Metastases in the lungs

In the tissues of the lungs, oxygen is introduced into the blood and carbon dioxide is released. Active blood supply creates excellent conditions for reproduction of microorganisms and tumor cells. The lungs are referred to the second place (some sources tend to the first) in terms of the number of lesions metastases (secondary tumors). Localization of primary malignancy affects the frequency and nature of metastasis. The share of an isolated metastatic process in lung tissue accounts for 6 to 30% of cases. The location of a number of cancer cells (with soft tissue sarcoma, kidney cancer, chorioepithelioma of the uterus) leads to the formation of distant mets in pulmonary tissues, and account for 60-70% of clinical practice.

[1], [2], [3], [4], [5]

Causes of the metastases in the lungs

Pulmonary tissues are provided with an extensive, branched capillary network. Being part of the vascular system and actively participating in the process of microcirculation, the lymphatic system ensures the transport of lymph (through the vessels, nodes and collectors to the venous system) and serves as a drainage system, which explains the causes of lung metastases. Lymph is the main channel for moving tumor cells and the origin of pathology. From the internal organs / tissues the outflow of lymph is due to capillaries passing into the lymphatic vessels, which in turn form the lymphatic collectors.

Lymphonoduses, as components of the immune system, have a leading role in the performance of protective and hematopoietic functions. Constantly circulating through the lymph nodes, lymph is enriched with lymphocytes. The nodes themselves are a barrier to any foreign body - particles of dead cells, any dust (household or tobacco), tumor cells.

[6], [7], [8]

Symptoms of the metastases in the lungs

Metastases in the lungs are detected in non-operated patients or after removal of the primary tumor focus. Often the formation of mets is the first sign of the disease. As a rule, the development of pulmonary metastases proceeds without significant symptomatology. Only a small percentage of patients (20%) note strong and painful manifestations: 

• persistent cough; 
• dyspnea; 
• cough with sputum or blood; 
• feeling of pain and stiffness of the chest; 
• body temperature increase up to 38 С; 
• weight loss.

The presence of dyspnea is due to the involvement of a large part of the lung tissue in the pathological process as a result of occlusion or compression of the bronchus lumen, which leads to a decrease in the segment / lobe of the lung tissue.

If the tumor covers the pleura, spine or ribs, then pain syndrome occurs.

This indicates a far-reaching process. In most cases, only by X-ray regular examination (after treatment of the primary cancer center) mets are identified at an early stage, when the maximum therapeutic effect is possible. In this regard, patients who have been treated with any malignant neoplasm should undergo a fluorography or X-ray examination of the thoracic region at least twice a year.

Cough with metastases in the lungs

Like cases of the primary tumor process, cough with lung metastases is the very first sign of a pathology and in clinical practice occurs in 80-90% of cases.

Despite the fact that cough is an inalienable companion of all bronchopulmonary diseases, when metastasizing into lung tissue its character has a number of characteristics.

Initially, patients suffer from a dry, hysterical, painful cough. Attacks are frequent, as a rule, at night. Further, the cough is transformed into a moist, with a mucus-purulent sputum, which is odorless. In the separated, there may be an admixture of blood veins. As the narrowing of the lumen of the bronchial tubes, sputum becomes purulent. There are signs of pulmonary hemorrhage.

At first, dyspnea worries during physical efforts, but soon becomes a companion of everyday activities (for example, when walking on a ladder).

Metastases in the lungs can germinate into the pleura, exert pressure on the bronchi, which will intensify the cough and cause severe pain, not giving to sleep. Metastasis of mediastinal nodes on the left leads to sudden hoarseness and aphonia. The localization of the mets on the right exerts pressure on the upper vena cava, causing swelling of the face, upper limbs, a sensation of the compressed throat and the appearance of a headache during a cough.

[9], [10]

Lung cancer and metastases

Metastases are formed in practically all patients with malignant neoplasms in the late stages. It happens that the process of metastasis often manifests itself at the beginning of the development of the tumor. Screening of cancer cells from the primary tumor into distant organs is a dangerous complication of oncology.

Lung cancer takes a leading place in the direct spread of malignant cells beyond the border of the affected lung, as well as the ability of early and extensive metastasis. The latter is due to the presence of a large number of blood and lymph vessels in the lung tissues.

According to the results of autopsy lung cancer and metastases occur from 80 to 100% of cases.

Metastasis occurs by lymphogenous, hematogenic, aerogenic and mixed pathways. According to most oncologists, the last way is the most common.

The doctors agreed that the formation of this oncological process has a number of regularities: 

• the influence of the patient's age on the speed of spread of pathogens; 
• frequency depends on the structure of tumor formation.
• For example, undifferentiated small cell lung cancer gives multiple mets.

Lung cancer and metastasis in the brain

The largest screening of mets (30-60%) in the brain is caused by malignant neoplasms of the lung tissue, especially for small-cell type cancer. The risk group includes patients over 50 years of age, and the incidence rate increases year by year. Such an oncological process contributes to the development of mental and physical disorders.

Metastatic brain damage is the cause: 

• increased intracranial pressure, which manifests itself as a pain in the head of a dilated species, a feeling of nausea and various impairments of consciousness (stunnedness, coma); 
• epileptiform seizures; 
• neurologic local disorders - signs of the disease appear on the site opposite the stricken one. For example, metastasis of lung cancer into the brain on the left is detected by symptoms (sensitivity change, paralysis, speech disorders, etc.) on the body on the right.

Often, metastases in the brain indicate the manifestation of primary oncology. So about 10% of patients with pulmonary oncology turn to doctors for neurological disorders.

Neurological symptoms can take the form of a stroke as the disease progresses.

It should be noted that every oncological patient with symptoms of headache, seizures, nausea, gait disturbance, memory loss, weakness in the extremities should be examined by CT / MRI.

Lung Cancer and Metastasis in the Liver

Oncological tumors of the lung tissue screen out malignant cells in the liver, lymph nodes, kidneys, brain, bone structures and other organs / tissues. At the initial stage, liver metastases do not manifest themselves. With the gradual replacement of liver cells, mets significantly reduce the functionality of the organ, while the liver becomes denser and acquires a pronounced tuberosity. Massive damage often causes jaundice and inherent intoxication.

The presence of pathology can be assumed by the following symptomatology: 

• a feeling of weakness, a decrease in efficiency; 
• weight loss; 
• lack of appetite, anorexia; 
• feeling of nausea, vomiting, protrusion of vascular asterisks, skin of earthy shade; 
• severity, pressure of the liver region, pains of a dull character; 
• presence of temperature, tachycardia; 
• increased veins on the abdomen, jaundice, ascites; 
• itching of the skin; 
• the appearance of flatulence, intestinal dysfunction; 
• gastroesophageal type of bleeding varicose veins; 
• engorgement of the mammary glands (the phenomenon of gynecomastia).

The liver in the human body performs the function of detoxification by means of intensive blood circulation (throughput per minute - over one and a half liters), which explains the frequency of development of mets in the organ.

The defeat of a vital organ excludes the use of radical surgical treatment in mind with increased generalization and rapid weakening of the body (often cardiopulmonary as well as respiratory failure is observed).

Lung cancer and bone metastases

In clinical practice, about 40% of the oncological process in bone structures is detected in primary oncology of pulmonary tissues. Metastasis is susceptible to: a vertebral column, hip bones, pelvic region and shoulders, sternum and ribs. The nature of the distribution along the skeletal axis is due to the peculiarities of localization of the red bone marrow. The presence of tumor cells in the vascular bed of the bone marrow is not a sufficient condition for the appearance of the mets foci, the connection of biological factors is required. These include the increased expression of parathyroid-like protein (activates metabolic processes in bone structures) secreted by tumor cells.

Metastases in the bones are osteolytic, osteoblastic and mixed. Clinical picture is inherent: 

• severe soreness; 
• deformation of bone structures and pathological fractures; 
• hypercalcemia (calcium supersaturation of plasma).

In rare cases, the formation of mets is asymptomatic. Difficult pain causes the use of narcotic painkillers and hospital treatment.

Non-small cell lung cancer and bone metastases serve as a criterion for unfavorable prognosis when the average survival is no more than three months.

Lung cancer and metastasis in the spine

Metastatic spinal cord injury is referred to secondary malignant formation, which occurs more often than primary oncology. Sometimes in every tenth case it is not possible to determine the primary source of cancer.

Lung cancer and metastases in the spine are found in 90% of clinical practice. Moreover, the oncological process is of a multiple nature, and the path of penetration of cancer cells - more often with the blood flow, less often - with lymph. The development of mets causes pain syndrome in the corresponding zone of the vertebrae, is expressed by the presence of neuralgic pains, the appearance of which is associated with pressure on the nerve roots of the spinal cord.

Often pockets accumulate in the lumbar region, causing pain (like sciatica) and even paralysis of the legs. Soreness increases gradually, intensifies at night. Without timely and proper treatment, the pain becomes intolerable. The appearance of the first symptoms of neurologic changes - radiculopathy or myelopathy - is an occasion for carrying out a radiography that detects the destruction of vertebral bodies and processes. More accurately visualize the metastases in the spine allows the technique of bone scanning.

Metastases in the liver and lungs

Metastatic lesions often appear in advanced stages of cancer. Distribution of mets is carried out by means of blood, lymph or in a mixed way. Most of the foci are localized in the lung tissues, liver, brain, bones.

The process of metastasis consists of a complex sequence of actions in which cancer cells change their location from the oncology focus, migrating with blood, lymph flow, or by direct expansion into other tissues. Initially, the cancer cell is separated from the tumor and causes protein degradation, resulting in the ability to move.

Three modes of movement are known to the human cell: collective, mesenchymal and amoeboid. Cancer cells are endowed with a special mobility, allowing you to switch from one type of movement to another.

At an early stage, metastasis develops asymptomatically. The feeling of heaviness in the zone of the right hypochondrium occurs only when the pathological focus is growing.

Cases of metastatic breast cancer in some patients cause a progressive pathology of vital organs leading to death, while in others - the slow development of the disease with long periods of stabilization (life expectancy reaches 10 years). Frequent cause of death of patients with breast cancer are metastases in the liver and lungs.

Kidney Cancer and Metastasis to the Lungs

Cancer kidney disease is more common among male patients, due to the addiction to smoking and work in harmful production. The average age of patients is 40-60 years, although recently there has been a trend towards detecting kidney cancer in the younger generation. The most common type of cancer is renal-cell (more than 40%), the second place is divided tumors of the renal pelvis and ureter (20%), cases of sarcoma is no more than 10% of cases.

Factors affecting the development of tumor processes in the kidney are divided into: hormonal, radiation and chemical. In a special group of risk smokers fall in whom metastasis is numerous and the disease is more severe.

Cancer cells spread haematogenously and lymphogenically. The incidence of kidney cancer on the spread of mets is observed in half of the patients. In most clinical cases of malignant kidney damage, metastases in the lungs, bone structures, liver and brain are revealed, which is explained by the existing interaction between the renal venous system and the main vessels of the thoracic and abdominal zones.

Cancer of the kidney, metastasis to the lungs is detected by the characteristic hemoptysis. A solid tumor process with an X-ray examination may resemble a cancer of a bronchogenic species, and the presence of multiple mets is a condition of pneumonia or tuberculosis.

Breast cancer and lung metastases

Oncological diseases are classified according to the stages of development, which makes it possible for the attending physicians to orient themselves in selecting effective treatment and to judge the prognosis. With breast cancer of the third degree, there are metastases to the lungs, lymph nodes are affected, and the tumor itself can have a different size. However, until the lymph nodes have merged into a single material, the outcome of the disease is considered favorable.

Oncology of breast cancer of the third stage has two sub-stages: 

• invasive process with tumor formation, not exceeding five centimeters. Lymph nodes are enlarged, have a close connection with nearby tissues; 
• the second sub-stage is characterized by the germination of tumor cells into the lymph nodes of the chest zone, which is determined by the reddish color of the skin.
• Breast cancer and lung metastases should be suspected when the following symptoms occur: 
• an impassable type of progressive cough of dry type or with discharge (mucus, impurity of blood); 
• many patients report shortness of breath; 
• soreness in the chest; 
• decreased appetite and weight.

Most mets affect the peripheral parts of the lung, which explains the complexity of their detection in differential diagnosis. The reason for the late treatment of patients is the lack of clinical manifestations of metastases in cases of single and solitary sprouting.

To metastases of breast cancer use chemo and hormonal therapy, but cases of complete recovery are rare. Therefore, the main goal of the treatment is to eliminate the symptoms and the ability for the patient to lead a full life, which is achieved by a more toxic scheme.

[11], [12], [13], [14]

Multiple metastases in the lungs

Metastases in the lungs are single or multiple nodes rounded in shape, the size of which reaches five centimeters or more.

Observations of the development of the disease led to the conclusion that multiple metastases in the lungs are distributed equally in both parts. The rapid development of the pathological process proves the malignancy of metastatic neoplasms. Within a year after confirming the diagnosis of the primary tumor, mets in patients were found in the following ratios: 

• about 30% - of the oligarchic type; 
• more than 35% - single defeat; 
• 50% of cases are multiple.

A characteristic phenomenon in foci of small size, without germination in the tissues of the bronchi and pleura, is that multiple metastases in the lungs do not cause any inconvenience to the patient. General weakness, discomfort in the form of shortness of breath, rapid fatigue, temperature occur with the progression of the disease.

In rare cases of multiple metastasis, one mets settle on the bronchus wall. With such a course of the pathological process, a cough of a dry nature manifests itself, which develops into a symptomatology of bronchogenic primary oncology with mucous sputum.

Stomach cancer and metastasis to the lungs

Through the bloodstream metastasis is observed in the late stages of the disease with stomach cancer, excluding the portal vein. So there are multiple metastases in the lungs, bone structures, kidneys, brain, spleen, skin.

Oncology of the stomach is in second place in the frequency of detection in men and the third among the female population. In idiopathic alveolitis, stomach cancer and metastasis to the lungs due to the lymphogenous pathway appear in 70% of the incidence. During the macro-research, it is found that the tumor cells form conglomerates in the lymphatic channel (peribronchial and subpleural vessels), representing whitish-gray nodules and thin whitish bands.

Often, multiple, round mets are characterized by small sizes and grow slowly. In most cases, bilateral, germinating isolated or against the background of metastatic lesions of bronchopulmonary, bifurcation lymph nodes are detected. Often there is an isolated pleural effusion (one-sided / bilateral) or lymphangitis with spreading to bronchopulmonary, mediastinal nodes.

Metastases in the lungs and spine

Metastasis in the spine is a relapse after treatment of primary oncology, in which mets were not completely destroyed. They are actively progressing, affecting nearby tissues. Metastases in the vertebral column can penetrate from neighboring organs.

The formation of metastases in the lungs and spine is caused by active blood supply in the lung tissues and bones. Tumor cells with blood flow penetrate into the bone marrow and bone tissue, activating the work of osteoclast cells, which dissolve the structure of bones. Through the lung tissue, blood is continuously pumped, which makes them the second available place (after the liver) for the growth of mets.

In its clinical picture, metastases in the lungs and spine at first do not reveal themselves. Pulmonary metastasis during development (more often with neglected forms) can be detected by coughing, bloody inclusions in sputum, subfebrile condition, exhaustion, difficulty breathing.

Progression of bone metastasis is expressed by pain syndrome, not fused fractures, metabolic disorders, hypercalcemia. The most unpleasant and serious symptom, hypercalcemia, is a combination of symptoms: thirst, dry mouth, active urine formation (polyuria), nausea, vomiting, inhibition, loss of consciousness. The defeat of the spinal column mets is fraught with increased pressure on the spinal cord, as well as neurological problems - changes in limb mobility, the function of the pelvic bones.

For a favorable outcome of metastasis in the lungs and the spine, it is important to recognize pathological manifestations at the onset of development and prescribe effective treatment.

Bowel cancer and metastasis to the lungs

Under the cancerous processes of the intestine is meant a malignant disease of the mucous membrane. Oncology occurs in any area of the intestine, but most often in the thick section. A fairly common cancer disease affects both male and female populations over 45 years of age.

Like many cancers, intestinal cancer is asymptomatic, and the first signs of the disease are often confused with colitis. The main symptom of intestinal lesions is the presence of cancer in the feces of blood.

Clinical manifestations are different depending on which of the sites is involved in the pathological process and the stages of development of oncology. Tumor processes on the right are characterized by diarrhea, abdominal pain syndrome, fecal inclusions in feces, iron deficiency anemia (due to the constant blood loss). Oncology to the left - constipation, swelling. Cancerous bowel disease should be suspected of prolonged (two weeks or more) dyspeptic manifestations: eructations, nausea, a feeling of heaviness in the stomach, a decrease in appetite, an irregular chair.

An equally important symptom of cancer of the intestine will be dislike for meat. Bowel cancer and metastasis to the lungs indicate the progression of the disease, the transition to an intractable form. To the general symptoms are added weakness, blanching of the skin, weight loss, excessive nervousness.

[15], [16], [17], [18], [19], [20]

Prostate cancer and metastasis to the lungs

Mets, affecting the vital organs, are considered disastrous in prostate cancer. And the cause of mortality is the later diagnosis of the disease (at the third, and even the fourth stage).

The process of metastasis begins already at an early stage of the disease, in which lymph nodes, bone structures, lung tissues, adrenals and liver are involved. Symptomatic also occurs when neglected oncology, when treatment is difficult or even impossible.

With malignant disease of the prostate it is noted: frequent urination, pain syndrome of the perineal zone, impurity of blood in urine and semen. Prostate cancer and metastasis to the lungs in addition to the adherence of pulmonary symptoms (cough, sputum with blood, chest pain, etc.) in the late stages of development of the tumor process have common signs of intoxication: a sharp slimming of the patient, weakness, fatigue, pale skin with earthy shade. Metastasis in prostate cancer is detected with edema of the legs (zone of the feet, ankles).

Having trouble urinating is an occasion to visit a urologist. Cancerous lesions in the prostate are more likely to affect men in old age.

Metastases of sarcoma in the lungs

Soft tissue sarcoma is a broad group of malignant tumors that are formed from a primitive type of embryonic mesoderm. The mezoderm is included in the mesoderm - the primary material for the formation of connective tissue, which constitutes tendons, ligaments, muscles, and the like.

Sarcoma is characterized by slow growth and lack of soreness. Most often, sarcomas are metastasized in the lung tissue, less often in the lymph nodes of the regional type. A common place of localization of the sarcoma is the lower limbs, pelvic region, retroperitoneal space. The size of the tumor itself is judged on the probability of spreading mets (the larger the lesion, the higher the probability of metastasis).

External sarcoma is a rapidly growing, inactive, painless and soft to the touch formation. The surface of the tumor is smooth or bumpy. The later stages are described by a characteristic purple-cyanotic hue, and the veins are expressed and expanded. Internal is detected when the process is started by squeezing surrounding organs with foci.

The path of penetration of metastasis into the lungs and other internal organs is hematogenous. The share of lymphogenous metastasis accounts for only 15% of all cases.

Metastases in the lungs of the 4th stage

Cancer of the 4th stage is an irreversible pathological process, characterized by the penetration of oncology into neighboring organs, as well as the appearance of distant mets.

Criteria for diagnosis: 

• progression of cancer with damage to bone structures, liver, pancreas, brain; 
• rapidly increasing tumor; 
• any type of bone cancer; 
• fatal cancerous formation (melanoma, pancreatic cancer type, etc.).

The level of five-year survival from the moment of diagnosis of cancer of stage 4 does not exceed 10%. For example, stomach cancer and metastases in the lungs of the 4th stage have a favorable prognosis with a survival rate of 15-20%. The maximum lifespan is observed in patients with tumors of the cardinal part, especially squamous type. While the positive prognosis for tumoral processes of the intestine does not exceed 5%. The main problem of patients with prostate cancer are violations of the liver, kidneys, which leads to a fatal outcome in the first five years after confirmation of the diagnosis.

How do metastases in the lungs look like?

X-ray diagnostics allows you to determine what metastases in the lungs look like. According to the clinical picture, the following changes in shape are distinguished: 

• knotty; 
• diffuse-lymphatic; 
• mixed.

The nodular form includes solitary (large-nodular) or multiple (focal) types. Foci of a solitary species are rounded with clear contours nodes localized mainly in the basal region. Such mets are often found in the asymptomatic course of the cancer process. According to the characteristics of development and the rate of sprawl, solitary mets resemble the original tumor.

The focal form of metastasis is encountered more often by physicians than by a large-nodal one. In most patients, small-focal metastases in the lungs are observed simultaneously with lymphangitis of the surrounding pulmonary tissues, therefore clinical symptoms (dyspnea, general weakness, cough without discharge) are manifested in the early periods.

Diffusive-lymphatic (pseudo-pneumatic) flow is characterized by changes in the heavy pattern, which appears on X-rays with thin linear seals. Progression of the pathological process leads to the growth of focal shadows. Such patients are considered to be the heaviest.

Mets pleural form at first can be confused with exudative pleurisy. The roentgenogram reveals a knobby type of bedding, the presence of massive effusion. Pathological processes of the pleura are characterized by pulmonary insufficiency, deterioration of well-being, subfebrile temperature.

In mixed form, in addition to knot lesions, lymphangitis and effusion of the pleura zone occur. Mediastinal knots are often involved in the process. These foci in the lungs are called pulmonary-pleural or pulmonary-mediastinal.

Metastases in the lungs on X-ray

Examination of the chest by the method of radiography allows you to study the structure of lung tissue, identify suspicious blackouts, changes in the position of the organs of the sternum, determine the size of the lymph nodes.

In order to determine the location and size of the mets, two variants of the images are taken - the front and side views. Metastases in the lungs on the X-ray are rounded (like a coin) dimming of different sizes (single or multiple), divided into types:

• nodular, including a large-nodular (solitary) and focal (multiple) form; 
• diffusive-lymphatic (pseudopneumatic); 
• pleural; 
• mixed.

For a solitary species, clearly defined contours of the affected nodes, located mainly in the basal parts of the lung, are characteristic. However, the structure of the lung tissue is not changed. The focal form is more widespread, being combined with lymphangitis of surrounding tissues.

Diffusive-lymphatic type radiographically revealed by a heavy pattern of thin linear seals of the peribronchial zone. The growth of the pathological focus transforms the strands into vague ones and further with clear boundaries of the shadow, diffusely located along the fields of the lungs.

The pleural form of mets in the lungs at an early stage is most often mistaken for a picture of exudative pleurisy. In rare cases, there is involvement of the pleura in the pathogenic focus. On the roentgenogram, a tuberous form of bedding, covering the pulmonary tissues, or effusion (often bilateral), the nature of which varies from the transudate / exudate to the expressed hemorrhagic, is noticeable.

The mixed species is characterized by the presence of nodes in the lung tissue along with lymphangitis and effusion of the pleural zone.

Forms

Secondary tumors - lung metastases (metastasis, mets) - are classified as follows: 

• by the nature of the lesion - focal or infiltrative; 
• on a quantitative basis - solitary (1pc), single (2-3pc) or multiple (over 3); 
• by the degree of increase - small or large; 
• by location - one / two-sided.

The appearance and development of metastases occurs as a result of the spread of cancer cells from other organs. The tumor focuses on millions of infected cells that penetrate the pulmonary tissues through the flow of blood or lymph. Any oncology is able to metastasize into the lungs, more often such processes are detected in malignant neoplasms: 

• breast cancer; 
• Bladder; 
• stomach and esophagus; 
• kidney; 
• cutaneous melanoma; 
• cases of colorectal cancer.

According to the degree of sensitivity to this or that method of treatment of primary neoplasms, metastases in the lungs are divided into groups: 

1. effective are chemotherapy and radiation exposure (testicular / ovarian cancer, trophoblastic lesion, osteogenic sarcoma); 
2. resistant to chemopreparations (melanoma, squamous cell carcinoma of the cervix, etc.); 
3. susceptible to conservative methods (tumors of the lung tissue, breast).

[21]

Treatment of the metastases in the lungs

The discovery of a secondary focus of malignant tumors until recently was a sentence for the patient. Such patients tried to improve the quality of life by anesthesia, often with the use of narcotic drugs. In modern medical practice, methods for eliminating metastases in the lungs have become known, which in the case of early diagnosis leads to complete recovery.

The choice of treatment affects a number of factors: the location and histological pattern of the primary tumor focus, the nature and effectiveness of the initial therapeutic effect, the somatic state of the patient.

Therapeutic tactics is based on the long-term oncological experience, which includes: 

• Chemotherapy is the most common technique in the fight against cancer cells, which controls the process of growth of mets. The course of treatment depends on the prescription period of previously passed therapy and used drugs; 
• hormonal therapy - the decisive factor is the sensitivity of the primary tumor to this method. The maximum positive effect is observed with breast cancer / prostate cancer; 
• surgical treatment - is rarely prescribed, if the foci have convenient localization and are resectable. An important condition is the absence of mets in other bodies; 
• radiotherapy - more often to relieve / relieve symptoms; 
• radiosurgery - effective treatment with the help of a cyber knife; 
• laser resection - it is advisable to use in situations where the tumor is the main respiratory obstruction (compression of the respiratory throat and bronchus).

If the tumor presses on the area near the main bronchi, apply endobronchial brachytherapy - the delivery of radioactive capsules with the help of a bronchoscope.

Treatment of lung cancer with metastases

Oncology of the lungs is a common disease regardless of gender, occurring twice as often among the male population as women.

In patients with lung cancer, metastasis is often observed in the brain. In order to increase the effectiveness of irradiation therapy, the whole brain region is subjected in this case, and stereotactic radiosurgery is used in the presence of multifocal lesion. The next step in the standard treatment will be chemotherapy. Refusal of full-fledged therapy and non-timely treatment lower the chances of survival (life span varies from one to several months in this case).

Treatment of lung cancer with metastases to the liver (in clinical practice occurs in 50%) is conducted in an operative and complex way, including chemotherapy.

The surgical effect in lung cancer with metastases is divided into: 

• radical - removal of the whole malignant structure (primary focus, regional lymph nodes); 
• conditional-radical - attach radiation and drug therapy; 
• palliative - is based on maintaining the quality of life of the patient. It is appropriate in those cases when none of the above methods yielded results.

Radical treatment is not applied if it is not technically possible to remove the tumor (adjacent organs and tissues are involved), abnormalities of the respiratory and cardiovascular systems are detected, decompensated organ diseases take place.

Radiation treatment of lung cancer with metastases is appointed as a result of its inoperable appearance, in case of refusal of the patient for surgical intervention, in case of pronounced contraindications to the surgical method. The best results of radiation therapy are observed in cases of squamous and undifferentiated types of cancer. This form of exposure is appropriate for radical (irradiate the tumor itself and regional mets) and palliative therapy.

An inoperable type of non-small cell metastatic cancer with contraindications to radiation therapy is treated with chemotherapy. The doctor makes an individual scheme for taking medications (cisplatin, bleomycin, paclitaxel, etc.) for up to six sessions. Chemotherapy is powerless when metastasizing to bone structures, the liver and the brain.

The goal of palliative care is to maintain the patient's quality of life, including: anesthetic local effect, psychological support, methods of detoxification and some forms of surgical intervention (nephrostomy, gastrostomy, etc.).

Are metastases in the lungs treated?

The methods of active chemotherapy and radiation exposure are indispensable means of preventing the appearance / spread of foci of cancer at an early stage. Of course, the treatment of cancer with metastases has some difficulties. Most of the mets have a resistance to chemotherapy.

The choice of treatment technique is influenced by the size and localization of mets, the characteristics of the primary tumor, the age of the patient and his physical condition in general, as well as previous medical effects.

Cancer patients with metastases in the lungs were recently considered hopeless. And the use of chemotherapy and surgical effects has a number of shortcomings. So during the operation, healthy tissue is injured, and with the use of medicines along with cancer, healthy cells also die. However, the newest methods allow minimizing the side effects of treatment and improving the survival of patients.

Tumors of lung tissue of small size can be treated with radiofrequency ablation. Successful application of the technique is associated with the possibility of concentrating RF radiation at the site due to the air space surrounding the foci. Another relatively new technology is a cyber-knife that irradiates metastases in the lungs accurately, without capturing healthy tissue more than a millimeter. This accuracy reduces the risk of unwanted reactions and subsequent fibrosis of the lung tissue.

The above technologies are shown for mets up to 5 cm in diameter. Patients with large tumors undergo targeted therapy to reduce the size of the foci.

[22], [23], [24], [25], [26]

How to treat metastases in the lungs?

Metastasis of the solitary type of the pulmonary area, which grows after surgery for a primary cancerous focus or radiation therapy, is surgically removed, in which the segment / lobe with the tumor node is excised. The appearance of multiple mets determines the inclusion in the therapeutic course of hormone-containing drugs (breast / prostate cancer) or the use of chemotherapy under the condition of sensitivity of cancer cells. Radiation treatment is shown in both single and multiple metastasis (sarcoma, reticulosarcoma).

The success of treatment depends on the timely detection of mets. Cancers of the fourth stage are the least amenable to therapy. Such patients are considered inoperable, and the therapeutic effect is aimed at alleviating and eliminating the main symptoms - cough, hemoptysis, respiratory illness, pain syndrome. Quite often it is necessary to eliminate in parallel developing, as exacerbation after radiation and chemotherapy, pneumonitis and pneumonia.

Chemotherapy for metastases in the lungs

Chemotherapy in oncology practice is performed before and after surgery. This method is given an important place in an inoperable tumor, when the lymph nodes of the mediastinum are already affected by metastases.

Chemotherapy happens:

• neoadjuvant - immediately before the operation, to reduce the size of the tumor. Identifies the degree of sensitivity of cancer cells to drugs; 
• adjuvant - after surgery to prevent relapses in the form of metastasis;
• therapeutic - to reduce mets.

Chemotherapy with metastases in the lung improves the quality and prolongs the life of the patient. The expediency of drug treatment depends on the histological structure of the tumor. The small cell type of cancer lends itself to drug therapy, and non-small cell lung tissue tumors are absolutely insensitive to drugs.

The greatest effect is observed when using platinum-based products. The construction of the regimen is based on: the degree of the disease, the effectiveness of the operation, the susceptibility of malignant cells to drugs, the general condition of the patient.

The most common and effective treatment regimens for metastatic lesions of lung tissue:

• CMFVR is a combination of five drugs: cyclophosphamide -2 mg / kg (intramuscular / intravenously for 28 days), methotrexate 0.75 mg / kg (intravenously once a week), 5-fluorouracil 12 mg / kg (once a week intravenously), vincristine 0.025 mg / kg (once a week intravenously), prednisolone - 0.25-0.75 mg / kg (three weeks inside, then another week for 10 mg);
• CMF-cyclophosphamide (100 mg / m2, daily two weeks), methotrexate (40 mg / m2 intravenously the first and eighth day), 5-fluorouracil (600 mg / m2 iv first and eighth day);
• AC - adriamycin (40 mg / m2 intravenously on the first day), cyclophosphamide (200 mg / m2 orally / intramuscularly for the third or sixth day);
• FAC-5-fluorouracil (500 mg / m2 first and eighth days intravenously), adriamycin (50 mg / m2 intravenously on the first day), cyclophosphamide (500 mg / m2 intravenously on the first day).

It should be noted that the cycles are repeated after three to four weeks.

[27],

Alternatives for metastases in the lungs

The basis for the treatment of traditional and alternative medicine are poisons that destroy cancer cells. Chemical and natural components can simultaneously have an adverse effect on healthy cells and tissues. To avoid negative consequences, it is not recommended to use several infusions in parallel, use highly concentrated agents. Each agent is taken separately and closely watches the body's response to it.

Alternatives for metastases in the lung: 

• plantain (large, lanceolate) - is a preventive measure against cancer of lung tissue and is indispensable in metastasis. A powerful restorer of the body's defenses, which is important in the fight against cancer and after chemotherapy. Dry or fresh leaves (1 st.l.) pour a glass of boiling water, after two hours drain. Drink up to four times a day for a tablespoon (for 20-30 minutes before eating). Fresh roots of plantain grind, take 1 tbsp. A glass of water, boil for five minutes, an hour later the tincture is ready. Drink one or two items. Spoons three times a day for hemoptysis; 
• celandine - use infusions, decoctions, and not fermented juice. Effectively suppresses cough, is used as an immunomodulator. The plant is poisonous, it is important to observe dosages! Contraindicated to epileptics. Dry crushed grass (1 tbsp) insist an hour a half liter of boiling water. The filtered composition is taken up to four times a day on a tablespoon. Perhaps, to add equal shares of nettle and marigold; 
• licorice root - antitumor activity is associated with the presence of coumarins. In enameled dishes 10g. Root pour 200ml. Boiling water, broth on the steam bath (under a dense lid) for about 20 minutes. After 40 minutes strain and wring out the remainder, dilute to the original volume with boiled water. Drink 1 tbsp. Broth for at least ten days for 4-5 times a day.

[28], [29], [30]

Forecast

Metastases in the lungs not so long ago reflected the dissemination factor of the pathological process and were a verdict for the patient. Patients with this diagnosis received only symptomatic treatment or made up a group not subject to active therapeutic effects. Modern medicine, provided timely and competent treatment by surgical methods, hormone and immunotherapeutic, chemoradiotherapy can prolong the life of the patient, improve its quality, and often completely heal.

The prognosis for metastases in the lungs depends on a number of factors: 

• localization and area of primary focus; 
• number; 
• values; 
• timeliness of diagnosis and treatment effectiveness.

If the patient does not receive the necessary treatment, almost 90% of cases include a fatal outcome two years after the diagnosis. The use of surgical methods causes a 30% survival rate. Identifying the primary focus and mets at the beginning of development increases the chances of success. Joint radiotherapy, surgical therapy, and the use of medications increase the level of five-year survival to 40%.

How many live with metastases in the lungs?

Based on medical statistics, lung metastases display disappointing data - the average life expectancy of operated patients with metastatic cancer is five years.

With the removal of the tumor focus of the digestive system, survival of up to ten years is observed in 50% of cases. The maximum life span (up to 20 years) occurs in patients with oncology of the genital area.

Primary tumor location	Average Survival Rate,%
	3 year old	5 year old
Malignant damage to bones	43	23
Soft tissue cancer	38	Thirty
Kidney Cancer	58	32
Malignant uterine body formations	65	44
Rectal cancer	38	16
Lungs' cancer	31	13
Mammary cancer	49	26th
Colon cancer	38	15

Analyzing the table, we can note the best results of five-year survival in patients with malignant bodies of the uterus, kidneys, soft tissue, breast and bone structures.

The data of surgical removal of metastases in the lungs confirm the expediency of using the method as part of a complex of treatment for cancer patients.

[31], [32], [33], [34], [35],