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Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung with a potential tometastasize, spread beyond lungs, to nearby tissues and later to other parts of the body. With the advent of modern treatment schedule, the metastasis can be checked or delayed to a great extent. However, lung cancer is the mostcommon cause of cancer related death in men and women.
There are two main types of lung cancer, small-cell lungcarcinoma and non small cell lung carcinoma. Small cell lung cancer often spreads quite early. Survival of a persondiagnosed with lung cancer depends on the stage, overall health and other factors, but overall 14% of peoplediagnosed with lung cancer survive 5years after the diagnosis.
Lung cancer metastasize through direct spread, blood vessels or via the lymphatics. The most common sites ofmetastasis are bones, brain, lymph nodes, liver, adrenal glands, contralateral lung. Once the metastatis finds anew and suitable spot, it forms a tumor there. This is the secondary tumor. The cells in the secondary tumorclosely resembles the original one. The tumor makes use of the existing blood vessels or cause new blood vessels to form.
Lung cancer is the third most common site of origin of metastatic cancer deposits in bone after breast and prostatecancer. Bone metastasis is most commonly seen with small-cell carcinoma. The most commonly affected bones are the spine, ribs, pelvis and long bones of hands and feet. The tumor in the lung sheds malignant cells directly into the arterial blood from where they can be seeded into other suitable spots. A smoker with age over 30 with multiple bone lesions is likely to have lung cancer.Signs and Symptoms: Bone pains, withincreasingly severe pain over few weeks to months. Chances of pathological fractures are high. Other symptoms include hypercalcaemia, painful thickening of the long and short tubular bones.
There is no role of surgery. orthopaedic stabilization of weekened bones needs to be done.
Lung cancer with bone metastasis is one of the most aggressive tumors and has unfavorable prognosis.Average survival after diagnosis is about 6months. In few cases with approppriate treatment survival can be prolonged.
48% of metastatic deposits in brain are due to lung cancer. There are no obvious symptoms to alert the patients that cancer has spread to brain. Follow up visits and brain scans are needed.
Vertigo, new onset headache, nausea and vomiting, personality and behavioural changes, memory loss, changes related to vision, increased intracranial pressure, seizures, bell’s palsy, lack of cordination of muscle movements , altered sensations in hands and legs.
Mainly palliative, the aim is to reduce symptoms and prolong life. More aggressive therapy is indicated in younger and healthier patients.
Median survival after metastasis to brain is 2 to 3 months.
When lung cancer travels through lymphatic system, they reach the lymph nodes where they can lodge and grow. The lung cancer thus spreads to the lymph nodes before spreading to other regions of the body. The regional lymph nodes becomes involved in the earlier stages before they reach the lymph nodes in the distant regions.
The lymph nodes commonly involved includes intrapulmonary, mediastinal and extra thoracic lymph nodes. Swelling in the neck or in the area just above the collar bone may be noticed, depending on which node is involved. Shortness of breath and hoarseness can occur due to pressure from a swollen lymph node.
The regional lymph nodes, when affected can be surgically removed, but when the distant sites areinvolved, chemotherapy or radiation becomes necessary.
The prognosis depends on several factors like the site of the node involved, type of lung cancer, size of tumor, whether tumor has spread to other areas and the general health of the patient.
If lung cancer spreads to liver there may not be obvious symptoms. they are commonly detected when a test such as CT scan is done to determine the stage of cancer.
Pain under the ribs on the right side of the body is the most common presentation. Jaundice, weight loss, nausea, loss of appetite and fever may appear later on.
Palliative treatment is advocated to give relief to the patient.
Prognosis is poor. The life expectancy after diagnosis is not above 8months.
Metastasis to adrenals does not usually cause symptoms, usually detected during routine scans.
Abdominal pain, back pain.
Chemotherapy is indicated. when there is a single spot on adrenal after the primary lung tumor is removed, surgery may be done to remove the adrenal gland.
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