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Chapter: Medicine and surgery: Respiratory system

Secondary lung tumours - Respiratory oncology

Metastases to the lung are very common due to haematogenous spread. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Secondary lung tumours

 

Definition

 

Metastases to the lung are very common due to haematogenous spread.

Aetiology

 

The site of primary is usually the kidney, prostate, breast, bone, gastrointestinal tract, cervix or ovary.

 

Pathophysiology

 

Secondary tumours nearly always develop in the lung parenchyma where they cause little or no symptoms. Carcinoma, particularly of the stomach, pancreas or breast can spread via the pulmonary lymphatic vessels causing a syndrome of lymphangitis carcinomatosa.

 

Clinical features

 

Usually asymptomatic, it is usually found as part of the screening of a patient with known malignancy. Rarely cause chest pain, haemoptysis or breathlessness (the last suggests lymphangitis carcinomatosa).

Investigations

 

Identification is by chest X-ray usually appearing as round shadow(s) 1.5–3 cm in diameter. CT scan shows up smaller metastases in most cases. Renal tumour metastases may present as a solitary round shadow. In lymphangitis carcinomatosa there is characteristically bilateral lymphadenopathy with dilated intrapulmonary lymphatic vessels appearing as streaky shadowing over both lung fields emanating from the hilar regions.

 

Management

 

Truly single metastases can be removed surgically, but this is uncommon.

 

Prognosis

 

Lymphangitis carcinomatosa is rapidly fatal.

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Medicine and surgery: Respiratory system : Secondary lung tumours - Respiratory oncology |


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