pulmonary metastases
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Epidemiology
- 30% of non-pulmonary cancers metastasize to the lung
- occurrence of pulmonary metastases
- choriocarcinoma (80%)
- osteosarcoma (10-75%)
- kidney cancer (25-70%)
- thyroid cancer (65%)
- melanoma (60%)
- breast cancer (55%)
- prostate cancer (45%)
- nasopharyngeal cancer (20%)
- gastrointestinal cancer (20%)
- gynecologic cancer (20%)
- soft tissue sarcoma (20%)
Pathology
- 75% present as multiple lesions
- solitary metastases
- hematogenous spread, lymphatic spread, direct infiltration or airway transcoelomic spread
- lymphangitic spread
- adenocarcinomas
- breast cancer
- stomach cancer
- thyroid cancer
- pancreatic cancer
- lung adenocarcinoma from another segment of lung
- melanoma
- lymphoma
- leukemia[2]
- adenocarcinomas
- endobronchial metastases
- 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]
More general terms
More specific terms
Additional terms
- breast cancer
- choriocarcinoma
- lung cancer
- malignant kidney neoplasm (kidney cancer)
- melanoma
- metastatic cancer of unknown primary
- osteosarcoma (osteogenic sarcoma)
- prostate cancer
- thyroid carcinoma
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 766-69
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Aquino SL Imaging of metastatic disease to the thorax. Radiol Clin North Am. 2005 May;43(3):481-95 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15847812
- ↑ 4.0 4.1 4.2 4.3 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 - ↑ 5.0 5.1 5.2 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 - ↑ 6.0 6.1 6.2 Qi H, Fan W. Value of ablation therapy in the treatment of lung metastases. Thoracic Cancer. Nov 29, 2017 9(2):199-207 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29193688 Free PMC Article https://onlinelibrary.wiley.com/doi/full/10.1111/1759-7714.12567