Metastatic disease to the lung is common. Since the entire cardiac output flows through the lungs, the risk of hematogenous metastases is very high. Excluding primary lung cancers, which do metastasize to either lung, the most common tumors involving the lung parenchyma are breast cancer, gastrointestinal tumors, kidney cancer, melanoma, sarcomas, lymphomas and leukemias, germ cell tumors, and rarely ovarian cancer.[1,2]
In most cases, management of metastatic cancer to the lung relies on systemic treatment for the primary malignancy. A few tumors, like sarcomas, metastasize almost exclusively to the lung and can on rare occasion be cured by treatment of the primary site and resection of lung metastases. Others, like testicular cancer, present with disseminated disease that can be eradicated with systemic chemotherapy (except for residual teratoma in the lungs and retroperitoneum which require surgical excision for cure). Finally, some tumors like kidney cancer can have a few slow-growing pulmonary metastases that can be resected to increase the disease-free survival.
There is an extensive surgical experience with resection of pulmonary metastases. Goals for resection of metastases are: (1) cure of the disease or
Thoracotomy has been the standard surgical approach for unilateral pulmonary metastases. Since up to 40% of patients thought to have unilateral metastases have bilateral metastases at surgical exploration, the use of median sternotomy to enable bilateral exploration has been advocated.[3,6,7] Bilateral thoracotomy  or median sternotomy are accepted surgical approaches for bilateral pulmonary metastases.
The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.
Under clinical evaluation:
Date Last Modified: 08/96