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Metastatic patterns of lung cancer

If untreated, lung cancer will, almost without exception, lead to metastasis due to invasion of lymph or blood vessels.

Lymphogenic spread is the most common primary route.

  • Tumors in the lower lobe usually drain via the posterior mediastinum to the subcarinal lymph nodes.
  • Tumors in upper right lobe usually drain to the upper mediastinum.
  • Tumors in the upper left lobe usually drain to the anterior mediastinum, as well as to the upper mediastinum in 1/3 of the cases.
  • Retrograde lymph drainage to the pleura can occur, especially from peripheral tumors.

Hematogenic spread to other organs also occurs frequently. 

The most common localizations are:

  • other lobe of the lungs
  • skeleton
  • liver
  • adrenal glands
  • brain

The primary tumor can also spread by direct invasion of neighboring organs, such as mediastinal pleura, diaphragm, chest wall, or vertebrae.

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