Background: Recent temporal trends in histology and stage of pulmonary tumors in the Netherlands were studied. The incidence of rare pulmonary tumors was determined. Methods: All tumors originating from trachea, bronchus, and lung recorded in the Netherlands Cancer Registry were included. Based on ICD-O morphology codes, five major subgroups were constructed: squamous carcinoma(SC), adenocarcinoma(AC), large-cell (undifferentiated) carcinoma(LC), small-cell lung cancer(SCLC), and other(including the uncommon tumors). Results: Between 1989-2003, 134,894 tumors were diagnosed. In males, the age-adjusted incidence of SC and SCLC decreased, AC remained stable and LC increased. In females, incidence of all subgroups increased. Since 1996, a stage shift was observed, with fewer patients in stage I, and more patients in stage IV at diagnosis. This stage shift occurred equally in SC, AC, and LC. In SC fewer patients presented with stage IV disease than in AC and LC (25% versus 44% and 49% in 2003, respectively). The incidence of adenosquamous carcinoma decreased (from 0.6 to 0.29/100,000;p<0.001). The incidences of carcinoid tumors, sarcomatoid carcinomas, and primary pulmonary sarcomas remained stable (0.44, 0.17, 0.08/100,000, respectively). Conclusion: The incidence of smoking-related tumors decreased in males (especially SC and SCLC) and increased in females (all subgroups). More patients presented with stage IV disease. The incidence of non-smoking-related, uncommon tumors remained constant.