that has spread into tissues around the lungs and might have spread into nearby lymph nodes.^[2]

Unfortunately, advanced cancer cannot usually be cured. But treatment might control it, help symptoms, and improve your quality of life for some time.^[2] Thanks to advances in treatment, patients with metastatic lung cancer are living longer than they did 10 years ago.^[7]

Where Large Cell Lung Cancer Spreads

Not all lung cancers will spread. But if the cancer does spread, there are certain parts of the body that it is more likely to go to. The most common areas for lung cancer to spread to are nearby lymph nodes or a single distant lymph node, the brain, bones, the liver, the adrenal glands, and other parts of the lung or the other lung.^[2]

In one reported case, metastatic large cell carcinoma of the lung caused acute small bowel obstruction, which is a rare presentation of the disease.^[5] Metastasis of primary lung cancer to the gastrointestinal tract is rare, with a reported rate of 0.2% to 1.7%.^[5]

Stages of Large Cell Lung Cancer

Large cell lung cancer is staged based on the size of the tumor, how far it has spread, and whether it has reached lymph nodes or other organs. The stages are as follows:^[1]

• Stage 0: The cancer is found only in the top lining of the lung and has not spread outside the lung
• Stage I (IA and IB): The cancer has not spread to the lymph nodes or other parts of the body. The difference between each sub-stage is based on the size of the tumor and whether it has spread to the lung lining
• Stage II (IIA and IIB): The cancer is larger than Stage I and has begun to spread to nearby lymph nodes or tissues, but not to distant organs. The difference between each sub-stage is based on the size of the tumor, its location, and whether it has spread to the lymph nodes or not
• Stage III (IIIA, IIIB, and IIIC): The cancer may be difficult to remove via surgery. The difference between each sub-stage is based on the size of the tumor, its location, and how much it has spread
• Stage IV: The cancer has spread (metastasized) to other parts of the body^[1]

Stage IV cancer has spread to the other lung, the fluid around the lung, the fluid around the heart, or distant organs.^[3]

Signs and Symptoms

The lungs do not have pain receptors. For this reason, many people have no symptoms when lung cancer is limited to the lungs. As a result, many lung cancer patients are diagnosed after the disease has metastasized, or spread to another area of the body.^[7]

Lung cancer typically does not cause symptoms early on. Symptoms of lung cancer usually happen when the disease is advanced. Signs and symptoms of lung cancer that happen in and around the lungs may include a new cough that does not go away, chest pain, coughing up blood (even a small amount), hoarseness, shortness of breath, and wheezing.^[6]

Symptoms of metastatic lung cancer depend on where the disease has spread. For instance, bone pain (such as hip pain) is common if lung cancer spreads to the bones. When cancer spreads to the brain, symptoms might include vision changes, headaches, dizziness, or weakness in an arm or leg. The lymph nodes, such as those in the neck, may also be swollen when lung cancer metastasizes.^[7]

Signs and symptoms that happen when lung cancer spreads to other parts of the body may include bone pain, headache, losing weight without trying, loss of appetite, and swelling in the face or neck.^[6]

How It Is Diagnosed

A diagnosis of large cell carcinoma is usually made after a biopsy of the lung tissue. A biopsy is a procedure in which tissue samples are removed from the body so that they can be viewed under a microscope by a pathologist to check for cancer cells. The pathologist will look at the tissue under a microscope and check for cancer cells. The pathologist will also check for certain features that are typical of large cell carcinoma.^[1]

The following tests may be used to diagnose lung metastases. A chest x-ray is usually the first test done to try to find out what is causing symptoms like a cough and shortness of breath. Doctors use a chest x-ray to look for any lung tumors. A CT scan (computed tomography scan) of the chest is a common test used to check for lung metastases and provides more detailed information.^[4]

Blood tests are usually done to check your general health and find out how some organs are working. These tests may find out if cancer has spread to organs other than the lungs. A complete blood count (CBC) is done to check your general health and how well the bone marrow is working. Other tests may measure sodium, potassium, and other substances to check for problems with the kidneys or liver.^[4]

Additional imaging tests that may be performed include abdominal CT scans to check for spread to the liver or other abdominal organs, and other specialized tests depending on symptoms.^[4]

Treatment Approaches

Treatments for metastatic lung cancer have advanced dramatically in recent decades. There are new targeted drugs and immunotherapies, improved radiation technologies, and less invasive surgeries.^[7]

Treatments such as chemotherapy, radiotherapy, or targeted cancer drugs can help to shrink the cancer, reduce symptoms, and help you feel better.^[15] For large cell lung cancer, multivariate analysis revealed that age, gender, marital status, laterality, tumor size, stage, chemotherapy, and surgery were independent factors affecting overall survival. The prognosis after surgery combined with chemotherapy was better than that after surgery alone.^[12]

Cancer experts have discovered that certain metastatic cancers, known as oligometastatic cancers, can be controlled for longer periods of time with more aggressive treatment approaches. In rare cases, these cancers can be cured. Oligometastatic means the cancer has spread to a limited number of sites. Treatment for oligometastatic lung cancer includes targeted radiation and/or surgery in addition to drug therapies.^[7]

Many people want to know what the outlook is and how their cancer will develop. This is different for each person. Your doctor is the best person to discuss this with you because they have all the information about your cancer.^[2]

Outlook and Survival

In total, 4,099 patients diagnosed with large cell lung cancer were included in one large database study. The data showed that 70.2% of patients were older than 60, and more male patients were found. Additionally, 60.2% of lesions were found in the upper lobe of the lung. Moreover, most patients showed poor differentiation and presented with stage III or IV disease.^[12]

The average life expectancy for large cell lung cancer is 35 months or around 3 years, with some patients becoming long-term survivors.^[13] Patients with metastatic lung cancer, both non-small and small cell lung cancers, are living longer than they did 10 years ago.^[7]

Many factors can affect survival, including the stage of cancer when diagnosed, age, overall health, and response to treatment. Your healthcare team can provide personalized information about your specific situation.^[2]

Living With Metastatic Large Cell Lung Cancer

Finding out that you cannot be cured is distressing and can be a shock. It is common to feel uncertain and anxious. It is normal to not be able to think about anything else.^[2] Everyone is different and there is no right way to feel.^[2]

There is no special diet that treats lung cancer, but eating well can help you feel your best. Focus on vegetables, fruits, lean proteins, and whole grains. Stay away from processed foods or choices that are high in sugar or fat. Drinking plenty of water, broth, or other healthy fluids can help make the side effects from your treatment less severe.^[18]

Physical activity, even light movement, can boost your mood, help you feel less tired, strengthen your heart and muscles, and lower your chance of secondary cancers. Talk to your doctor about how you can get moving safely.^[18]

You do not have to go through this alone. Talk to friends, family, or a therapist about what you are going through. Ask for help with chores, errands, and meals. Bring a loved one with you to appointments. There are also support groups online or in person that can connect you to others dealing with lung cancer.^[18]

Healthcare teams place great emphasis on helping to ensure patients have the quality of life that they desire during and after treatment. A wide range of treatments and supportive services are available to help prevent or relieve pain, breathing difficulties, and other symptoms.^[7]

Palliative care does not mean end-of-life care. Your team can help get you the resources and support you need to ease the physical and emotional symptoms you feel. They can also help you better understand your condition and treatments.^[18]