Mts in the lungs is in question. Treatment methods for lung metastases

The organ most often affected by secondary cancer is the lungs. Metastases in the lungs rank second among secondary cancers after the liver. In 35% of cases, primary cancer metastasizes to the pulmonary structures.

There are two ways for metastases to spread to the lungs from the primary focus - hematogenous (through the blood) and lymphogenous (through the lymph). This location of metastases is life-threatening, since they are detected in most cases on.

Causes of lung metastasis

Cancerous tumors contain large numbers of abnormal cells. By connecting with blood and lymph, cancer cells spread to neighboring organs. There they begin to actively divide, forming a secondary focus of cancer - metastasis.

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Lung metastases can spread from almost any cancer.

Most often they occur in such primary oncological diseases as:

• Skin melanoma;
• Breast tumor;
• Bowel cancer;
• Stomach cancer;
• Liver cancer;
• Kidney cancer;
• Bladder tumor.

The abbreviated name for metastases is MTC (MTS - from the Latin “metastasis”).

Video - Tumor metastasis

What types of metastases can there be in the lungs?

Secondary lesions can occur in both the left and right lungs. Pulmonary metastases are divided according to characteristics into groups such as:

1. Single-sided and double-sided;
2. Large and small;
3. Solitary (single) and multiple;
4. Focal and infiltrative;
5. Nodal metastases;
6. In the form of tissue strands.

If SUSP is suspected of secondary oncology, you should undergo examination.

Symptoms and signs of pulmonary metastases

Metastases to the lungs (Dynamics) x-ray

In the early stages, metastases in the lungs do not manifest themselves in any way, the disease is asymptomatic. As cancer cells decay, they release toxic substances that poison the body. The patient seeks medical help more often at the latter stage.

The presence of secondary foci of oncology in the lungs is accompanied by the following symptoms:

• Frequent shortness of breath, which appears not only during physical activity, but also at rest;
• Regular dry cough, turning into a wet one, which can be confused with another disease;
• Sputum mixed with blood;
• Chest pain that does not go away even with painkillers. Only narcotic drugs can reduce pain;
• Swelling of the face and upper extremities with localization of a secondary lesion in the right lung, headaches.

What do lung metastases look like?

Metastases in the lung can be determined using radiography. Secondary foci of oncology on X-ray images appear in nodular, mixed and diffuse forms.

Nodal metastases appear in single or multiple forms. Single or solitary formations look like rounded nodules, reminiscent of the primary focus of oncology. Most often they form in the basal tissue.

If the secondary genesis is pseudopneumatic, then on x-ray it appears as thin linear formations.

With metastasis to the pleura, large tuberous formations are visible on x-rays, as a result of the progression of which the condition of the cancer patient worsens and pulmonary failure develops.

How long do people live with pulmonary metastases?

Life expectancy for lung metastasis depends on how quickly the secondary cancer is detected.

If you experience at least one of the above symptoms, you should immediately consult a doctor and undergo an examination. In medical practice, there have been cases of detection of pulmonary metastases long before the detection of the primary tumor site.

The progression of a secondary tumor causes the organism as a whole. To identify the presence of metastases, you should know how the symptoms of the disease manifest themselves. The first signs of progression of secondary lung cancer are:

• Decreased appetite and, as a consequence, body weight;
• General malaise, fatigue and decreased performance;
• Increased body temperature, becoming chronic;
• Dry cough with metastases becomes constant.

The above signs may also indicate a primary one. This rather dangerous disease is more often observed in smokers. Metastases in small cell lung cancer spread rapidly, grow quickly, and if they are not detected in a timely manner, the prognosis for the patient will be dismal. Primary lung cancer is treated with chemotherapy. If the procedure is carried out in a timely manner, there is a chance to cure cancer completely. But this form of the disease is usually detected in the last stages, when it is no longer possible to cure it. Taking strong analgesics, you can live from four months to a year.

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There are forms of primary lung cancer that do not progress as rapidly as small cell cancer. These are squamous cell carcinoma, large cell carcinoma and adenocarcinoma. These forms of cancer are treated with surgery. If the operation is performed in a timely manner, the prognosis for recovery will be good. If metastases occur in other organs, the patient will face death.

Diagnosis of metastases in the lungs

To detect the presence of secondary genesis in the lung, the following diagnostic methods are used:

1. Radiography– examines the structure of lung tissue, reveals dark spots, location of metastasis and its size. To do this, two photographs are taken - from the front and from the side. On the images, multiple metastases appear as round nodules;
2. Computed tomography– serves as a complement to radiography. A CT scan shows the areas where metastatic tumors are located, their size and shape. Using CT, momentary changes in the lungs are detected;
3. Magnetic resonance imaging– is prescribed to people who have previously been exposed to radiation, as well as to children. Such a study makes it possible to identify secondary neoplasms, the size of which barely reaches 0.3 mm.

What do lung metastases look like? - Video

Methods of treatment of secondary foci of oncology in the lungs

How to treat secondary lung cancer?

In modern medicine, the following methods are used to treat metastases in the lungs:

• Surgical intervention– the affected area is removed. This method of treatment is effective only if there is a single focal lesion, so it is used quite rarely;
• Chemotherapy– serves as a complement to other treatment methods. The duration of the chemotherapy course depends on the main method of treatment and the patient’s well-being. In medical practice, chemotherapy is used in conjunction with radiation therapy. To raise the level of leukocytes in the blood after the procedure, dexamethasone is prescribed;
• Radiation therapy– helps slow down the active growth of cancer cells and reduces pain. Irradiation is carried out in stationary conditions using a remote method;
• Hormone therapy– used in the presence of a hormone-sensitive primary lesion in the prostate or mammary glands. Serves as an addition to primary therapy;
• Radiosurgery– (beam of rays) remove hard-to-reach tumors.

Disability for lung cancer is issued in the case of removal of one lobe.

Are metastases treated with folk remedies?

Treatment of secondary oncology in the lung can also be done using traditional methods. The most common folk remedy is celandine. It is necessary to pour boiling water over a tablespoon of dried herb and leave in a thermos for about an hour and a half. Then strain the infusion and take it twice a day, two tablespoons before meals.

In conclusion, we can say that there are various forms of lung cancer. This includes both primary cancer and metastases that have spread from other foci. The disease can be asymptomatic, which means that the patient can seek help when treatment no longer gives the desired result.

The survival prognosis depends on the stage of the disease, type, shape and location of tumors.

Lung metastases are clusters of cancer cells that have formed in the lungs due to cancer in the lung itself or other organs. These cancer cells are carried through the circulatory system through blood vessels (hematogenous route) or through the lymphatic fluid through the lymph nodes (lymphogenous route).

Metastases penetrate into the lungs, as a rule, with more advanced forms of cancer, the third or fourth. It is the stage of the cancer, its localization and the rate of metastasis that determine the further life prognosis.

Causes of metastatic lung damage

The reasons for lung metastasis is the fact that the lungs are an organ consisting of many blood vessels through which blood and lymph circulate. Through these fluids, pathogenic cancer cells from other organs enter the lungs.

Statistics show that most often kidney and liver cancer (sarcoma) can metastasize to the lungs, but other types of this dangerous disease can also cause metastases. This, for example, could be breast cancer, ovarian cancer, cervical cancer, bladder cancer, skin cancer, stomach cancer, or lung cancer itself.

It happens that they appear in the place where there was previously a tumor, and after its removal there was a relapse. The presence or absence of metastases may also depend on the general clinical picture of the disease and the immune components of the patient’s medical history.

In some cases, a person can detect pulmonary metastases in the first stages of the disease (for example, with breast cancer) and stop their progression, and sometimes they can go undetected for a long time.

The earlier foci of cancer cells are diagnosed and treatment is started, the more favorable the prognosis. But it is not always possible to diagnose them in the early stages. This is where the insidiousness of the disease manifests itself.

In oncological diseases, cancer cells form a primary focus in the organ whose cancer is diagnosed. Cancer cells can be transported to the lungs through the blood or lymph, forming a secondary lesion. There are several types of metastases:

The above classification will determine the further treatment strategy.

Stages of metastasis

The appearance of metastases is a sequential process, manifested in several stages (stages):

In medical practice, there is a common classification of cancer stages, called TNM:

1. That means there is no cancer.
2. Tis or T1 – cancer is present, there are no metastases, the tumor is not progressing.
3. T2 – cancer has been detected, metastases are present, but within one organ and do not spread throughout the body.
4. T3 – there is cancer, metastases in one organ, there is a possibility of distant foci.
5. T4 – there is cancer, widespread metastases. Fatal outcome most often.

In accordance with this classification, the stages of metastasis are determined - Mx, M0 and M1. In Mx, metastases are not detected; in M1, they are present within the organ affected by the primary cancer; in M2, distant metastases are found.

The rate at which lesions appear in the lungs, their spread and course depend on the general clinical picture of the disease, the location of the primary tumor, its type, the age of the patient, the treatment measures taken, and the degree of response of cancer cells to this treatment.

Treatment of cancer is complex, but has its own nuances depending on the type of cancer, its stage, degree of spread and size of metastases.

After surgical removal of the primary tumor, radiation therapy (radiotherapy) is widely used, aimed at targeting cancerous areas with radiation. Aims to stop the growth of pathogenic cells. Chemotherapy is also used to fight the disease, it stops its spread.

Endobronchial brachytherapy has a direct effect on the bronchi - radioactive content is delivered to the bronchi using special equipment. If the tumor is hormonal in nature, then hormone replacement therapy has a positive effect on the course of the disease.

At the fourth stage, secondary metastases and the primary tumor are most difficult to treat, however, progressive techniques such as neutron and gamma radiation appear. They are aimed at removing the tumor using a so-called radioactive knife, bypassing healthy tissue.

How to determine the presence of metastases, symptoms

Metastases in the lungs at first do not have pronounced manifestations. The patient may live in complete ignorance. A person may notice shortness of breath, which is often ignored. However, as the disease progresses and there are multiple metastatic nodes, there are symptoms such as a cough, which can be dry, lingering or wet, with sputum and blood clots.

Chest pain is often felt, not only during coughing attacks, but also when breathing. Shortness of breath and difficulty breathing becomes constant, not only during physical exertion, but even at rest.

The consequence of metastases can be frequent manifestations of infectious diseases affecting the lungs: bronchitis, tracheitis, pneumonia. Body temperature may also rise, general weakness of the body, loss of weight and appetite may be felt. The presence of these symptoms indicates the third or fourth stage of the disease.

Metastases in the lungs may have similar symptoms to other diseases that are benign in nature and do not pose a threat to life: benign lung formations, pneumonia, bronchitis, pulmonary tuberculosis.

At the slightest suspicion of the presence of pulmonary metastases, a person should undergo a full examination, which includes x-ray and fluorographic examination of the lungs. Computed tomography (CT) or magnetic resonance imaging (MRI) is used to detect very small lesions.

These modern diagnostic methods can detect secondary lesions smaller than 0.3 mm. In addition to hardware techniques, a cytological examination of secreted sputum is taken, as well as a puncture of the lung.

Survival predictions when primary and secondary metastases are detected

The life expectancy of a patient with lung metastases depends on how timely they are diagnosed. Treatment in the early stages has a more favorable prognosis. So, on average, a person can live 5-10 years after treatment.

Survival rate is also influenced by the factor of which organ cancer was diagnosed initially. For lung cancer, the prognosis is disappointing, no more than three years. With tumors of the genitourinary system, many live up to 20 years.

Oncologists make unfavorable prognoses if metastases appear in the lungs during the first year after removal of the primary tumor, if they spread too quickly, their number is very large, they are large in size and have numerous foci. Such cases include, for example, sarcoma. Unfortunately, death in such cases is likely within two years.

How long people live with lung metastases and how well the disease responds to treatment is also influenced by the state of the body’s immune system. With high resistance, the prognosis is favorable, and you can stay alive for 15 years.

One of the most important functions performed by the lungs is to enrich the blood with oxygen and remove carbon dioxide from it. Since the lungs have a powerful blood supply, and their structure itself is loose, they are an excellent breeding ground for many harmful organisms, as well as malignant cells.

Often metastases appear in the lungs, which are secondary malignant formations. They are formed from cancer cells that enter the lung tissue through the circulatory system. Yes, it is the organ already affected by cancer cells that infects the lungs.

Causes

The cause of metastases is the progression of cancer in an already affected organ. When stage 3 or 4 of the disease appears in this organ, the malignant formation itself is more than 6 cm in size and contains a fairly large number of cancer cells. These cells are very dangerous, as they separate from the affected organ and begin to spread throughout the body thanks to the circulatory system.

Having reached any organ, the infected cell begins to take root, thus forming a secondary tumor (metastasis).
Many scientists, while studying this abnormal cell, came to the conclusion that it cannot always provoke a recurrence of the disease. Recurrent disease does not occur in people with strong, stable immunity, since the first tumor cannot develop and metastasize because of this.

Cases were often observed when, long after the tumor was removed, metastases occurred, which was called because of this - cancer relapse.

Signs

It is almost impossible to determine the presence of metastases in the lungs at the initial stage, since there are no special signs. A person only feels constant fatigue, loss of appetite and other symptoms characteristic of a cold.

Even in the presence of single lesions, signs may not be detected, since the lungs are very large compared to the lesion. Detection in such a situation can only be done by chance. With massive damage, they can already be detected, and their symptoms begin to manifest themselves much more strongly:

1. Pain in the chest area.
2. Regular cough.
3. Presence of wheezing.
4. Decreased breathing.
5. Weakness of the body.
6. Weight loss.
7. Sputum with blood particles.

It even happens that the presence of metastases can manifest itself already at the last stage of its development. More striking signs of this disease are found in about 20% of cases.

Diagnostics

The presence of metastases in the lungs can be diagnosed in only 3 ways:

1. Radiography. Thanks to this study, the doctor can easily diagnose, indicate the size and area of ​​the lesion.
2. Computed tomography. Using digital processing of X-ray images, you can more accurately indicate everything about the foci and stage of development of the disease.
3. Magnetic resonance imaging. With this examination, you can get better diagnostics and a clearer image.

Treatment

Having diagnosed the presence of metastases in a person, you can begin to treat it. To treat metastases, one of the methods is used, which is individual for each patient and depends on the stage of the disease.

1. Surgical intervention. This method is considered the most effective in treatment, but it is carried out very rarely. This rare treatment is due to the fact that in most cases metastases are located en masse on the lungs. This method will be effective only for single foci of metastases.
2. Radiation therapy method. The malignant tumor is exposed to highly active x-ray radiation, which helps stabilize the process and reduce pain. Irradiation is carried out with an ionizing beam in a stationary setting.
3. Treatment with chemotherapy. When treated with this method, the spread of cancer cells can be controlled through the systemic administration of cytostatic agents. The course of treatment is individual for everyone, and depends on the treatment of the underlying malignant tumor, and on the patient’s well-being. Currently, to enhance the therapeutic effect, doctors are trying to combine this method with radiation therapy.
4. Hormone therapy. The method is used exclusively when the main tumor is hormone-sensitive (breast and prostate organs). Treatment is carried out using hormonal drugs. This method is effective in cases of complex therapy.
5. Laser resection. The method is used to treat the bronchi, and the process itself occurs under the control of bronchoscopy.
6. Radiosurgery. This is a completely new technology that allows you to treat hard-to-reach areas using beams of ionizing radiation.

The presence of metastases in the lungs can only indicate that they have penetrated all organs through the circulatory system and the patient’s immunity is weakened. Remission in such cases is practically impossible, but you can undergo palliative treatment, which will relieve painful symptoms and prolong life.

We are talking about metastases in the lungs when malignant cells that have penetrated there from other systems of the body are found in the respiratory organs. As a rule, cancer begins to spread them in the terminal stages of its development. They enter the lung tissue through the blood and lymphatic routes.

Detailed characteristics of the pathology

Multiple metastases in the lungs are secondary foci of malignant neoplasms. They spread by lymphogenous and hematogenous routes, but implantation metastasis is also possible. In this case, mutated cells multiply when the tumor touches or grows into the pleura. In addition, they are able to penetrate into the lungs through the bronchi from a disintegrating neoplasm located in the upper respiratory tract.

When a patient learns about metastases that have penetrated into the lungs, how long do I have to live - this is the first question he asks the doctor. It is difficult to answer this, since everything depends on the stage of the disease, the rate of spread of mutagenic cells, the effectiveness of the therapy and the patient’s state of health. Most often, the prognosis for metastases in the lungs is unfavorable, which is associated with delayed diagnosis and the presence of an abundance of pathological cells in the tissues of the respiratory organs.

However, once you hear your diagnosis and find out what metastases are in lung cancer, you don’t need to despair. If the immune system is able to fight pathology, then you can live with the disease for up to 15 years or even more.

What a lung metastasis looks like depends on the type of tumor. Most often, this pathological cell is represented by a node, the size of which varies from several millimeters to several centimeters (5 cm or more). If there is only one node, then it is called solitary. In addition, metastases in lung cancer can be single (no more than three nodes) or multiple (more than three nodes). There are also diffuse-lymphatic (metastases look like thin cords) and pleural forms of the disease (metastases look like layers rising in bumps above the pleura).

About the causes of the pathological process

Detection of a lung with metastases most often occurs when other organs are affected by cancer. The fact is that the lung tissue is extensively penetrated by lymphatic and blood vessels, through which pathological cells easily migrate. Having reached the lungs, they settle there and begin their growth and development. In the future, such foci will independently spread pathological cells throughout the body. Therefore, such patients often learn about lung cancer with metastases in the brain, liver, bone tissue or other organs. For example, implantation metastasis is often observed in breast cancer, which is especially important for an aggressively growing tumor.

So, pathology is diagnosed for the following oncological diseases:

1. In breast cancer, metastases may be found in the lungs.
2. Cancer of the stomach, esophagus, rectum, and prostate is important in terms of the development of the disease.
3. Cancer of the hepatobiliary system often leads to the penetration of metastases into the lung tissue through the hematogenous route. That is, the mutated cell passes through the bloodstream through the hepatic portal vein and reaches the lung, where it begins its pathological development.
4. Lung damage is also possible with kidney and bladder cancer. According to available statistics, kidney cancer with metastases to the lung is observed in more than 50% of cases. Nodes in the respiratory organs can be detected both during the initial examination and after nephrectomy. In the early stages, metastases in the lungs of kidney cancer can only be determined by performing a computed tomography scan.

In general, secondary tumors in the lungs can be detected in almost any cancer in the body.

Symptoms of pathology

At the initial stages of the formation of metastases in the lungs, the symptoms do not indicate in any way an oncological process that has arisen in the body. It is for this reason that the disease is diagnosed late, when it is already difficult to help the person. Early pulmonary metastasis is manifested by the following symptoms:

1. Depressive mood, indifference to everything happening around.
2. Weakness that is not associated with overwork.
3. Lack of desire to eat.
4. Losing weight.
5. An increase in temperature to subfebrile levels without visible signs of infection.

These markers of the disease are very nonspecific and do not force the patient to see a doctor for examination. As the disease progresses, signs of metastases in the lungs begin to disguise themselves as cold infections: bronchitis, pneumonia, flu. Despite this, most often the patient’s health condition is satisfactory, until the development of the terminal stage of the disease. Only in the presence of multiple large nodes do pathognomic symptoms of respiratory tract oncology appear:

1. Cough with metastases in the lungs is not accompanied by sputum at first and bothers the patient during the night's rest. Subsequently, a mucous discharge appears, in which purulent and bloody inclusions are found.
2. The bronchi narrow more and more, which leads to thickening of sputum. During this period, pulmonary hemorrhage may develop.
3. When breast cancer metastasizes to the lungs, pain occurs as tumor cells grow into the pleura and ribs and can affect the spinal column.
4. The sonority of the voice is lost, it becomes hoarse, which is important when the lymph nodes on the left side of the upper parts of the chest cavity are affected.
5. Swelling of half the body in the upper part is observed when the lymph nodes of the right part of the mediastinum are involved in the pathological process.

Symptoms before death, which give rise to lung metastases, do not differ from the symptoms of other terminal stages of cancer. The patient stops eating, coughs up blood, and has irregular heart rhythms. Severe cough and shortness of breath do not subside. The pain becomes very intense, which requires the administration of narcotic drugs. Over time, a person loses the ability to breathe independently, as a result of which he is transferred to mechanical ventilation.

How to detect metastases?

Increased body temperature with metastases in the lungs and deterioration in general health forces a person to visit a doctor. The doctor collects general information about the disease and finds out what kind of cancer is in the family history. It is impossible to make a diagnosis only on the basis of examination and complaints of the patient; instrumental studies are necessary.

Detection of metastases in the lungs on X-ray is possible, but to clarify their location and to identify small nodules, computed tomography is necessary. This method allows you to detect even those cancer cells that are located subpleurally. Metastases in the lungs on x-rays look like dark spots that have a round shape or the shape of strands. In fact, the actual color of the nodes and cords depends on the primary tumor. For example, with melanoma they are brown or white, but with sarcoma they may be pinkish-gray.

If there is a need to reduce the radiation dose to the body, the patient is sent to undergo magnetic resonance imaging. This procedure makes it possible to visualize microscopic neoplasms up to 0.3 mm in diameter. The tumor marker СYFRA 21-1 makes it possible to detect metastases in the lungs at the early stages of their development. Of course, the doctor is faced with the task of detecting a primary tumor, which spreads pathological cells throughout the body through the circulatory or lymphatic system. To do this, additional examinations of all internal organs are carried out.

Treatment provided

For metastases in the lungs, treatment directly depends on what kind of tumor is found in the patient, as well as how it reacts to the drugs administered. Important factors are criteria such as: the number of nodes, their location, the general well-being of the patient, etc.

For metastases in the lungs, chemotherapy can eliminate some lesions or stop their growth. Treatment may be aimed at both getting rid of tumor cells and improving the patient’s quality of life. Chemotherapy can be carried out as an independent therapeutic method, or in combination with other methods of getting rid of the disease.

Once the focus of the spread of pathological cells has been established, the doctor will decide how to treat metastases in the lungs. The fact is that some types of tumors are sensitive to radiotherapy, for example, metastases from Ewing's sarcoma or osteogenic sarcoma.

If a patient has single nodes, surgical removal is possible. It is important that there are no metastases in other organs, and that the primary tumor responds well to the therapy. In this case, you can expect that the life expectancy of a patient with lung metastases will be increased to one to two decades.

In general, many factors influence how long a particular patient will live with lung metastases. The average five-year survival rate of such patients is 40%. This is possible with early detection of the pathology and provided that the patient has not practiced folk remedies for metastases in the lungs. The best results can be achieved when the pathology was caused by cancer of the uterus, breast, bones and kidneys.

Metastases in the lungs pose a particular danger to cancer patients. Their appearance indicates the progression of the disease and the prevalence of the malignant process. The likelihood of death and the patient's life span depend on many factors, which must be taken into account when selecting an effective treatment regimen.

What are metastases?

Metastases are secondary foci of a malignant tumor. Cancer cells are separated from the maternal carcinoma and travel to nearby lymph nodes. An unfavorable prognosis criterion for life is damage to distant organs. Most often, metastases are detected in the lungs. Secondary lesions also arise in other organs, where there are favorable conditions for their development:

• brain;
• bones;
• liver;
• peritoneum;
• kidneys

Metastases can appear anywhere. Where exactly the fragment of the maternal tumor will be transferred, where it will linger and begin to actively develop, depends on the localization of the primary focus. The rate of the process is influenced by the degree of differentiation of neoplasia.

The appearance of metastases significantly worsens the prognosis of the disease, and when the lungs are affected, it becomes the main cause of death.

Principle of development and ways of distribution

The development of metastases is a complex biological process. It begins when cancer cells break away from the primary neoplasia, enter the blood, lymph, or spread through other routes. Metastasis occurs in stages:

1. Malignant tumor cells rapidly divide. They lose their differentiation and cease to perform functions. They have one goal - to reproduce.
2. The connection between cells is lost. Normally, each cell fits tightly to the neighboring one. With loss of differentiation, these connections weaken and the cell easily separates.
3. The tumor grows into the blood vessels. Cancer cells enter the lymphatic or bloodstream, implant into neighboring organs, and spread throughout the body. Once in another organ, they become fixed there and form a secondary focus.

This happens when the immune system is greatly weakened. If the body’s defenses are triggered, then the atypical cells are destroyed. A few of them reach other organs. Metastasis to the lungs does not occur by chance. Here, the conditions are most optimal for the spread and further development of malignant tumors:

• Lung tissue cells produce cytokines - growth factors that stimulate tumor development.
• A developed dense capillary network that allows the cancer embolus to move into the lung tissue.
• Developed lymphatic system.
• There are arteriovenous fistulas.

Secondary lesions arise rapidly if, before the removal of the primary tumor, there were already micrometastases that cannot be detected by modern methods. Sometimes lung damage is initially detected, and only then they begin to look for the maternal lesion. Even small-sized neoplasias that have not yet manifested themselves clinically can grow into blood vessels and spread to distant organs.

Cancer cells enter the lungs in the following ways:

• Hematogenous. Tumor cells linger in the smallest capillaries, arterioles, and venules of the lungs, penetrate the vascular wall, become established and form metastases. Usually the lesions are located at a distance from each other. Sometimes single nodes appear.
• Lymphogenic. With the lymph flow, tumor cells are transported to the lymph nodes of the roots of the lungs and mediastinum. They multiply there, replace the tissue of the nodes, lead to insufficiency of the valves of the lymphatic vessels, and this allows atypical cells to disseminate into the lungs.
• Bronchogenic. Cancer of the larynx, root of the tongue, trachea, oro- and nasopharynx spreads in this way. Malignant cells slough off the surface of the tumor and enter the bronchi. There they are implanted into the wall, multiply intensively, and grow into the lungs.
• Metastasis continued. In this way, tumors of nearby organs (breast and thyroid glands, esophagus) spread.

The main reason for the appearance of metastases in the lungs is reduced immunity. Normally, even if cancer emboli enter the blood, they are destroyed.

The main task of oncologists is to promptly identify metastases and begin treatment. That is why patients, after removal of the primary tumor, are monitored at the dispensary for a long time and are periodically examined. X-ray examinations or computed tomography of the lungs are required.

The shape, type and number of metastatic nodes significantly influence the treatment tactics and further prognosis.

Classification of metastases to the lungs

When determining the effectiveness of a particular treatment method, the oncologist is guided by the form of metastases, their number, and from which maternal tumor they developed.

Based on their histological structure, metastases are classified like the primary tumor from which they arose (they are similar in morphological and cytological characteristics).

According to the number of metastases in the lungs there are:

• single (one node identified);
• single (no more than 3 metastatic nodes);
• multiple.

The prognosis is most favorable if a single metastasis is detected in the lung. Such a tumor is easier to treat, especially if there are no contraindications to surgery. Sometimes a solitary secondary focus is formed by the fusion of multiple metastatic nodules and looks like a single tumor.

Based on their form, pulmonary metastases are classified into:

• spherical;
• nodular (miliary carcinosis);
• pneumatic;
• interstitial (metastatic lymphangitis).

Globular. The most common form of metastases. They are round and have a uniform structure. Foci of destruction and inclusions of calcium salts appear in some formations. Partial calcification is characteristic of metastases of thyroid, prostate, and bone cancer. If there are obstacles that prevent uniform growth, the formations become ovoid or irregular in shape. This occurs if the metastatic tumor is localized near:

• ribs;
• diaphragms;
• interlobar pleura.

Miliary carcinosis. It is characterized by the presence in the lungs of many small, uniform, evenly distributed nodules. The X-ray description of the changes resembles disseminated tuberculosis. The appearance of many small nodes is characteristic of hematogenous spread of metastases.

Pneumoma-like metastases. Mostly multiple, most often occur with bronchogenic spread of cancer cells. The X-ray picture is similar to manifestations of inflammatory infiltration of the lungs. This complicates timely diagnosis, since metastases in the lungs manifest symptoms similar to pneumonia and tuberculosis.

Interstitial metastases. Characteristic of lymphogenous spread of tumor emboli. By origin, lymphangitis is:

• retrograde;
• orthograde.

Retrograde lymphangitis develops when metastases spread through the lymph nodes against the flow of lymph.

Orthograde is associated with tumor dissemination from small lymph nodes located subpleural to the root of the lung. In the picture, interstitial metastases look like manifestations of pneumosclerosis.

The form of metastases depends on the location of the primary tumor and the route of their spread. The same factors influence the clinical manifestations of secondary lesions.

Symptoms (signs)

Most patients (70–80% of cases) with single small metastases do not have pronounced symptoms. Clinical manifestations occur as the disease progresses. Patients come to the doctor with complaints of:

• Cough with sputum that occurs when a tumor grows in the bronchi.
• Hemoptysis, characteristic of disintegrating metastatic tumors, severe damage to the pulmonary parenchyma.
• Chest pain that appears when the secondary lesion is centrally located or when the tumor invades the pleura.

As the disease spreads, general symptoms are added:

• low-grade body temperature;
• fatigue;
• anemia;
• decreased appetite;
• weight loss.

The appearance of metastases of thyroid cancer and other malignant tumors during hematogenous metastasis occurs almost asymptomatically.

When metastases spread through the lymphatic vessels (typical for cancer of the stomach, colon, pancreas, breast), in 15–20% of patients, symptoms appear before changes in the X-ray picture. For a long time they have been unsuccessfully treating inflammatory diseases (bronchitis, pneumonia). This is due to the fact that the symptoms of lymphatic metastasis to the lungs are clinically manifested, like these diseases. Patients complain about:

• shortness of breath;
• dry cough;
• increased body temperature;
• weakness.

Cough with metastases in the lungs and other symptoms do not go away after specific antibiotic treatment. Within 2–3 months, the patient’s condition deteriorates sharply:

• respiratory failure increases;
• general condition worsens;
• anemia increases.

In addition to the typical manifestations of pulmonary metastases, patients complain of symptoms characteristic of a malignant primary tumor and damage to other organs by metastases. For example:

• ascites (for ovarian, gastrointestinal, kidney cancer);
• symptoms of spinal cord decompression (with damage to the vertebrae);
• constipation, intestinal obstruction (colorectal cancer);
• dysphagia (cancer of the larynx, esophagus, thyroid gland);
• and many others, typical for cancer of a certain localization.

With early diagnosis of metastatic lung disease and timely adequate therapy (even if the primary tumor is not identified), the patient’s quality of life improves. If solitary metastases are treated, the patient can forget about the existence of the disease for many years.

If metastases cannot be treated with various methods, the process quickly spreads and the patient’s condition deteriorates sharply. Patients complain about:

• Persistent painful cough.
• Hemoptysis. Sometimes it is so intense that patients are afraid of dying from hemorrhage.
• Severe pain, difficult to relieve with narcotic analgesics.
• Shortness of breath. Persistent breathing problems cause panic in the patient, and this intensifies the symptom.

In the terminal phase, the drainage of the trachea and bronchi is disrupted. Due to the accumulation of secretions in the respiratory tract, a so-called death rattle occurs. It manifests itself as noisy, bubbling, gurgling breathing. In this case, most patients are either unconscious or exhibit confusion.

The main question asked by relatives and patients with metastases in the lungs is: “How long to live?”, especially when the patient feels worse every day and treatment does not help. Before death, the patient practically does not get up; every movement causes pain, which is eliminated with strong narcotic drugs. Due to anemia, the skin is pale. The condition is very serious. To improve the quality of the remaining life, patients are offered to be hospitalized in hospices, where proper medical care will be provided.

At what stage do pulmonary metastases appear?

When diagnosing a malignant tumor, the stage of the disease must be indicated. This information is important for selecting treatment tactics, predicting the success of treatment and the patient’s life expectancy. Main criteria for determining the stage:

• neoplasia size;
• invasion into surrounding tissues;
• damage to regional lymph nodes;
• the presence of distant metastases.

Various diagnostic procedures are carried out and the histological structure of the tumor is established. Be sure to examine the lungs, bones and other organs where tumors most often metastasize. After this, the stage is determined:

• 0 – tumor cells are detected by microscopic examination. The main symptoms appear rarely and are characteristic of background and precancerous diseases.
• I – the tumor is small. For most cancers, its size does not exceed 2 cm. Regional lymph nodes are not affected.
• II – formation 2–5 cm. There are no more than 2–3 metastases in the nearest lymph nodes.
• III – neoplasia of large size, grows into neighboring organs and structures. Numerous lesions of regional lymph nodes are detected.
• IV – the tumor is either very large, disintegrating, invading nearby organs, or, regardless of its size, metastases are determined in distant organs.

The appearance of metastatic nodes in the lungs, regardless of the size of the primary lesion (sometimes it is not detected) – stage IV. Secondary lesions indicate the spread of the malignant process, which significantly worsens the prognosis for life.

According to the TNM system, stage IV, with metastatic lesions of the lungs is: any T (tumor size), any N (damage to regional nodes) and M 1pul (metastases in the lungs).

According to ICD-10, metastatic lung disease without an identified maternal tumor is designated by code C78.0.

Primary tumor with metastases in the lungs

In some patients, metastatic lung disease is detected during a preventive medical examination. Secondary lesions are detected during X-ray examination of the respiratory organs, when patients seek medical help with complaints of cough, dyspnea (shortness of breath). Then it is necessary to detect the primary tumor. When prescribing diagnostic procedures, it is taken into account that carcinomas of a certain localization most often disseminate into the lungs.

Frequency of metastatic lesions of the lungs in tumors of various locations

*The table shows statistical data for lung metastases without an identified maternal lesion and with treated primary cancer.

A clue as to where to look for the primary lesion is often characteristic radiological signs.

Round shadows, small sizes, nodes of approximately the same size are typical for cancer metastases:

• mammary gland;
• stomach;
• melanoma;
• osteosarcomas;
• colon;
• chorionepitheliomas of the uterus.

Globular metastases of different sizes are typical for cancer:

• kidney;
• testicles;
• thyroid gland;
• sarcomas of the uterus.

Lesion in the form of metastatic lymphangitis is detected in stomach and breast cancer. These tumors often spread to the lungs through the lymphatic route.

Sometimes the primary tumor cannot be identified. It can be small in size, poorly differentiated (in this case, histological examination will not tell in which organ the neoplasia arose). The search does not go deep; in case of metastases in the lungs, treatment must be started immediately using all available effective methods, so as not to waste precious time.

The difference between a metastatic tumor and a primary one

Treatment and prognosis for the patient’s life with metastases in the lungs and their primary lesion are significantly different. It is imperative that differential diagnostics be carried out between these conditions. Take into account:

• X-ray picture;
• histological structure of the formation;
• prevalence and localization of lesions;
• damage to regional lymph nodes;
• manifestation of paraneoplastic syndromes.

Even if the primary lesion is known, which could give metastases, it is still necessary to make sure that the lung damage is secondary. There are cases of synchronous cancer of various organs.

The main differences between primary lung cancer and metastases

Metastases	Lung neoplasia
The histological structure is the same as that of the primary tumor.	The histological structure characteristic of lung cancer (large cell, small cell) is determined.
There are no pretumor changes in the pulmonary parenchyma.	Background or precancerous changes detected: scarring; dysplasia; carcinoma in situ (stage 0 cancer).
No regional metastases	Regional lymph nodes are affected (when diagnosing stage 3 carcinoma).
Parenchyma affected	The bronchi are affected.
Characteristic radiological signs of metastases	Typical radiological and endoscopic picture of a primary lung tumor (depending on location).
Multiple nodes are more common	Mostly single lesions are detected
A short period of time passes before the second metastasis appears.	More than 2 years pass before the second tumor develops (without appropriate treatment)
Paraneoplastic syndromes characteristic of cancer of other localizations.	Parneoplastic syndromes typical for lung carcinoma (thrombophlebitis, myo-, neuropathy, Horner's syndrome; KAVA symptom, Marie-Bamberger osteoarthropathy).
Tumor markers specific for tumors not localized in the lungs (thyroglobulin, PSA, CA 15-3, etc.).	Tumor markers for lung cancer CA 125, CYFRA 21-1
After radical treatment, the process quickly generalizes.	Lack of generalization of the malignant process after tumor removal.
The patient is not at risk for lung cancer.	The presence of several risk factors for developing lung carcinoma.

Lung metastases are more often found in the lower lobes. They are usually localized in peripheral areas. Unlike primary cancer, large bronchi and visceral pleura are not involved in the malignant process. An unambiguous diagnosis is established taking into account the results of various studies in order to exclude error.

Diagnostics

In most cases, metastatic cancer is detected during an X-ray examination of the lung. The picture of secondary lung damage in the images is varied. It is often necessary to carry out differential diagnosis with other diseases:

• pneumonia;
• tuberculosis;
• primary lung cancer;
• lung sarcoma:
• carcinoid;
• benign tumor.

X-ray examination is carried out in various projections in order to most fully determine the presence of pathological foci, compactions, and their localization. Sometimes it is recommended to conduct a study with the introduction of contrast. This allows you to more accurately identify the presence of metastases. Sometimes, without the introduction of a contrast agent, small pathological lesions are not so noticeable on the image.

In most cases, additional examinations are prescribed:

• Computed tomography. A more accurate research method than x-rays. With its help, metastatic nodes with a diameter of 3 mm or more are identified.
• MRI, PET-CT and transesophageal ultrasound are recommended to determine the degree of involvement of pulmonary blood vessels, the atrium in the malignant process, and to identify metastases in other organs.
• Videothoracoscopy. A method that allows you to examine the bronchi (they can also be involved in the metastatic process). During this procedure, it is possible to take a fragment of the tumor for further histological analysis. Thoracoscopy is performed for the same purpose, but this method is more traumatic.
• Histological examination. This method is the most accurate. Only by studying the structure of the pathological focus can one determine with confidence whether the changes detected on the x-ray are really metastases, or whether it is primary lung cancer, a benign formation.

Based on the results of visual diagnostic methods, the number and location of lesions are identified, the possibility of surgical treatment is determined, and palliative care tactics are developed.

Histological examination not only helps to establish the type of tumor and suggests where the possible primary focus is located. With its help, the resistance of metastases to:

• chemotherapy;
• hormonal treatment;
• radiation therapy.

When searching for a maternal tumor, one is guided not only by radiological characteristics and histological structure. Clinical studies provide a lot of valuable information, for example:

• Microcytic anemia is characteristic of gastrointestinal cancer.
• Microhematuria accompanies kidney and bladder cancer.
• An increase in total protein in the blood indicates multiple myeloma.
• Increased levels of alkaline phosphatase and PSA occur in prostate cancer.
• Bence Jones protein is detected in lymphoma and myeloma.
• Increased levels of specific tumor markers in cancer of a certain localization.

Diagnosis is not made based on clinical studies alone. It is necessary to carry out clarifying diagnostic procedures:

• endoscopy with targeted biopsy.

The final diagnosis is established based on the totality of all research results.

After carrying out the necessary procedures, the optimal treatment tactics are selected. If the prognosis is favorable, it is aimed at remission. If unfavorable, it will improve and prolong the patient’s life as much as possible.

Treatment

The appearance of distant metastases in the lungs is an unfavorable prognostic criterion. The success of treatment, the duration and quality of life of the patient depend on many factors that are taken into account when selecting therapeutic tactics. This:

• Number of metastases in the lungs.
• Histological structure of malignant formation.
• The presence of metastases in other organs.
• Possibility of surgical treatment.
• Tumor resistance to chemoradiotherapy and hormone therapy.
• The time during which metastases formed, the speed of their spread.
• Individual tolerance to drugs and radiation.
• Presence of a primary lesion (it was removed, a relapse occurred, it was detected after detection of metastatic lesions of the lungs, or it was not found).

In case of solitary, single metastases, tumors sensitive to chemoradiotherapy and hormonal treatment, when it is possible to surgically remove metastases, it is possible not only to prolong the patient’s life, but also to cure stage IV cancer.

The course of therapy lasts a long time. A set of methods is used:

• chemotherapy;
• immunotherapy;
• hormone therapy;
• radiation treatment;
• minimally invasive methods;
• surgical treatment.

Patients complement complex therapy with various traditional methods. Metastases of hormone-dependent tumors and osteogenic sarcoma can be successfully treated. It is more difficult to select effective drugs for the treatment of a secondary focus of lung cancer in non-hormone-dependent tumors of the pelvic organs. Metastases of kidney cancer, melanoma, and chondrosarcoma are the most resistant to treatment.

The following factors indicate an unfavorable prognosis and failure of treatment:

• Rapid progression of the malignant process.
• The primary tumor was not removed.
• Metastases are resistant to various treatment methods.
• Other organs are affected (spine, brain, liver, etc.).

In this case, they try to improve the patient’s quality of life as much as possible by eliminating symptoms. Palliative treatment is prescribed. If the patient is in serious condition and needs constant medical care, he is hospitalized in a hospice (sometimes relatives themselves care for the dying person).

Symptomatic treatment is also indicated for patients with a more favorable prognosis.

Symptomatic treatment. Eliminating symptoms is not a cure for cancer. With a more favorable prognosis, it is used as a complementary method. If things go unfavorably, this is the only possible way to make the life of a cancer patient easier.

Patients are prescribed:

• bronchodilators (for shortness of breath);
• mucolytics and other antitussive drugs;
• nonsteroidal anti-inflammatory drugs (they reduce pain and are antipyretic);
• tranquilizers (reduce shortness of breath, they are effective antiemetics and sedatives).

If severe complications occur (pneumonia, pleurisy, pneumothorax, bronchial obstruction), palliative operations are performed.

In most cancer patients, especially in the terminal stage of the disease, the main symptom is pain. It can be stopped in various ways.

Chemotherapy. For disseminated malignant process, the main treatment method is chemotherapy. In some cases, it contributes to a temporary reduction in the size of metastases, and sometimes even their complete disappearance.

To treat stage IV, aggressive therapy is prescribed. Cytotoxic, antitumor drugs cause many side effects. They are used because in most cases this is the only way to prolong the patient’s life, and with a favorable prognosis, to achieve remission.

Chemotherapy for lung metastases is effective for certain types of tumor and its sensitivity to certain drugs.

The effectiveness of chemotherapy for cancer of various locations

*Efficacy is taken into account in 5-year patient survival. Stable remission with the most favorable prognosis can be achieved in 20–30% of cases.

**Patients with Ewing's sarcoma after chemotherapy are at high risk of disease recurrence with more rapid progression.

For the treatment of pulmonary metastases, the same drugs are prescribed as for the treatment of the primary tumor. They are recommended to be administered intravenously. Prescribed:

• cytostatics, cytotoxins (5-fluorouracil, platinum drugs, Dacarbazine);
• targeted drugs (Trastuzumab, Rituximab, Bevacizumab, etc.).

The success of treatment depends on the degree of tumor differentiation. Metastases of undifferentiated and poorly differentiated formations are more easily affected by medications.

Biotherapy. Melanoma, kidney tumors and some other localizations are insensitive to various chemotherapy regimens. A positive effect is observed when this method is combined with immunotherapy. Prescribed:

• Interleukin-2;
• Interferon-ά;
• Interferon-γ.

Highly toxic doses are used to treat disseminated cancer. They cause various side effects, but for metastatic lung disease they increase the effectiveness of treatment by 10%. With small solitary metastases, tumor regression is observed in 15% of cases.

Hormone therapy. Most often, metastases in the lungs occur with hormone-dependent tumors. The prognosis in this case is the most favorable.

Depending on the location of the tumor and the presence of receptors for certain hormones, patients are prescribed:

• androgens (Tetrosterone, Proloteston, Methyltestosterone);
• gonadotropin-releasing hormone agonists of the pituitary gland (Buserelin, Triptorelin, Leuprorelin);
• progestogens (Gestonoronkaproate, Megestrol, Medroxyprogesterone);
• antiestrogens (Tamoxifen, Toremifene);
• estrogens (Phosfestrol, Chlortrianizen, Synestrol).

• late occurrence of metastases (more than 5 years have passed since the removal of the primary tumor);
• old age;
• single metastases;
• tumor of high and moderate degree of differentiation.

If a positive effect is not observed within 8 weeks, patients change the hormonal drug or transfer to chemotherapy.

In case of secondary lung damage, radiation therapy is carried out as palliative treatment to relieve pain and tumor regression. They are used depending on the type of tumor, type of pulmonary metastases, and treatment goals:

• remote gamma therapy;
• irradiation at linear accelerators;
• endobronchial radiation treatment;
• radiopharmaceuticals.

In most cases, radiation treatment is prescribed for palliative care. For some types of cancer, such as thyroid tumors, radiopharmaceuticals (radioactive iodine) promote regression of metastases.

Minimally invasive surgical interventions. Minor surgical operations are recommended for the removal of small single metastases, for palliative purposes (for bronchial obstruction, fluid accumulation in the lungs).

To influence the secondary focus, the following methods are used:

• Intra-arterial chemoembolization. A special catheter is installed through which highly toxic doses of chemotherapy drugs are delivered directly to the pathological focus.
• Radiofrequency ablation of the tumor. Hyperthermia has a destructive effect on cancer cells. Healthy cells are less sensitive to high temperature, and the source of radiofrequency action directly affects the tumor.
• Endoscopic laser coagulation. With its help, small metastases are destroyed and bleeding is prevented.
• Photodynamic therapy. The patient is injected with a photosensitizer, then the metastasis is exposed to laser radiation. The formation becomes necrotic.

Minimally invasive operations are performed under the control of CT, MRI, and ultrasound. This allows you to act directly on the pathological focus.

The effectiveness of these manipulations is high for small solitary nodes. A minimally invasive operation, if multiple metastases are detected in the lungs, is performed to alleviate the patient’s condition when complications develop (the accumulated fluid is pumped out, large metastases that compress the bronchi, nerves, and large vessels are removed).

Radical surgical treatment. Radical treatment of stage IV cancer with an advanced process is carried out for palliative purposes to remove single metastases. When the doctor determines the need for surgery, will it really improve the quality of life? In most cases it is contraindicated, especially with multiple lesions.

• the primary tumor has been removed;
• the histological type of maternal carcinoma was established;
• only the lungs are affected by metastases;
• all secondary lesions in the lungs are removed;
• the risk of surgery is low.

Surgical treatment is performed in 10–20% of patients. Gentle, economical operations such as wedge-shaped or marginal sublobar resection or segmentectomy are used.

Palliative operations aimed at improving the quality of life and prolonging it are more often performed.

Traditional treatment. Herbal medicine and other non-traditional methods of treatment are used by many patients with advanced cancer and lung damage. They use all available and incredible methods. For breast cancer with metastases in the lungs and melanoma, it is recommended to apply a cabbage leaf and coat the painful areas with honey. In principle, with their help you can relieve pain somewhat and reduce inflammation (especially if you believe that the methods are effective). The main thing is not to replace the main therapy with them.

Among all the popular, alternative methods, there are those that oncologists categorically do not recommend. This is a replacement for chemotherapy, analgesics:

• fly agarics;
• hemlock;
• celandine.

Using poisonous mushrooms and plants is very dangerous. In pharmaceuticals, dosages are strictly calculated. The doctor prescribes medications taking into account their tolerability and effect on the tumor.

Some folk methods can be used as part of complex treatment. Useful:

• Rosehip decoction (100 g of berries per 0.5 liter of water). It will provide the body with the necessary vitamin C, help remove toxins from the body, and improve tone.
• Fruit and vegetable juices (from beets, carrots, tomatoes), birch sap. They contain a lot of useful substances necessary to fight the disease and recover after treatment.
• Elderberry decoction with walnuts (1 tbsp elderberry flowers, 4 crushed walnut kernels, 0.5 liters of water). Drink 1 glass if you have a severe cough.

• Chamomile and linden tea. Helps with the inflammatory process of the respiratory tract, which often accompanies the appearance of metastases in the lungs.
• Lemon. It can be added to teas and decoctions. It is rich in vitamin C and has a general strengthening effect.
• Garlic. It contains substances that have an antimicrobial effect, enhance immunity, and delay the spread of metastases.
• Soda solution. You can drink it if you have to take a lot of NSAIDs, and this causes heartburn. It is better to replace soda with special preparations.

With severe shortness of breath, cool air helps patients (for this they use a regular hairdryer or fan). You can use an oxygen concentrator. It is used for obvious signs of hypoxia. Patients with chronic pulmonary diseases should use it carefully. In this case, oxygen therapy may cause respiratory failure.

For severe coughing and accumulation of phlegm in the lungs, physical therapy and light massage are recommended. In order not to harm yourself or worsen your health, the necessary exercises and procedures are carried out under the supervision of a specialist.

Alternative cancer treatments focus on treating symptoms rather than curing the disease.

Pain reliever for metastases in the lungs. Pain not only interferes with normal life, it has a depressing effect on the patient. It causes depression. Sometimes it is so unbearable that the patient has no strength left to further fight the disease. Painkillers for metastases in the lungs are prescribed depending on the intensity of the pain. According to WHO recommendations, three-stage therapy is prescribed:

1. NSAIDs. Treatment begins with large doses. Prescribed Prednisolone, Dexamethasone. Then the dose is gradually reduced to the threshold. If NSAIDs do not provide the desired effect, move on to stronger analgesics.
2. Weak opiates and opioids. Codeine, Promedol, Tramal are prescribed. Sometimes these drugs are recommended to be used in combination with NSAIDs.
3. Strong opioids. Morphine, Buprenorphine, Omnopon are prescribed to relieve severe pain. They are recommended to patients as a strong sleeping pill when intense pain prevents them from falling asleep.

In order for the use of analgesics to have a positive effect, they are taken strictly on time. The oncologist determines what medications are needed. NSAIDs and opioids cause various side effects.

Nonsteroidal anti-inflammatory drugs indirectly reduce cough and shortness of breath. This causes undesirable effects:

• Prevent platelet aggregation, impairing blood clotting.
• They negatively affect the gastrointestinal tract and provoke the development of ulcers.
• Causes liver damage. Ibuprofen has the least hepatotoxic effect.
• Impair kidney function. They provoke oliguria, hyperkalemia, hyponatremia, and in some concomitant diseases cause acute renal failure.

Non-opioid analgesics are prescribed in the absence of contraindications. To reduce the likelihood of developing NSAID gastropathy, Omeprazole and Ranitidine are additionally prescribed.

• nausea, vomiting;
• intestinal obstruction;
• constipation;
• respiratory depression.

Taking opioids and cytotoxins is the main cause of vomiting with metastases in the lungs and other side effects that can be controlled with accompanying therapy.

Fentanyl is dangerous in case of metastatic lesions of the lungs. It causes a decrease in the excitability of the respiratory center, provokes and aggravates shortness of breath.

Any of the narcotic analgesics can cause acute opioid withdrawal.

To reduce pain and relieve an irritating cough, local inhaled anesthetics are prescribed:

• Lidocaine;
• Bupivacaine.

To reduce the risk of side effects (numbness in the throat, disturbance or distortion of taste), after the procedure it is not recommended to drink or eat for 1 hour.

Which methods of pain relief the oncologist will prescribe depends on the intensity of the symptom, the effectiveness of weaker non-narcotic analgesics, concomitant diseases, and individual susceptibility to drugs.

Psychological assistance

All cancer patients, especially those with diagnosed disseminated cancer, need psychological support. Which methods should be used depends on:

• individual characteristics;
• social problems;
• emerging psychological difficulties.

Everyone's disease progresses differently. In some cases, when the prognosis is favorable, it is necessary to support the patient - help him get out of depression, and direct all efforts to fight the disease. To do this, they use methods that distract from the disease and its manifestations, helping to cope with the situation. Various psychological techniques are used:

• Distraction therapy (listening to music, reading your favorite books, various hobbies).
• Progressive muscle relaxation (gradual tension and relaxation of 16 muscle groups).
• Method of mental images (meditation).

Patients with an unfavorable prognosis need psychological support in order to comprehend what is happening and come to terms with the situation. One of the common techniques is to draw your illness on paper (as the patient imagines it). Then the drawing is burned.

Communication with patients who have already coped with their illness helps. The patient’s desire to get well contributes to treatment.

With metastases in the lungs, the prognosis is rarely favorable, but there are patients who have coped with the disease using complex treatment. They undergo a complex course of treatment, overcoming all the side effects of chemoradiotherapy, fear of surgery, pain after treatment and associated with the disease, and in the end they win.

Cure from cancer with metastatic lesions of the lungs is not a miracle - it is hard work not only of oncologists and oncological psychologists, but also of the patient himself.

Course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. Primary lung disease is rare in children. In most cases, detected malignant tumors are metastases. They occur when:

• Wilms tumors;
• osteosarcoma;
• rhabdomyosarcoma;
• neuroblastoma;
• thyroid cancer;
• angiosarcoma;
• teratoma;
• Ewing's sarcoma.

Children are characterized by an aggressive course of the disease and rapid spread of the process. How long children with lung metastases live depends on the primary tumor and timely detection of the pathology.

Pulmonary metastases appear:

• shortness of breath;
• cough;
• hemoptysis;
• difficulty swallowing;
• pain.

Sometimes they are accompanied by superior or inferior vena cava syndrome.

Treatment depends on the type of primary tumor. If metastases are initially detected, the prognosis is more unfavorable. All available methods are used for treatment:

• aggressive triple chemotherapy;
• irradiation with large fractions;
• radiopharmaceuticals (for thyroid cancer, osteosarcoma);
• surgical removal of solitary metastases.

Chemotherapy treatment is started. It is supplemented with nonspecific restorative treatment (vitamin therapy, symptomatic treatment, hemostimulating therapy). The swelling gradually decreases and the intensity of pain decreases. After which radiation is prescribed.

Unfortunately, with metastatic damage to the lungs in some types of cancer (Ewing's sarcoma), relapses of the disease and its sharp progression are possible. For other tumors (thyroid gland), the prognosis is more favorable. All the same, patients need to undergo constant examinations after treatment and recovery, as the disease may return.

Pregnancy and lactation. In pregnant and lactating women, the prognosis of the disease and treatment tactics depend on:

• features of the primary tumor;
• number of metastases;
• gestational age.

There is no standard answer to how to treat pregnant women and whether to have an abortion. Everything is purely individual. Chemotherapy can be administered in the second and third trimesters. In the first trimester, the use of pharmaceuticals is dangerous for the fetus. If metastases are detected in the last stages of pregnancy and the cancer does not progress quickly, then treatment is carried out after childbirth. Prescribed:

• cytotoxins;
• targeted drugs;
• immunomodulators;
• hormonal treatment;
• radiopharmaceuticals.

It should be remembered that during pregnancy the disease spreads faster.

If a metastatic lesion is discovered after childbirth and the child is breastfed, then he is transferred to artificial feeding. The mother needs to undergo a course of highly toxic chemotherapy, radiation treatment, and hormone therapy.

Advanced age. In old age, the course and treatment of disseminated cancer is complicated by concomitant diseases. When selecting chemicals, take into account their toxicity and negative impact on other organs. In most cases, even with solitary metastases, they are not removed. This is due to the fact that the risk of surgical intervention is much higher than without treatment. Sometimes specific therapy for metastatic lesions is more harmful than the disease itself. In these cases, only palliative care is indicated. Medicines and manipulations are prescribed to reduce symptoms and improve quality of life.

Recovery process after treatment

For disseminated cancer, treatment usually lasts for the rest of your life. To improve its quality, you have to repeatedly undergo therapeutic courses and then recover from them. Pharmaceuticals, surgery and radiation disrupt the smooth functioning of the body, but without them cancer cannot be cured. To restore you need:

• restorative therapy;
• physiotherapy;
• psychological and social rehabilitation.

Correction of any complications that arise is carried out so that in the future they do not lead to complete loss of ability to work.

It is necessary to observe a work-rest regime and not perform complex tasks while the body is weakened by the fight against the disease.

Physical exercise (with gradually increasing load) and proper nutrition will help you recover faster.

Diet

For metastatic lung disease, doctors do not recommend fasting (although many healers claim that this can destroy the tumor). The body is weakened and needs nutrients. The diet is selected so that it is sufficiently high in calories, and the products contain all the necessary substances. It is necessary to limit consumption:

• smoked meats;
• alcohol;
• fast food;
• salinities and other carcinogenic products.

Particularly dangerous are those that contain various preservatives, flavors, and dyes.

• fish;
• nuts;
• eggs;
• porridge (especially buckwheat);
• lean meat.

It is better to eat more fresh vegetables and fruits. Greens (lettuce, dill, parsley) are especially useful. You need to eat a little, but often. You should drink fresh juices, green tea, and decoctions of medicinal herbs (recommended by your doctor).

Treatment of cancer with metastases in the lungs in Russia, Israel and Germany

In most cases, lung metastases cannot be completely cured. In all countries, complex treatment is used to combat the disease. Traditional and experimental methods are used. The type of primary tumor, the number of metastases in the lungs, and damage to other organs are taken into account. Combine various methods:

• cytotoxins, cytostatics;
• targeted drugs;
• immunomodulators;
• hormonal therapy;
• irradiation;
• radiopharmaceuticals;
• removal of metastases.

Many countries are conducting clinical trials of new treatment methods. Sometimes for patients with lung metastases this is the only chance to cope with the disease. Metastatic lesions should be treated in specialized clinics where there is a department of oncopulmonology, chemotherapy, and radiotherapy.

Treatment in Russia

There are many large clinics in Russia where patients with advanced cancer receive the necessary medical care. Depending on the structure of the tumor and the characteristics of the course of the disease, the following is prescribed:

• symptomatic treatment;
• chemoradiotherapy;
• minimally invasive and surgical removal of metastases.

If the tumor is sensitive to drug or hormonal treatment, then the course begins with these drugs. If the course is favorable, remission of the disease or regression of metastases is achieved. Then radiation treatment is carried out.

In large cancer centers, solitary metastases are removed using minimally invasive techniques. Video-assisted operations are performed with mini-access through one incision. In case of multiple lesions, thoracoscopic interventions and robot-assisted operations are performed according to indications. Cyberknife for metastases in the lungs is used for palliative treatment, removal of single small lesions.

Palliative care is provided both in special institutions and in district clinics. When choosing a clinic where to undergo treatment, you need to focus on the availability of equipment, specialists, and the level of medical and psychological care provided.

Large oncology centers where they treat lung metastases:

• The center provides radiotherapy treatment. There is a department for the study of new anticancer drugs, where patients with advanced cancer are selected for effective complex therapy and palliative care is provided. The latest and traditional treatment methods are used (cryotherapy, radiofrequency ablation). The center conducts clinical trials.
• Federal State Budgetary Institution "Russian Scientific Center of Surgery named after. B.V. Petrovsky", Moscow. The clinic is equipped with modern technologies. It is possible to remove metastases using video-assisted operations. Medicines and targeted drugs are prescribed depending on the sensitivity of the tumor to them. To administer chemotherapy, arterial chemoembolization is performed. An artificial blood circulation is created to the tumor, and highly toxic drugs are introduced into it to destroy cancer cells.
• MNIOI named after. P.A. Herzen, Moscow. Treatment tactics are developed by a council of specialists. According to indications, patients are prescribed chemoradiotherapy, hormone therapy, resection of single metastases, symptomatic therapy, and palliative surgery.

In Russia, in most large cities there are many clinics where patients receive appropriate medical care for metastatic lung disease. For seriously ill patients in the terminal stage, hospitalization in hospice is possible. Quota treatment is free. There is a possibility of paid treatment.

Approximate cost of treating lung metastasis

*Price does not include medications. They are selected individually depending on contraindications and the tumor’s response to treatment with certain medications.