Large cell lung cancer: what it is, symptoms, tests and treatment in the UK

Lung cancer is not one disease. Cancer Research UK explains that the type of lung cancer you have tells you the type of cell the cancer started in, and that knowing this helps doctors decide which treatment you need. Primary lung cancers are divided into two main groups: small cell lung cancer and non small cell lung cancer, with the non small cell group being the more common.

Within non small cell lung cancer, Cancer Research UK describes two main types, squamous cell cancer and non squamous cell cancer. Large cell carcinoma sits in the non squamous group, alongside adenocarcinoma, which is described as the most common type. Cancer Research UK says the cells of a large cell carcinoma appear larger than a typical cell under the microscope. That is essentially a description of what the pathologist sees rather than of a particular cause or behaviour.

Cancer Research UK also notes that when cancer cells look very undeveloped under the microscope, a doctor may not be able to tell what type of cancer it is, and further tests on the sample can be done to get more information. This is one reason a diagnosis can involve several stages: the label on a pathology report may be refined as extra laboratory tests come back.

The NHS does not list separate symptoms for each lung cancer type. The symptoms it describes apply to lung cancer generally, and many of them are common and can be caused by other conditions. Having them does not definitely mean you have lung cancer, but the NHS stresses that they are worth getting checked, because if the cause is cancer, finding it early may make it easier to treat.

• A cough that is not going away

• Shortness of breath

• Coughing up blood

• Chest or shoulder pain

• Often having chest infections, or a chest infection that is not getting better

• Losing weight without trying, and not feeling hungry

• Feeling tired all the time

• Less commonly: swelling of the face or neck, difficulty swallowing, a hoarse voice that does not go away, and finger clubbing (fingertips that look wider than usual or curve downwards)

The NHS advises seeing a GP if you have had a cough for longer than 3 weeks or have any other symptom of lung cancer. It advises asking for an urgent GP appointment or getting help from NHS 111 if you have coughed up blood or noticed blood on a tissue you have coughed into.

The NHS says to call 999 or go to A&E if you are struggling to breathe, meaning you are choking, gasping and unable to speak, or if you have pain in your chest or upper back. Do not drive yourself to A&E.

At a GP appointment the NHS says the doctor will ask about your symptoms, general health, medical history and whether anyone in your family has had lung cancer. They may listen to your chest and may ask for a blood test or a chest X-ray. If they think your symptoms could be cancer you may get an urgent referral to a specialist, which the NHS is clear does not definitely mean you have cancer.

The NHS says it is not always known what causes lung cancer, but it can be caused by lifestyle, genetic changes and environmental factors, and having certain health conditions can make you more likely to get it. The risk factors it lists are not specific to large cell cancer, so the same list applies whichever type of lung cancer is found.

• Smoking

• Having often breathed in other people's smoke over a long period (passive smoking)

• Chronic obstructive pulmonary disease (COPD)

• A close relative who has had lung cancer

• Working, or having worked, in the building industry and breathing in asbestos fibres over a long period

• Long-term exposure to air pollution

• Long-term exposure to radon, a natural gas found at high levels inside buildings in some areas of the UK

If a GP refers you to a specialist because they think you could have lung cancer, the NHS says the main tests are a CT scan and a bronchoscopy, in which a thin, flexible tube with a small camera on the end is passed down your throat and into your lungs so the doctor can look inside. You may get some results on the same day, or after a few days or weeks.

If lung cancer is found, the NHS says you may need more tests, which can include an MRI scan, a PET scan, a biopsy, blood tests and genetic testing. Together these show what type of cancer you have, how far it has spread and whether it has been caused by certain changes in your genes. That information is what separates a large cell carcinoma from adenocarcinoma, squamous cell cancer or small cell cancer, and it directly shapes the treatment options.

The NHS says you will be supported through diagnosis and treatment by a team of specialists that includes a clinical nurse specialist, who will be your main point of contact during and after your treatment and can answer questions.

The NHS says the treatment you have for lung cancer depends on the size of the cancer and where it is, the type of lung cancer, whether it has spread to other parts of the body, whether it has certain genetic changes, your general health and which options you decide are right for you. You may be offered a combination of treatments.

The NHS is open about the fact that advanced lung cancer may be hard to treat and not possible to cure. In that situation it says the aim of treatment is to slow the growth and spread of the cancer, help with symptoms and help you live longer. You will be referred to a symptom control or palliative care team, who help manage symptoms and make you feel more comfortable and can help you and your loved ones get other support.

Hearing this can be very hard news. The NHS signposts Macmillan Cancer Support, which has a free helpline, and the Roy Castle Lung Cancer Foundation and Marie Curie as sources of support.

Suspected lung cancer is normally investigated through the NHS urgent referral route described above, with imaging, bronchoscopy and biopsy arranged by the hospital team. Some people also use private care to have scans or consultations, and this can sit alongside NHS care. Whichever route you use, the specialist team that confirms the cell type and stage, usually through a multidisciplinary meeting, is what guides treatment, so it is sensible to ask for copies of your pathology and scan reports.

The NHS suggests that to lower your risk of lung cancer you should quit smoking, stay active and exercise regularly and eat a healthy diet that includes at least 5 portions of fruit and vegetables a day. It also repeats that it is important to get any symptoms of lung cancer checked by a GP.