Secondary Lung Tumors Clinical Presentation

Updated: Feb 08, 2019
  • Author: Daniel S Schwartz, MD, MBA, FACS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History

Patients with multiple pulmonary nodules as a result of metastatic spread can be asymptomatic, especially those with indolent, slow-growing cancers, such as papillary thyroid cancer or adenoid cystic carcinoma of the salivary gland. However, the clinical presentation of patients with pulmonary metastatic lesions occurring late in the course of advanced extrapulmonary cancer is commonly dominated by the signs and symptoms of advanced/terminal malignant disease and by signs and symptoms associated with the primary cancer.

Lymphangitic spread of the cancer into the lungs is associated with the recent onset of rapidly progressive dyspnea at rest and, occasionally, dry cough. This pattern is usually encountered in patients with a known history of cancer, most commonly of the breast, stomach, pancreas, or prostate.

Endotracheal and endobronchial metastases can be associated with new-onset cough, shortness of breath, and, occasionally, hemoptysis and chest pain.

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Physical Examination

Upon physical examination, signs of atelectasis, postobstructive pneumonitis, or postobstructive airtrapping can be evident. However, most patients are asymptomatic.

Solitary pulmonary nodules occupying the single site of distant metastatic spread is frequently the presenting finding in patients with secondary lung tumors, and patients with this type of spread are most commonly asymptomatic. This presentation is particularly common in renal cell cancer, Wilms tumor, testicular cancer, and sarcomas, but the finding of a solitary nodule is not specific and can be observed in any type of cancer.

Aside from secondary lung tumors, the differential diagnosis of discrete masslike lesions of the lung that appear in a patient with a known primary tumor includes unrelated primary malignancy (so-called synchronous second primary tumor) and benign neoplastic or nonneoplastic lesions.

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