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Metastatic disease

Definition
  • A process where cancer cells spread from the primary site of origin to distant sites in the body, involving the respiratory system.
Pathophysiology
  • Haematogenous Spread: Via the bloodstream to other parts of the body.
  • Lymphatic Spread: Through the lymph system, especially to mediastinal nodes.
  • Direct Invasion: Adjacent tissues or organs are invaded by the cancer.
Common Primary Cancers Leading to Lung Metastasis
  • Renal cell carcinoma.
  • Colorectal cancer.
  • Breast cancer.
  • Testicular cancer.
  • Osteosarcoma.
Clinical Features
  • Asymptomatic (often detected on imaging).
  • Cough.
  • Dyspnoea.
  • Chest pain.
  • Haemoptysis.
Investigations
  • Chest X-ray: Multiple round nodules are typical.
  • CT scan of the thorax: Better definition of lesions.
  • PET scan: Delineate active metabolic areas, suggesting malignancy.
  • Biopsy: Confirm diagnosis and identify primary tumour if unknown.
Management
  • Systemic therapy: Chemotherapy or targeted therapy based on the primary cancer.
  • Radiation: Palliation or directed therapy for limited metastases.
  • Surgery: Metastasectomy in selected cases with isolated lung metastases.
  • Palliative care: Symptom management and improving quality of life.
Prognosis
  • Depends on the primary cancer type, number, and location of metastases, and overall health of the patient.
  • Generally poorer than localised disease, but some isolated metastases can be curatively treated.
Complications
  • Respiratory failure.
  • Superior vena cava syndrome.
  • Pleural effusion.
  • Pneumothorax.
  • Infection within necrotic metastatic nodules.
Prevention
  • Regular monitoring and follow-up for patients with known malignancies.
  • Early detection and treatment of primary tumours.

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