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  • • Pulmonary metastases occur via hematogenous spread from primary site; lymphatic and transbronchial spread are rare

    • Secondary metastatic spread to pulmonary and mediastinal lymph nodes may occur

    • Known extrathoracic primary cancers:

    • -Multiple pulmonary lesions: Metastatic disease

      -Solitary lesions: Benign disease, 20%; new primary lung cancer, 20%; metastatic disease, 60%

    • Solitary squamous cell nodules should be addressed as a new primary lung cancer

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Epidemiology

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  • • 30% of patients with malignancies develop pulmonary metastases

    • 12% of isolated lung disease is totally resectable

    • 10% of patients (1.2% of all patients) have solitary lung metastases

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Symptoms and Signs

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  • • Most asymptomatic

    • Cough, hemoptysis, fever, dyspnea, and pain

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Imaging Findings

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  • • Chest film or CT scan identifies nodule(s)

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  • • Pathologic diagnosis is essential

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  • • Chest x-ray

    • Chest CT to assess lungs for other nodules

    • CT scans detects 3 mm nodules, with false-positive rate of 55%

    • Pathologic diagnosis is essential: obtained at the time of resection, via fine-needle aspiration, or bronchoscopy

    • Thorough search for other sites of metastasis including bone scan, head CT, or MRI

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  • • If complete resection not possible, resection should not be offered

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Surgery

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  • • Wedge resection treatment of choice unless lesion is solitary squamous cell carcinoma or adenocarcinoma—treated as primary lung cancers with lobectomy and mediastinal lymph node dissection

    • Lobectomy or even pneumonectomy occasionally required if proximal pulmonary artery or bronchus involved

    • Primary tumor controlled or imminently controllable

    • No other sites of disease exist

    • No other therapy can offer comparable results

    • Low operative risk

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Prognosis

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  • • Best prognosis

    • -Testicular: 51% 5-year survival

      -Head-neck cancers: 47% 5-year

    • Osteogenic, sarcomas, renal cell, colon: 20-35%

    • Melanoma: 10-15% survival

    • Rectal cancer with isolated pulmonary metastasis: 55% 5-year

    • Poor prognosis:

    • -Multiple or bilateral lesions

      -> 4 lesions on CT

      -Tumor doubling time < 40 days

      -Short disease-free interval

      -Advanced age

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References

Skubitz KM, D’Adamo DR: Sarcoma. Mayo Clin Proc 2007;82:1409.  [PubMed: 17976362]

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