Tumors, malignant: metastases from lung cancer

Over half of the patients presenting with lung cancer have metastatic disease. The most common sites of metastatic involvement in lung cancer are regional lymph nodes, brain, bone, liver, and adrenal glands. The international staging system for lung cancer arose from recognition that the presence and extent of metastatic disease has a major impact on survival. N (node) and M (distant metastasis) staging is the most important determinant of treatment outcomes. Guidelines for management recommend algorithms to accurately determine the stage of disease in an individual patient, while balancing the financial cost associated with routinely performing staging investigations on all patients, and the morbidity costs of invasive investigations. Fortunately, technological advances in imaging modalities are providing increasingly reliable means of noninvasive staging for lung cancer. Metastatic disease from lung cancer presents tremendous clinical challenges in palliation of symptoms produced by expanding mass lesions, including pain, dyspnea, and loss of function. The potential of systemic therapy to control symptoms, improve quality of life, and extend survival in extensive stage lung cancer has been demonstrated in clinical trials of chemotherapy in patients with good performance status. Major challenges for the future include realizing a reduction in the proportion of patients presenting with metastatic disease through improved early detection, improving detection of micrometastases and understanding their significance, translating the promise of new biologically targeted therapies to control the development of metastasis, and developing new and better means of symptom palliation