The lungs are characterized by the presence of fairly large areas of tissue structures through which blood is continuously pumped. That is why this paired organ takes the second place in the distant metastasis after the liver.
When the cancer develops in the intestine and other organs, it will metastasize into the lung structures at 30-35%.
Pulmonary metastasis is a screening of primary malignancy, spreading through hematogenous and lymphogenous transfer. Such localization of metastases is life-threatening, since they are detected only at the final stages of the oncoprocess.
Reasons for
As it was already specified, pulmonary structures have an extensive network of capillaries. The lymphatic system, being an integral part of the vascular system and an active participant in the processes of organic microcirculation, carries lymph and performs drainage functions, which explains the lymphogenous origin of pulmonary metastases.
Most commonly in lung tissue metastasizes cancer:
- Urinary or renal;
- Esophagus;
- Gastrointestinal;
- Colorectal;
- Milky fat;
- Skin( melanoma).
Lung damage in renal cancer
Statistically, renal cancer most often metastasizes into the lungs( 50-60%).In some patients, secondary malignant foci are found during primary treatment, others develop after nephrectomy.
Usually pulmonary metastases in renal cancer look like ovoid or rounded nodes, clearly visualized by radiographic diagnosis or computerized tomography.
Clinically pulmonary metastasis is similar to the primary lesions of this organ, although in the case of metastases it can be asymptomatic for a long time.
Metastatic nodules are multiple and single, and their size is limited to 0.5-2 cm.
In case of breast cancer
In case of breast cancer, pulmonary metastasis can be detected already in the early stages of oncology. The spread of the tumor process to the lungs takes place by hematogenesis.
Metastases with a similar cancer are usually spherical, tuberous, solitary and lytic. They can intensively increase, but not lose their form.
Types of
Pulmonary metastases are divided into many different types:
- The diameter of the is small and large;
- By location of - two-sided and one-sided;
- By the number of - multiple, single( 2-3) and solitary( single);
- By the type of metastases - infiltrative and focal;
- By the features of the distribution of - mediastinal and disseminated.
In addition, pulmonary metastases vary by X-ray. They are:
- Pseudo-pneumatic - in the form of thin strands of dense fabric;
- Nodular - multiple and solitary metastases, which in the images look in the form of nodes with clear contours;
- Mixed - when multiple forms are combined;
- Pleural - on symptoms resembles exudative pleurisy, on the lungs there are tuberous outgrowths, in the pleura there may be an effusion.
Symptoms and signs of metastases in the lungs
Metastatic pulmonary lesions can develop for a long time in secret, so they are often detected already in advanced stages.
As for the specific symptomatology, it is as follows:
- Dyspnea;
- Throat intestinal pain;
- Hemoplegia;
- Cough;
- Lack of appetite;
- Subfebrile condition.
Minor hyperthermia may persist for a long time. Similar signs may indicate a primary pulmonary tumor.
They are explained not by the presence of a tumor, but by the development of the inflammatory process of the cell-to-cell localization. It happens that pulmonary metastases are detected earlier than the primary cancerous focus.
Cough
One of the first manifestations of pulmonary metastasis is a cough that occurs in 85-90% of cancer patients. But the metastatic cough is significantly different from the traditional one.
Initially, patients are worried about a dry, painful and hysterical cough, especially exhausting at night.
Then it passes into the wet one and is accompanied by the release of sputum purulent-mucous character, sometimes with bloody impurities.
Over time, the bronchial lumen narrows, the sputum structure becomes purulent. Sometimes in the bronchopulmonary discharge there are blood veins.
There may also be signs of bleeding in the lungs. If the metastases germinate into the pleural tissues, they press on the bronchi, which strengthens the cough and provokes severe pain, preventing sleep.
How the metastases in the lung tissue of
look. It is possible to determine pulmonary metastases by radiographic diagnosis.
- In the pictures secondary foci appear in the nodal, mixed and diffusely-lymphatic form. Nodal foci are multiple or solitary formations.
- Solitary are clearly defined rounded nodes, which are usually located in the basal structures. Solitary metastases are similar to primary foci.
- Usually pulmonary metastasis is manifested in the focal form, although there are also large-nodal variants. Metastatic tumors are often accompanied by lymphangitis, so the characteristic symptomatology begins to appear already in the early stages.
- If the metastatic formations are pseudo-pneumatic, the heavy pattern changes, on the X-ray, displayed as linear thin seals.
- Metastasis in the pleural zone resembles pleurisy. A radiographic image shows a massive effusion and knobby plate growths. As a result of oncological processes in the pleura, pulmonary insufficiency develops, subfebrile condition is constantly present, the general condition of the oncological patient worsens.
Diagnostics
Diagnostics is performed using laboratory and instrumental studies. The patient must carry out chest radiography and CT, which allows to determine the presence of small metastases.
Patients of childhood and people who have been repeatedly exposed to radiation studies are shown to perform magnetic resonance imaging. Such a study can reveal secondary tumors smaller than 0.3 mm.
Confirmation of the diagnosis is carried out with the help of a cytological analysis of effusion and sputum or histology of biomaterial obtained from a biopsy.
X-ray
X-ray examination helps to clarify the structure of tissues, to detect blackouts, etc. Usually in the course of the study, images of the organ and metastatic formations are taken in two projections - from the side and from the front.
The photo shows how the metastases in the lungs look on the x-ray image of
. On the X-ray, lung metastases look like coins with different-sized blackouts of different character( pleural, multiple, solitary, etc.).Appearance of these forms is described above.
How to treat secondary formations?
Treatment of secondary pulmonary oncochambers is identical to primary formations. Radiation, laser, hormonal and chemotherapeutic methods are used.
- Surgical interventions are justified only in cases of single metastasis and in the absence of metastatic lesions of other organs.
- In prostatic or breast cancer with pulmonary metastasis hormonal therapy is effective.
- The basis of treatment is often the chemotherapeutic effect of antitumor drugs.
- Radiotherapy is justified if there is reticulosarcoma, osteogenic sarcoma or Ewing, which are hypersensitive to radiation exposure.
In addition to the above methods, laser surgery and radiosurgery are used. If the large bronchi are compressed, then endobronchial brachytherapy is performed.
Video shows thoracoscopic removal of lung metastasis:
Prognosis and life expectancy of
patients Prognostic results are determined by a number of factors, such as the size and number of metastases, the degree and location of the primary focus, the timeliness of the treatment. Statistics indicate that pulmonary metastasis has disappointing predictions.
The average life expectancy even after the ectomy of primary cancers is about 5 years.