Lung cancer metastasis: pathways, coping strategies and follow-up

Author: Zhi Xiuyi, Chief Physician of Beijing Tsinghua Chang Gung Hospital affiliated to Tsinghua University

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Lung cancer is one of the most common malignant tumors in the world with the highest morbidity and mortality. Its complex disease progression and diverse treatment strategies have always been the focus of medical attention. In particular, the metastasis pathway and treatment of lung cancer are directly related to the patient's prognosis and quality of life.

The metastasis of lung cancer is an important sign of disease progression, which is mainly achieved through two pathways: lymph node metastasis and hematogenous metastasis. Lymph node metastasis is one of the most common ways of metastasis of lung cancer. The lesions can gradually spread from the hilar lymph nodes to the mediastinal lymph nodes, or even to lymph nodes in more distant areas. This metastasis pattern not only affects the control of local lesions, but may also indicate that the disease has entered the middle and late stages.

On the other hand, hematogenous metastasis is more common in poorly differentiated, highly malignant tumors. These tumor cells can spread earlier through the blood circulation system to distant organs such as bones, brain, liver, kidneys, and adrenal glands, forming extensive multiple metastatic lesions. The appearance of hematogenous metastasis often indicates that lung cancer has entered the advanced stage, and the difficulty of treatment has increased significantly.

Figure 1 Original copyright image, no permission to reprint

In view of the metastatic characteristics of lung cancer, clinical treatment strategies need to be flexibly adjusted. For patients with lymph node metastasis, postoperative adjuvant radiotherapy and regional treatment are indispensable treatment methods, aiming to consolidate the surgical effect and reduce the risk of recurrence. For advanced patients with hematogenous metastasis, drug treatment should be the main method, through targeted drugs, immunotherapy and other means to inhibit tumor growth and prolong patient survival.

Although traditional concepts hold that surgical treatment has lost its main value after lung cancer metastasis, with the advancement of medical technology, especially the rise of targeted therapy and immunotherapy, some patients with specific types of metastasis have seen new hope for treatment. For example, for patients with isolated brain metastasis or bone metastasis, if the primary lesion is well controlled and the general condition allows, surgical removal of the metastasis can be considered, combined with systemic treatment to consolidate the therapeutic effect.

It is worth noting that even in the treatment of advanced lung cancer where drug therapy is dominant, surgery can still play a key role in certain circumstances. For example, when patients suffer from obstructive pneumonia, severe hemoptysis, or chest tightness and shortness of breath due to tumor compression, palliative treatments such as chest drainage and pleurodesis can effectively relieve symptoms and improve the quality of life.

Figure 2 Original copyright image, no permission to reprint

Surgery for lung cancer is a complex and delicate treatment process. Its success depends not only on the level of surgical technique, but also on the comprehensive management of the perioperative period. Before surgery, doctors need to conduct a comprehensive assessment of patients, especially the control of comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, etc., to ensure that patients can tolerate surgery. During surgery, doctors need to work closely with the anesthesiology department, adopt gentle manipulation techniques and standardized surgical procedures to reduce trauma and complications.

Postoperative management is also crucial. Doctors need to pay close attention to common complications such as bleeding, infection, and air leakage, and take effective measures to prevent and treat them. At the same time, strengthening airway management and promoting sputum discharge and lung function recovery are also important aspects of postoperative management. In addition, with the promotion of the concept of rapid recovery surgery, more and more hospitals have begun to adopt minimally invasive techniques and multidisciplinary collaboration models to shorten operation time, reduce trauma, and promote early recovery of patients.

In addition, postoperative follow-up is an important part of lung cancer treatment. Through regular follow-up, doctors can timely understand the patient's condition changes, evaluate the treatment effect, and adjust the treatment plan as needed. For patients who may have recurrence or metastasis, early detection and early treatment are key measures to improve the treatment effect.