Breast Cancer

Epidemiology

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Diagnosis

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Clinical

Metastases to Lung

  • Epidemiology
    • Breast cancer commonly metastasizes to the lungs
    • Lung is only site of metastasis in 21% of cases
  • Physiology
    • Hematogenous Dissemination to lungs: most common mechanism of spread to lungs
    • Lymphatic Dissemination: also occurs
    • Direct Invasion of Lungs: occurs in some cases from mediastinal lymphadenopathy
  • Clinical
    • Lung Nodules (see Lung Nodule or Mass, [[Lung Nodule or Mass]])
      • 3 mm-6 cm (of various size) smooth or slightly lobulated nodules
      • Lower-lobe predilection
      • Calcification is rare
      • May cavitate
      • Usually absent hilar and mediastinal lymphadenopathy
    • Pleural Metastases with Pleural Effusion (see Pleural Metastases, [[Pleural Metastases]] and Pleural Effusion-Exudate, [[Pleural Effusion-Exudate]])
    • Endobronchial Metastases (see Lung Metastases-Endobronchial, [[Lung Metastases-Endobronchial]])
      • Most common tumor to metastasize to the airway (accounts in 36% of endobronchial mets, by autopsy studies)
      • Occurs more commonly in post-menopausal cases
      • May occur up to 33 years later
      • Rarely, breast cancer may also directly invade trachea from mediastinal mets
    • Lymphangitic Metastases (see Lung Metastases-Lymphangitic Carcinomatosis, [[Lung Metastases-Lymphangitic Carcinomatosis]])
    • Autopsy Studies: 24% of breast cancer cases have lymphangitic lung mets
    • Mechanism: mediastinal or hilar node involvement with retrograde spread to lung lymphatics

Treatment

Treatment of Pulmonary Metastases

  • Pulmonary Metastatectomy: see above
  • Survival is related to aggressiveness of malignancy: Patients with <1 year disease-free interval between initial diagnosis and discovery of pulmonary mets have short survival times after surgical resection

References

  • Massive cavitation of solid pulmonary metastatic lesions in a breast cancer patient: a case report. Ann Clin Onc 2002; 3: 173-174