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pulmonary metastases

Epidemiology: 1) 30% of non-pulmonary cancers metastasize to the lung 2) occurrence of pulmonary metastases a) choriocarcinoma (80%) b) osteosarcoma (10-75%) c) kidney cancer (25-70%) d) thyroid cancer (65%) e) melanoma (60%) f) breast cancer (55%) g) prostate cancer (45%) h) nasopharyngeal cancer (20%) i) gastrointestinal cancer (20%) j) gynecologic cancer (20%) k) soft tissue sarcoma (20%) Pathology: 1) 75% present as multiple lesions 2) solitary metastases a) colon cancer b) kidney cancer c) testicular cancer d) breast cancer e) melanoma f) sarcomas 3) hematogenous spread, lymphatic spread, direct infiltration or airway transcoelomic spread 4) lymphangitic spread a) adenocarcinomas - breast cancer - stomach cancer - thyroid cancer - pancreatic cancer - lung adenocarcinoma from another segment of lung b) melanoma c) lymphoma d) leukemia [2] 5) endobronchial metastases a) kidney cancer b) colon cancer c) Hodgkin's lymphoma d) breast cancer 6) diffuse disease Clinical manifestations: - multiple, peripheral or subpleural pulmonary nodules - less commonly, solitary pulmonary nodule [2] Management: - ablation of pulmonary metastases [5,6] - radiofrequency ablation - microwave ablation - interstitial laser ablation - irreversible electroporation - cryoablation (cryotherapy) - seems feasible, safe & reasonably effective [4] - triple-freeze protocol - tumor is frozen for 3 minutes, thawed for 6 minutes, frozen for 10 minutes, followed by a 13-minute thaw period, & finally frozen for 20 minutes - appears to be an interventional radiology procedure using bronchoscopy & presumably liquid nitrogen [4] - tumors > 3 cm with 21 month recurrence rate of 13.6%, compared with 4.7% for the smaller lesions [4] - all procedures associated with advantages & disadvantages - cryoablation associated with less risk of pneumothorax, but higher risk of bleeding than other procedures [5,6]

Related

breast cancer choriocarcinoma lung cancer malignant kidney neoplasm (kidney cancer) melanoma metastatic cancer of unknown primary osteosarcoma (osteogenic sarcoma) prostate cancer thyroid carcinoma

Specific

secondary lung cancer

General

metastasis

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 766-69
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  3. Aquino SL Imaging of metastatic disease to the thorax. Radiol Clin North Am. 2005 May;43(3):481-95 PMID: 15847812
  4. Turkel F. Freezing Metastatic Lung Tumors Feasible. Provides low morbidity alternative MedPage Today. Dec 02, 2017 https://www.medpagetoday.com/meetingcoverage/rsna/69617 - Aoun H, et al Lung cryoablation of primary lung tumors for high efficacy with low morbidity, Radiological Society of North America (RSNA) 2017
  5. Pal S Ablation Tx: Eradicating Lung Cancer Mets 'Ablation is often safer for patients that have lesions in the no-fly zones' MedPage Today. ASCO Reading Room 03.16.2018 https://www.medpagetoday.com/reading-room/asco/lung-cancer/71799 - Pal S Colon-Lung Metastasis: Good Outcomes in the Right Patients Appropriate selection can substantially influence survival. MedPage Today. ASCO Reading Room 01.13.2017 https://www.medpagetoday.com/reading-room/asco/lung-cancer/62485
  6. Qi H, Fan W. Value of ablation therapy in the treatment of lung metastases. Thoracic Cancer. Nov 29, 2017 9(2):199-207 PMID: 29193688 Free PMC Article https://onlinelibrary.wiley.com/doi/full/10.1111/1759-7714.12567