# Large cell neuroendocrine carcinoma of the lung

Source: https://onco.cc/cancers/lung-lcnec/  
OnCo record `lung-lcnec` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Large cell neuroendocrine carcinoma is a lung cancer that looks like a large-cell tumour under the microscope but has the neuroendocrine markers and the fast, aggressive behaviour of small-cell lung cancer. It sits between the two halves of the usual split, which is why teams disagree about whether to treat it as one or the other.

## Summary

What it is. The fifth edition of the World Health Organization classification of thoracic tumours (2021) places large cell neuroendocrine carcinoma in the lung neuroendocrine neoplasm chapter, alongside typical carcinoid, atypical carcinoid and small cell carcinoma, rather than among the non-small-cell types it resembles by size and architecture (Nicholson 2022). The diagnosis needs both a neuroendocrine morphology, organoid nesting, rosettes or a trabecular pattern with a high mitotic count and necrosis, and confirmation of neuroendocrine differentiation by immunohistochemistry, which is why it is rarely diagnosed confidently on a small biopsy.

Where it sits in the family. It belongs to neither side of the clinical split that organises every other page in this family. The IASLC's ninth-edition staging work analysed pulmonary neuroendocrine carcinoma as its own group within the lung database, and clinical practice has run it both ways, as a non-small-cell cancer eligible for resection and adjuvant chemotherapy and as a small-cell cancer given platinum and etoposide. On this site it is a child of the lung cancer family page rather than of non-small-cell or small-cell lung cancer; the reasoning is set out in the taxonomy section of docs/CANCER-PAGES.md.

How it is treated. No randomised trial has settled it and this record does not claim one. Localised disease is resected where it can be, as for other non-small-cell tumours of the same stage, and advanced disease is generally given a platinum doublet, with the choice between the small-cell and the non-small-cell backbone decided case by case. The parent record carries the staging, the diagnostic pathway and the screening and prevention material that apply here unchanged.

What it is not. It is not large cell carcinoma, which by the 2021 definition is an undifferentiated tumour with no glandular, squamous or neuroendocrine features and is a diagnosis of exclusion made on a resection specimen. It is not small cell carcinoma, whose cells are small with scant cytoplasm and finely granular chromatin. It is not a carcinoid: typical and atypical carcinoids are low and intermediate-grade tumours with a very different course, and sit under the neuroendocrine family page in this corpus.

## Fields

- Kind: Cancer
- Last checked: 2026-09-25
- Also known as: Pulmonary large cell neuroendocrine carcinoma; LCNEC; Large-cell neuroendocrine carcinoma; Large cell neuroendocrine carcinoma (a WHO 2021 lung neuroendocrine carcinoma, between small-cell and non-small-cell disease); High-grade pulmonary neuroendocrine carcinoma, non-small-cell type
- Tags: lung; subtype-page
- Group: lung
- Burden: Rare, and counted differently depending on which classification a registry uses. GLOBOCAN does not report it, and registry series that separate the four main histological types put large cell carcinoma as a whole at 6.5 percent of lung cancers in both men and women worldwide (101,861 cases in men and 59,271 in women in 2022, Lancet Respiratory Medicine 2025); large cell neuroendocrine carcinoma is a subset of that group, so no separate incidence figure can be quoted from the sources read here.
- Subtypes: Pure large cell neuroendocrine carcinoma of the lung; Combined large cell neuroendocrine carcinoma (with an adenocarcinoma, squamous or small-cell component)
- Biomarkers: Neuroendocrine morphology with a high mitotic count and necrosis, recorded in the pathology report; Neuroendocrine differentiation confirmed by immunohistochemistry; TTF-1 and p40 to exclude adenocarcinoma and squamous cell carcinoma

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/lung-lcnec/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/lung-lcnec/#overview
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/lung-lcnec/#what-it-is [2 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/lung-lcnec/#finding-it [3 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/lung-lcnec/#treating-it [2 settings]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/lung-lcnec/#evidence
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/lung-lcnec/#science
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/lung-lcnec/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/lung-lcnec/#living-with-it [8 questions]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/lung-lcnec/coming/
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/lung-lcnec/data/ [9 connected records]

## Standard of care

- Localised disease: Resection where the tumour is resectable, staged by TNM 9 as for any other lung cancer, with adjuvant chemotherapy decided case by case; no randomised trial establishes the regimen, and teams differ over whether to use the small-cell or the non-small-cell backbone. ([Resectability in lung cancer](https://onco.cc/terms/resectability-lung-cancer/), [TNM 9: what changed in lung cancer staging](https://onco.cc/terms/tnm-9-lung-cancer/))
- Advanced disease: A platinum doublet, with the choice between the small-cell and the non-small-cell backbone made case by case; the parent and the small-cell page carry the regimens. ([Small-cell lung cancer](https://onco.cc/cancers/sclc/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/))

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Large-cell_lung_carcinoma
- Nicholson, J Thorac Oncol 2022: the 2021 WHO classification of lung tumours, impact of advances since 2015: https://doi.org/10.1016/j.jtho.2021.11.003
- Lancet Respir Med 2025: estimated worldwide variation and trends in incidence of lung cancer by histological subtype in 2022 and over time (GLOBOCAN 2022 with Cancer Incidence in Five Continents): https://doi.org/10.1016/s2213-2600(24)00428-4
- J Thorac Oncol 2023: IASLC lung cancer staging project, the new database to inform revisions in the ninth edition of the TNM classification: https://doi.org/10.1016/j.jtho.2023.01.088
- NICE NG122: lung cancer, diagnosis and staging (published 28 March 2019, last updated 8 March 2024): https://www.nice.org.uk/guidance/ng122/chapter/Diagnosis-and-staging

## Connected records

- cancers: [Large cell carcinoma of the lung](https://onco.cc/cancers/large-cell-lung-carcinoma/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Lung neuroendocrine tumours (typical and atypical carcinoid)](https://onco.cc/cancers/lung-net/), [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Small-cell lung cancer](https://onco.cc/cancers/sclc/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [PET (positron emission tomography)](https://onco.cc/technologies/pet/)
- terms: [Endobronchial ultrasound (EBUS-TBNA)](https://onco.cc/terms/ebus-tbna/), [Mediastinal lymph node stations](https://onco.cc/terms/mediastinal-lymph-node-stations/), [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/), [Resectability in lung cancer](https://onco.cc/terms/resectability-lung-cancer/), [TNM 9: what changed in lung cancer staging](https://onco.cc/terms/tnm-9-lung-cancer/), [TTF-1 and p40 (how lung histology is decided)](https://onco.cc/terms/ttf1-p40/)

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JSON: https://onco.cc/api/v1/entities/lung-lcnec.json