How are secondary lung tumors treated?

Updated: Feb 16, 2021
  • Author: Daniel S Schwartz, MD, MBA, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Surgical treatment of secondary lung tumors should be considered for a pulmonary metastasis of primary lung cancer and, infrequently, for metastases of other types of primary cancer.

Surgical resection of a lung metastasis should not be performed unless, as indicated by predictive postoperative pulmonary function testing or cardiopulmonary exercise testing, the procedure has a significant likelihood of being curative and not disabling.

A metastatic nodule in the same lobe as a primary lung tumor was once considered a T4 tumor, as designated in the 1997 tumor-node-metastasis (TNM) classification scheme of the American Joint Committee on Cancer (AJCC) and the Union for International Control of Cancer (UICC). In the revised seventh edition of the TNM staging system, however, it was classified as a T3 lesion instead [30] ; the same was true in the eighth edition. [31]

According to the 1997 classification, the presence of two malignant nodules of the same histologic type in two different lobes on the ipsilateral side of the lung indicated metastatic disease or stage IV lung cancer. According to the seventh and eighth editions of the staging system, however, this was indicative of potentially resectable T4 lesions. [30, 31]

In both cases, surgical management that is more aggressive than is otherwise recommended for the same stage of the disease has been advocated. Every effort should be made to document the diagnosis of both individual nodules if they are located in different lung lobes, because the approach is more aggressive if two separate synchronous lung cancers are documented. (Synchronous lung cancers are staged separately, but the overall prognosis is poorer than for a single lung cancer of a similar stage.) This becomes particularly important if one the lesions proves benign.

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