Lung metastases

Cancer that starts in one part of the body and spreads to the lungs is called lung metastases. It's sometimes called metastatic lung tumours. Cancer that starts in the lung is different and is called primary lung cancer.

Metastatic cancer is also called:

• metastatic tumour, tumours or disease
• metastasis (one cancerous tumour)
• metastases (more than one cancerous tumour)
• advanced cancer

Some kinds of cancer are more likely to spread to the lung than others. The most common cancers that spread to the lung are:

• breast
• colorectal
• kidney
• head and neck (such as laryngeal)
• testicular
• bone (such as osteosarcoma)
• soft tissue sarcoma
• melanoma
• thyroid

Cancer can spread to anywhere in the lungs. Sometimes there is only a single metastasis in one lung. Sometimes there are many metastases in one or both lungs. Most lung metastases develop near the edges of the lungs and in the lower lobes. Cancer can also spread to areas outside of the lung, such as the pleura and mediastinum.

Lung metastases may not cause any symptoms at first. The symptoms vary depending on the number of tumours and where they are in the lungs. Other health conditions can cause the same symptoms as lung metastases.

See your doctor if you have these symptoms:

• a cough that doesn't go away
• shortness of breath
• frequent chest infections
• coughing up blood
• pain or discomfort in the chest
• weight loss

Diagnosis is the process of finding out the cause of a health problem. The following tests may be used to diagnose lung metastases. Many of the same tests can also help your healthcare team plan treatment and watch for changes to the cancer.

Your health history is a record of your symptoms, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about a personal history of symptoms that suggest lung metastases.

A physical exam allows your doctor to look for any signs of lung metastases. Your doctor may listen to your lungs.

Find out more about a physical exam.

Blood tests are usually done to check your general health and find out how some organs are working. These tests may find out if cancer has spread to organs other than the lungs.

A complete blood count (CBC) is done to check your general health and how well the bone marrow is working.

An electrolyte panel measures sodium, potassium, chloride, magnesium, phosphate and bicarbonate. It helps find problems with the kidneys.

Liver function tests are done to look for any problems with the liver.

Oxygen saturation, which is the amount of oxygen in your blood, may be measured to check if your lungs are bringing enough oxygen into your body.

Tumour marker tests measure the amount of a specific protein in the body. They may be done if you have had cancer before. An increase in the tumour marker levels in the blood may mean that the primary cancer has come back and spread to the lungs.

Find out more about a complete blood count (CBC), blood chemistry tests and tumour markers.

Imaging tests are an important part of diagnosing lung metastases. It is common for people to have one or more imaging tests when the doctor thinks that cancer may have spread to the lungs. These tests include the following.

A chest x-ray is usually the first test done to try to find out what is causing symptoms like a cough and shortness of breath. Doctors use a chest x-ray to look for any lung tumours.

A CT scan of the chest is a common test used to check for lung metastases. It provides more detailed images of lung tumours than a chest x-ray, including the size and location of the tumours. It can also be used to check for cancer in nearby lymph nodes.

A PET scan of the lungs or the whole body may be done. It may be used to check if lung tumours are cancerous or not.

Find out more about x-rays, CT scans and PET scans.

A bronchoscopy is a test used to look inside the trachea (windpipe), bronchi (large airways of the lungs) and lungs using an endoscope. It is often done to find out why a person is coughing up blood. A biopsy can be taken during a bronchoscopy.

Find out more about a bronchoscopy.

A biopsy is a test that removes cells or tissues so they can be examined under a microscope. It is sometimes done when the doctor finds lung tumours with imaging tests. If you have had cancer, doctors may be able to diagnose lung metastases with imaging tests alone. But if the doctor can't tell if there are lung metastases based on imaging tests, or if there is no history of cancer, a biopsy may be done.

Doctors usually use an imaging test like a CT scan to help locate the specific area to biopsy. The types of biopsies used to diagnose lung metastases include:

• needle biopsy through the chest wall (called a transthoracic needle aspiration biopsy)
• endoscopic biopsy during bronchoscopy (called a transbronchial biopsy)
• surgical biopsy

Find out more about biopsies.

If lung metastases are found before the primary cancer is diagnosed, the doctor may order tests to find out where the cancer started. Other tests may also be used to check for metastatic cancer in other parts of the body. These tests include:

• mammography to check for breast cancer

• CT scan of the abdomen and pelvis to check for colorectal cancer and liver metastases

• mediastinoscopy to check lymph nodes in the middle of the chest

• ultrasound to check for testicular cancer

If you have lung metastases, your healthcare team will create a treatment plan just for you. It will be based on your needs and usually includes a combination of different treatments. Treatments can control and slow the growth of lung metastases, but the metastases usually don't go away completely.

Treatments can also manage or prevent problems caused by lung metastases. These treatments are called supportive therapies.

When deciding which treatments and supportive therapies to offer for lung metastases, your healthcare team will consider:

• where the cancer started
• your symptoms
• the size, number and location of metastases in the lungs
• if the cancer has spread to other parts of the body
• cancer treatments you've already received
• the general health of your lungs
• what you prefer or want

You may be offered the following treatments and supportive therapies for lung metastases.

Chemotherapy is the most common treatment for lung metastases. It is used to help shrink and control the growth of cancer. Chemotherapy is sometimes used along with other treatments such as surgery and targeted therapy.

Chemotherapy drugs circulate (flow) throughout the body to destroy cancer cells. The drugs are usually given intravenously (through a needle into a vein) or orally (as a pill by mouth).

The type of chemotherapy drug or combination of drugs used depends on where the cancer started and if you've had chemotherapy before. The drugs, dose and schedule will vary for each person.

Side effects of chemotherapy will depend mainly on the type of drug, the dose and how it's given. Common side effects include low blood cell counts (called bone marrow suppression), nausea and vomiting, mouth problems and bowel problems.

Find out more about chemotherapy.

Hormonal therapy may be used to control the growth of cancer and help relieve symptoms. It is given for some types of cancer that have spread to the lungs, such as breast and thyroid cancers.

Hormonal therapy adds, blocks or removes certain hormones to slow or stop the growth of some types of cancer cells that need hormones to grow. Drugs, surgery or radiation therapy can be used as hormonal therapy to change hormone levels or block their effects.

Side effects will depend mainly on the type of hormonal therapy. Common side effects include hot flashes and weight gain.

Find out more about hormonal therapy.

Targeted therapy uses drugs that find and attach to specific substances (such as proteins) on the surface of cancer cells or inside cancer cells. These substances help send signals that tell cells to grow or divide. The targeted therapy drugs block the substances to stop or slow the growth and spread of cancer cells.

Targeted therapy may be used to control the growth of lung metastases from some types of cancer. The type of drug used will depend on where the cancer started. It is most often used along with chemotherapy.

Side effects depend mainly on the type and dose of the drug. Common side effects include skin problems, flu-like symptoms and fatigue. Most side effects go away on their own or can be treated. Tell your healthcare team if you have these side effects or others you think might be from targeted therapy.

Find out more about targeted therapy.

Immunotherapy boosts the immune system or helps the immune system to find cancer and attack it. Immunotherapy may be given as a treatment on its own, but it is most often used with other types of therapy such as chemotherapy and radiation therapy.

The type of immunotherapy drug used will depend on where the cancer started.

Side effects of immunotherapy depend mainly on the type and dose of the drug. Common side effects include flu-like symptoms and fatigue. Most side effects go away on their own or can be treated. Tell your healthcare team if you have these side effects or others you think might be from immunotherapy.

Find out more about immunotherapy.

Surgery is most often used for colorectal cancer, bone cancer or soft tissue sarcoma that has spread to the lungs. Called a lung resection, it may be used to treat lung metastases when cancer is only in one small part of the lung (called isolated, or limited, metastases). This surgery removes part (usually a wedge-shaped piece) of a lung. The goal of a lung resection is to completely remove the metastases so that there are no cancer cells in the healthy tissue that is removed along with the tumour (called negative surgical margins). Only part of the lung is removed so that the lungs will still work as normally as possible after surgery.

A lung resection is done by a surgeon who specializes in lung surgery (called a thoracic surgeon). It is usually done by making a cut (incision) in the chest (called open lung resection). Video-assisted thoracoscopic surgery (VATS), or video-assisted thoracoscopy, may be done in some cases. These techniques can be used when there are only a few small tumours.

Not everyone with lung metastases can have surgery. Doctors will decide if surgery is an option based on things like the size, number and location of tumours, how well the primary cancer is controlled and your overall health.

Side effects of surgery will depend mainly on the type of surgery done, the amount of lung removed and your overall health. Some side effects of a lung resection are pain, bleeding, wound infection and lung infection.

Find out more about surgery.

Ablation therapy is a procedure that removes or destroys cells or tissues with heat, chemicals or other methods. Different types of ablation therapy may be used to treat lung metastases. They are usually used to treat small tumours and control symptoms when surgery can't be done because it's not safe or possible.

Ablation therapies for lung metastases are done by surgeons with specialized experience. They may not be available at all treatment centres.

The following ablation therapies may be used to treat lung metastases. Side effects will depend mainly on the type of procedure done and how much of the lungs are treated.

Radiofrequency ablation (RFA) uses electrical currents to create heat that destroys cancer cells. A needle is placed directly into a lung tumour. The surgeon will use an imaging test, such as an ultrasound or a CT scan, to guide the needle into the tumour. Electrical currents are passed through the needle. These currents heat and destroy the tumour.

Laser therapy, or laser surgery, uses a laser (a high-intensity beam of light) to make bloodless cuts in tissue. The doctor uses a thoracoscopy to locate the tumour and direct the laser beam at it. The laser beam heats and destroys the cancer cells. Laser therapy is usually used when cancer is blocking the windpipe or a large airway.

Find out more about radiofrequency ablation and laser surgery.

Radiation therapy is not usually used to treat lung metastases. But in some cases, external radiation therapy may be used to relieve symptoms like breathing problems, coughing and bleeding.

During external radiation therapy, a machine directs a beam of radiation through the skin to the lungs. How long external radiation is used depends on things like the goal of treatment, the number of tumours and how many areas of the lungs are affected by cancer. A short course of radiation therapy is usually given for lung metastases. Radiation therapy is given once a day for 5 days. Sometimes only a single treatment is given.

Stereotactic body radiation therapy, or stereotactic ablative radiotherapy, delivers a high dose of targeted radiation. It creates many beams of radiation from different angles that meet at the tumour. The tumour itself receives a high dose of radiation, while the individual beams that travel through surrounding tissue are a lower dose. This lowers the effects of radiation on healthy tissue surrounding the tumour. Stereotactic body radiation therapy is given in fewer treatments than standard external radiation therapy. How many sessions are used depends on the size, location and number of metastases being treated.

Side effects will depend mainly on the type of radiation therapy, how much of the lungs are being treated and the length of treatment.

Find out more about radiation therapy.

Thoracentesis may be used to treat an abnormal buildup of fluid in the space between the lungs and chest wall (called pleural effusion).

During thoracentesis, the doctor inserts a hollow needle through the skin and into the space between the lungs and the chest wall (called the pleural cavity). The doctor uses the needle to drain extra fluid from the chest cavity.

Sometimes the doctor may use a procedure called pleurodesis to stop fluid from building up again. A special mixture of talc is injected into the space between your lung and chest wall. The talc mixture causes the tissues to become inflamed and creates scar tissue. The scar tissue blocks the space where fluid could build up, preventing another pleural effusion.

Find out more about thoracentesis and pleural effusion.

Oxygen therapy gives you extra oxygen through a mask over your mouth or through tubes in your nostrils. It makes sure you get enough oxygen if you have trouble breathing.

Lung metastases can grow inside the lungs and block the airways in the lungs. They can also put pressure on structures outside the airway and make it narrow. The doctor may place a stent (small tube) inside an airway to hold it open. It is inserted into the airway using a bronchoscopy. The stent can usually stay in the airway permanently.

Clinical trials look at new ways to prevent, find or treat cancer. Talk to your doctor about clinical trials open to people with metastatic cancer in Canada. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Adjusting to life with lung metastases can take time. A person with lung metastases may have concerns about the following.

Difficulty breathing (also called shortness of breath, or dyspnea) is a common problem in people with lung metastases. It can be caused by:

• a tumour blocking or narrowing an airway
• cancer causing pressure on structures outside of an airway
• pleural effusion
• low levels of oxygen in the blood (called hypoxemia)
• an infection in one or both lungs (called pneumonia)
• low red blood cell count (called anemia)
• anxiety and stress

How breathing problems are managed depends on the cause. Treatments for breathing problems include: ·

• oxygen therapy
• medicines that open your airways
• anti-anxiety medicines
• stent placement
• thoracentesis when there is pleural effusion
• relaxation and breathing exercises

Find out more about difficulty breathing.

A diagnosis of advanced cancer can lead to questions about survival. There is no way of knowing exactly how long someone will live with lung metastases. It depends on many factors, including the type of cancer, the number of lung metastases and if surgery can be done. Survival with lung metastases is sometimes measured in months. But some people can survive for many years, especially if surgery is done to remove the metastases. Some people may live much longer than expected, while others may die sooner than expected.

The best person to talk to about survival is your doctor. Your doctor may be able to estimate survival based on what they know about you and the type of cancer, but everyone responds differently to cancer and cancer treatments.