Lung metastasis
| Classification according to ICD-10 | |
|---|---|
| C78.0 | Secondary malignant neoplasm of the lungs; Metastasis of cancer in the respiratory or digestive organs; Secondary malignant neoplasm of the lungs |
| ICD-10 online (WHO version 2019) | |
A lung metastasis ( pulmonary filia ) is the malignant daughter tumor of an original tumor that has grown outside or inside the lung ( primary tumor ). Lung metastases arise from cells from other or similar tissues that have entered the lungs via the blood or lymphatic system or - in the case of the lungs - have been carried within the airways. In contrast, tumors that grow out of lung cells are called lung cancer (bronchial carcinoma).
Lung metastases can be single (solitary), but also penetrate the lungs with many (multiple) metastases .
Lung metastases occur in around 30% of people with cancer . 8 to 10% of all people develop lung metastases in the course of their life. In most cases, the primary tumors of these metastases are carcinomas of the colorectum ( large and rectum ), kidneys , tumors of the head and neck area , testicular cancer, and bone and skin cancer .
Symptoms
Lung metastases initially cause little or no discomfort. Only in the advanced stage does bronchitis , coughing up blood , increasing shortness of breath , weight loss and chest pain occur , with pain in the chest area indicating that the tumors have grown into the wall structures and into the ribs .
diagnosis
Since there are initially no symptoms, lung metastases are often found on chest x-rays as part of follow-up examinations . Lung metastases generally appear as round nodules in the area of the lung mantle, but can also grow centrally within the bronchi and spread to the surrounding lymph nodes .
The most important diagnostic instruments are the x-ray of the lungs in 2 planes (representation of round nodules from a diameter of 1 cm), the computed tomography of the lungs with or without administration of contrast agent and, in case of doubt, a puncture of the metastatic tissue.
The number and size of lung metastases, but also any metastasis in other organs and the general condition of the patient's lungs are important for decisions regarding therapy.
The suspicion of lung metastases is not always confirmed. For example, in about half of all cases in colorectal cancer patients, the tumors shown with imaging methods are not lung metastases, but independent new tumors (e.g. lung or bronchial cancer) and sometimes also benign tissue changes in the lungs.
Therapy - listing of treatment methods
surgery
A complete surgical removal of the lung metastases while maintaining a safe distance in healthy tissue offers the best chances to sustainably counter lung metastases. However, lung metastases can only be surgically removed in about a third of patients. In the other cases, for example, there are too many metastases or they are in an unfavorable location. The five-year survival rate after surgical removal of lung metastases is given as 15–40%. In about half of the patients there is progressive tumor growth despite radical surgery. It can also be operated successfully repeatedly with a healing intention, provided that there is no additional metastasis to other organs.
In a study on 153 patients with colorectal lung metastases, it was shown that gender, age, primary tumor location, primary tumor stage, preoperative CEA , metastasis size and a previous liver resection in the case of liver metastases have no influence on the survival prognosis of the patients. In contrast, significant prognostic factors were the number of metastases, the selected surgical procedure, the length of the disease-free interval between the treatment of the primary tumor and the development of the distant metastasis, the lymph node status, the distance between the metastases and the resection margin, and the administration of blood reserves during the operation.
In suitable cases, metastases located in the area of the lung jacket can be removed using a minimally invasive method, which is gentle on the tissue . In the case of centrally located metastases, it may be necessary to remove a lobe of the lung ( lobectomy ) or the entire lung on one side (pneumonectomy).
In order to clarify the surgical risk, various examinations such as B. Pulmonary function test and blood gas analysis performed.
chemotherapy
With systemic chemotherapy , the patient is injected with cancer drugs (cell toxins, cytostatics ) into a vein on the arm. A special access system, a so-called port , is often placed in a central vein in the chest area. In the case of lung metastases, this form of chemotherapy is usually given palliative (life-prolonging) or to reduce the size of the metastases in order to make them operable. Only the lung metastases from testicular cancer respond well to chemotherapy.
radiotherapy
Radiation therapy can be used in the form of radiosurgery for lung metastases as long as there are only a few metastases and these are each small. First results of prospective studies show high success rates with very low risk.
Transpulmonary Chemoembolization (TPCE)
This process, which was developed at the Frankfurt Hospital of the Johann Wolfgang Goethe University, is still at an experimental stage. It enables local chemotherapeutic treatment directly at the metastasis. With the help of an endovascular balloon catheter, the chemotherapeutic agent is placed directly in the focal point via the pulmonary artery (pulmonary artery). Since a lower dose is sufficient than with intravenous therapy, there are fewer side effects for the patient.
Of the 23 patients treated at the clinic, 60 percent of the tumor growth stopped or decreased in size. Cancer reductions were found in six of the patients, with the mean reduction in tumor mass being 56.8 percent. Progressive tumor growth was measured in nine cases. TPCE responds particularly well to lung metastases from solid tumors such as thyroid, muscle and renal cell carcinomas.
Laser-induced thermotherapy (LITT)
A fiber optic light guide is advanced through the chest into the tumor tissue in a small operation. Tissue-destroying temperatures arise at the tip of the light guide, which heat the tissue to over 60 ° C and cause it to die. The metastases destroyed in this way are left in the tissue. For LITT from lung metastases, the following indication criteria were applied for from the Federal Joint Committee (G-BA) in 2005: number of metastases ≤ 3 per side, size ≤ 3 cm, exclusion of an extrapulmonary, clinically relevant metastasis. In the statement of its decision, the G-BA decided “In lung tumors, the significance of LITT compared to standard therapy for primary tumors has not been clarified.” And further: “With such experimental therapies, trials should be based on the Declaration of Helsinki - especially for protection of patients - remain limited to the implementation of controlled studies that are suitable to provide evidence of effectiveness. "
Individual evidence
- ↑ Dieter Köhler , Bernd Schönhofer, Thomas Voshaar: Pneumology. Georg Thieme Verlag, 2010, ISBN 978-3-131-46281-7 , p. 241 ( limited preview in the Google book search).
- ↑ a b c d e f Institute for Diagnostic and Interventional Radiology at the University Hospital Frankfurt / Main ( Memento of the original dated February 12, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ a b www.darmkrebs.de, Felix Burda Foundation ( Memento of the original from January 30, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Schirren et al .: The surgical therapy of lung metastases. Hessisches Ärzteblatt 05/2006, pp. 319–328. ( Memento of the original from May 30, 2009 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF file; 526 kB)
- ↑ 27th German Cancer Congress. Berlin, 22.-26. March 2006. Düsseldorf, Cologne: German Medical Science; 2006. Doc PO413. Yedibela et al .: Surgical therapy of colorectal lung metastases - Erlangen's experience in 153 patients. (Abstract)
- ^ Rau et al .: Surgery of the lung metastases of extrapulmonary primary tumors. Switzerland Med Forum No. 49–4. December 2002.l (PDF file; 50 kB)
- ↑ KE Rusthoven, BD Kavanagh et al .: Multi-institutional phase I / II trial of stereotactic body radiation therapy for lung metastases. In: J Clin Oncol . 2009; 27 (10), pp. 1579-1584.
- ^ TJ Vogl, A. Wetter, S. Lindemayr, S. Zangos: Treatment of unresectable lung metastases with transpulmonary chemoembolization: preliminary experience. In: Radiology. 2005 Mar; 234 (3), pp. 917-922. PMID 15681689 .
- ↑ Summary report of the "Medical Treatment" subcommittee of the Federal Joint Committee on the evaluation of laser-induced interstitial thermotherapy (LITT) for malignant tumors in accordance with Section 135 (1) SGB V, November 4, 2005 (PDF; 5.1 MB)
