Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 +++ Epidemiology + • 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 +++ Symptoms and Signs + • Most asymptomatic• Cough, hemoptysis, fever, dyspnea, and pain +++ Imaging Findings + • Chest film or CT scan identifies nodule(s) + • Pathologic diagnosis is essential + • 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 + • If complete resection not possible, resection should not be offered +++ Surgery + • 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 +++ Prognosis + • 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 +++ References ++Skubitz KM, DâAdamo DR: Sarcoma. Mayo Clin Proc 2007;82:1409. [PubMed: 17976362] Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.