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Lung Metastasis: Symptoms Can Be Subtle

Many people who have metastatic breast cancer develop lung metastases. Usually the symptoms are shortness of breath and/or a chronic cough. The symptoms can be fairly subtle, and they typically come on slowly, since the cancer has to use up a lot of your lungs before it compromises your breathing.

There are a couple of different places the cancer can appear in your lung. One is in nodules—usually several—that show up on a chest X ray. If it shows up in only one nodule, your doctor may want to do a needle biopsy or a full biopsy to find out if it’s lung cancer or a breast cancer that has spread. (Lung cancer usually starts in just one spot, but a cancer that has spread to the lung through the bloodstream or lymphatic channels is likely to hit multiple spots in the lung.)

Another form of metastasis in the lung is called lymphangitic spread. In this situation, the cancer spreads along the lymphatics and instead of forming nodules it occurs in a fine pattern throughout the lung. This isn’t all cancer. Some of the changes in the lung are due to a lack of lymphatic drainage and fibrosis in the lymph channels. This type of metastasis is subtler and harder to detect on a chest X ray, but it, too, will ultimately cause shortness of breath, since it takes up room and scars the lungs, making them less able to expand and contract and bring oxygen into your bloodstream.

The third way it can show up is through fluid in the pleura, the lining of the lung. (The pleura is a sack with a smooth lining around it. The lung sits inside of this sack so that it can move without sticking to the chest wall.) This usually indicates that the cancer has metastasized only to the pleura and not the lung itself. In this situation, the cancer creates fluid around the lung (effusion), and the fluid causes the lung to collapse partially. This, too, will result in shortness of breath.

For lung metastases, the treatment is usually systemic—chemotherapy or hormone therapy. If you develop fluid in the pleura, it can be treated by sticking a needle into the chest and draining the fluid. This works immediately, but frequently for only a short time. Often the fluid comes back right away. In order to prevent the reaccumulation, your doctor may want to perform a procedure that will fasten the pleura to the lung itself. However, often an effective hormonal therapy or chemotherapy will keep the fluid in the lung from reaccumulating, at least for a while. Occasionally women with reocurring fluid will have a catheter left in so that they can be drained as needed. However, many women with such fluid in the pleura will get permanent relief by a combination of local drainage, scarring of the pleura, and a systemic therapy.

Source: DrSusanLoveResearch.org; retrieved September 2016