LUNG METASTASIS
Lung is a common site for metastasis from malignancies from other
organs.
- Lung is a capillary
bed and the entire cardiac output passes through
it, thus it is no surprise tumors get trapped in lungs.
- Various patterns of
metastasis should be recognized. Common patterns are
- Solitary
- Cannon balls
- Lymphangitic
- Pleural effusions
Clinical Presentation
Mode of clinical presentation varies depending on the pattern of
metastasis.
- Asymptomatic, detected on
routine CXR.
- Cough, hemoptysis,
pneumonia, wheezing with endobronchial mets.
- Shortness of breath, cough
with lymphatic spread.
- Pleuritic pain, cough and
shortness of breath with pleural effusions.
Diagnosis
Again depends on the metastatic pattern.
- FNAB for solitary or
multiple lung mets.
- Sputum cytology and
bronchoscopy for endobronchial mets.
- Pleural fluid cytology for
effusions.
- Tranbronchial lung biopsy
for lymphatic spread.
Treatment
Very important treatment issues revolve around the presence and pattern
of metastasis.
- Lung metastasis most often
would preclude a surgical curative resection of the primary.
- Surgical resection of a solitary lung
metastasis along with resection of the primary can accomplish cure in
certain tumors.
- Brachytherapy therapy may be useful to
relieve symptoms with endobronchial mets.
- Pleural sclerosis is necessary in
pleural effusions.
- Certain chemotherapeutic
agents can sequester in effusions.
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