Secondary tumours

The lung is a common site for secondary tumours as it acts as a large filter. These are commonly multiple rather than solitary and affect both lungs. Occasionally, a secondary lesion in the lung, when resected, is so characteristic that the primary site is obvious but more commonly, although it

Figure 18.14. Metastatic tumour to the lung, demonstrated on CT.

is considered to be a secondary tumour, the primary site remains occult. An exhaustive search for a hidden primary may often be unrewarding but in males it is important to rule out carcinoma of the prostate and in females carcinoma of the breast and ovaries as these are amenable to hormone or cytotoxic chemotherapy.

When the primary site has been well controlled and there is a significant interval between the original operation and development of a pulmonary metastasis, it is worthwhile resecting the pulmonary lesion if there is no evidence of metastases elsewhere. Some tumours, particularly sarcomas, have a predilection to metastasize to the lung, which is often the only site of metastasis, and particularly as they tend to occur in younger patients, should be treated aggressively resecting all the lesions but sparing as much lung tissue as possible.

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