Cerebral metastases as first symptom of bronchogenic carcinoma: a prospective study of 37 cases
Article Abstract:
In some forms of cancer, the disease may begin to metastasize, or spread through the body, before the primary cancer begins to cause any symptoms. Lung cancer is one such cancer; indeed, lung cancer is usually quite advanced by the time chest symptoms appear, so very often the first symptoms of the disease arise from other organs. One of the other organs of the body which is preferentially colonized by metastatic lung cancer cells is the brain. Thirty-seven cases are reviewed in which the symptoms of a brain tumor were the presenting symptoms for which the patient sought medical attention; they were only subsequently diagnosed with lung cancer. Of the 37 cases, only two occurred in non-smokers. Headache was one of the more common symptoms for which the patients sought medical attention; other symptoms included behavioral disturbances, loss of vision, and seizures. In all patients, abnormalities were visible on computed tomography (CT). In 34 of the 37 cases, abnormalities could be observed on chest X-rays. Of the three patients with normal X-rays at the time of initial presentation, one had signs of cancer visible on chest CT and the remaining two developed signs of lung cancer at six and nine months after the initial presentation. Eleven patients were found to have lung cancer of the non-small-cell type while the remainder had small cell lung cancer. At the time of diagnosis, there was evidence that the cancer had spread to other organs besides the brain in 11 patients. These other organs included the liver, adrenal glands, bone, spleen, skin, and bone marrow. The brain metastases were surgically removed in 20 patients, and in only 15 was the removal considered to be complete. The primary tumors in the lungs were variously treated with surgery, chemotherapy, and radiation according to the details of the individual case. Only one patient has survived for an extended period of time; this patient remains alive 10.5 years after the initial diagnosis. In general, the occurrence of metastatic disease in the brain is an indicator of poor prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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The applications of imaging in lung cancer
Article Abstract:
Medical imaging techniques play two closely related, but distinct, roles in the treatment of lung cancer. The first is diagnosis, and the chest radiography is sufficiently sensitive for this purpose. However, for the staging of the disease, in preparation for treatment, there is still some discussion about the best method of imaging. The traditional chest radiograph is sufficient for the staging of the primary tumor in the majority of cases. However, observation using computed tomography (CT) or magnetic resonance imaging (MRI) may be superior in terms of revealing metastatic disease in the lymph nodes. Since lung cancer has a great propensity to spread to the brain, there is some rationale for imaging the brain in such patients, as well. Among thoracic surgeons in North America, only 36 percent use CT routinely, but 85 percent use CT to examine patients whose chest X-ray suggests the likelihood of disease in the lymph nodes. MRI provides no significant advantage over CT in the examination of lymph nodes, with the exception of the hilar lymph nodes. This exception is of minor consequence, since disease involving only the hilar lymph nodes is still likely to be amenable to surgery. The only advantage obtained from any of these imaging methods, however, is to reduce the number of surgical procedures in patients who will not benefit from them anyway. Modern advances in imaging techniques have not altered the fact that lung cancer is a disease out of control. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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