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What Are Pulmonary Metastases?
Pulmonary metastases occur when a cancerous tumor from another part of the body has metastasized (spread) to the lungs. Usually, the presence of lung metastases makes a cancer stage-IV.
Pulmonary metastases may also be called secondary lung cancer, because the cancer did not start in the lungs. If the cancer had started first in the lungs, it would be called primary lung cancer. Primary lung cancer can also metastasize to other parts of the body.
Several types of cancer in children can lead to lung metastases, including:
- Neuroblastomas – A common extracranial (outside the brain) solid tumor in children.
- Osteosarcomas – A type of bone cancer.
- Sarcomas – Cancer of the bones and soft tissues, including Ewing sarcoma.
- Wilms tumor – A type of kidney tumor.
- Differentiated thyroid cancer (DTC) – The most common type of thyroid cancer, which includes both papillary and follicular thyroid cancers.
When tested, these cancer cells appear as the original organ’s cancer cells, not lung cancer cells, because the cancer originated elsewhere. This information is important for understanding what type of cancer is present and how best to treat it.
What are the types of pulmonary metastases?
The type of pulmonary metastases depends on your child’s original type of cancer. For example, if your child has osteosarcoma that has metastasized to the lungs, it is called metastatic osteosarcoma or stage-IV osteosarcoma, not metastatic lung cancer or stage-IV lung cancer.
This distinction is important to understand because cancer treatment is based on the specific type of cancer your child has. Some treatments work better than others on certain cancers. Your child’s doctors will want to diagnose the specific cancer type so proper treatment can be planned.
What causes pulmonary metastases?
Cancer cells are different from normal healthy cells in our bodies. Healthy cells like to stay in place due to how their molecules are created. Cancer cells, on the other hand, do not always stay in one place. When cancer cells break off, they can travel through the bloodstream or lymph system to other parts of the body.
Once in or near a new organ, cancer cells can quickly settle there and grow into tumors. Pulmonary metastases are cancer cells from another part of the body that have moved into the lungs and begun to grow there.
Complications of pulmonary metastases
If left undiagnosed, pulmonary metastases can worsen cancer symptoms and cause severe illness and death. It is important to talk with your care team right away if you believe your child’s cancer has spread to their lungs.
How common are pulmonary metastases?
Although cancer in children is not common, pulmonary metastases are common in children with solid tumors. Up to 30% of children with solid tumors already have lung metastases at diagnosis. Another 15% to 20% will develop them later.
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What Are the Signs and Symptoms of Pulmonary Metastases?
When cancer has metastasized to the lungs, there may be no symptoms at first.
Depending on the number and size of tumors in the lungs, symptoms may become more moderate or severe.
Symptoms include:
- Chest pain.
- Coughing up blood.
- Fluid in and around the lungs.
- Trouble breathing.
- Weak appetite.
- Unexplained weight loss.
If your child is experiencing any of these symptoms, call their primary care doctor right away.
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How Do You Diagnose Pulmonary Metastases?
If your child’s doctor is concerned that a primary cancer has metastasized to the lungs, they will begin by asking you questions about your child’s symptoms and health history, including your child's primary cancer diagnosis.
Information about your child’s current cancer is critical to understanding the type of cancer that may be spreading to the lungs. You can expect the doctor to run bloodwork to check your child’s overall health and organ function.
These blood tests may include:
- Complete blood count (CBC) — Checks your overall health and bone marrow function.
- Electrolyte panel — Measures your electrolytes and the function of your kidneys.
- Liver function test — Checks in on your liver.
- Oxygen saturation — Determines the amount of oxygen in your blood, which can show if your breathing capacity is limited by cancer in the lungs.
- Tumor marker test — Measures a specific protein that can indicate cancer.
Your doctor will also order imaging tests to get a better look at the tumors, such as:
- Bronchoscopy — Looks inside the lung airways, or bronchi, using a thin, lighted tube with a camera attached to the end.
- Chest x-ray – Can show small tumor growths in the lungs.
- CT scan – Helps show tumor size and location.
- Lung biopsy – Removes a small cluster of lung tissue to test for cancer.
- PET scan — Helps capture detailed images of the lungs to locate the tumor(s).
Pulmonary metastases prognosis
The prognosis for secondary lung cancer depends on many factors, including:
- How much the cancer has metastasized and where it has spread.
- Primary cancer stage.
- Primary cancer tumor size and location.
- Your child’s overall health.
While pulmonary metastases in children have often been associated with poor outcomes, treatments and survival rates have improved in recent years. More treatment options are now available to help ease symptoms and prolong life.
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How do You Treat Pulmonary Metastases?
Like any metastatic cancer diagnosis, treatment depends on a variety of factors. Finding the right treatment method is critical to minimizing symptoms, providing comfort, and prolonging life.
Depending on the primary cancer, general health, and size of metastases in the lungs, treatment may involve surgery, chemotherapy, radiation therapy, immunotherapy, or other types of cancer treatments.
What happens during pulmonary metastases treatment?
Chemotherapy
Chemotherapy uses drugs to shrink and kill cancer cells. It is a common treatment method for pulmonary metastases. It can be taken orally as a pill or through a needle in an IV.
Many different drugs can be used for chemotherapy, and your child’s care team will decide which drugs and what doses, depending on where their cancer originated. These treatment plans are tailored to your child’s specific needs since every cancer diagnosis is different.
Fatigue, nausea, vomiting, and bowel problems may occur as side effects from chemotherapy.
External radiation therapy
Unlike typical radiation therapy, which is not used for pulmonary metastases, external radiation therapy can help relieve lung cancer symptoms. During this procedure, a machine sends radiation beams precisely to the tumor in the lungs. Radiation treatment is usually shorter and can be less intense on the body, sparing healthy tissue surrounding the tumor.
Immunotherapy
Immunotherapy uses drugs to boost the immune system to fight cancer. It is most often used alongside chemotherapy and radiation therapy. Side effects include extreme fatigue and flu-like symptoms.
Surgery
A lung resection is a surgical procedure to remove the lung metastases and all cancer cells from the lung while preserving as much healthy tissue as needed for the lung to function. Depending on your child's diagnosis, this option may be the best or only option.
Surgical resection is typically used to treat cancers that originate in the bone or soft tissues. In some cases, minimally invasive surgery may be done to remove the tumors. In others, surgery may not be an option at all because of the size, number, or location of the tumors.
When pulmonary metastases are small or deep in the lung, they can be difficult to find during surgery. UPMC Children’s is a world leader in image-guided surgery techniques that can aid in identifying the most difficult-to-find lesions. This includes localization techniques, radio-guided surgery, and fluorescent-guided surgery.
Other treatment methods
More options for treating pulmonary metastases include:
- Ablation therapy — Treats small tumors when surgery is not possible. Ablation therapy can use electrical currents, heat, or lasers to heat and destroy cancer cells. Laser therapy may be especially helpful if cancer is impacting an airway.
- Clinical trials — Many patients enroll in clinical trials to see if new and developing cancer treatment options may help. Talk with your child’s care team to see if there is a clinical trial for which your child might be eligible.
- Hormonal therapy — Alters certain hormones in the body to stop the growth of cancer cells in the lungs. The hormones may be added, removed, or blocked to help shrink tumors or lower the risk of recurrence.
- Targeted therapy — Uses drugs that attach to substances on the cancer cells to block their growth and division. It is usually paired with chemotherapy and can cause flu-like symptoms and extreme fatigue.
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