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Multiple primary lung cancers

Authors
Thomas E Stinchcombe, MD
Shamus Carr, MD, FACS
Billy W Loo Jr., MD, PhD
Section Editors
James R Jett, MD
Rogerio C Lilenbaum, MD, FACP
Joseph S Friedberg, MD
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Patients with lung cancer may present with more than one primary lesion arising in the lung at the same time (synchronous multiple primary lung cancer) or may develop a second, metachronous, primary lung cancer after treatment of the initial lesion. This is becoming a more common clinical issue and remains a challenge due to how these tumors are classified [1].

Multiple primary lung cancers (MPLC) pose a variety of clinically important diagnostic and therapeutic problems, which may differ from those in patients presenting with a single primary tumor. These issues are reviewed here for both synchronous and metachronous MPLC.

DIAGNOSTIC CRITERIA

Synchronous MPLC — Patients presenting with more than one pulmonary nodule at the same time must fulfill strict criteria to be classified as having synchronous multiple primary lung cancers (MPLC) [2,3].

Both lesions must be malignant and must arise independently in the lung. The second lesion cannot be assumed to represent a second primary lung cancer. A benign nodule, infectious process, or metastasis from an extrapulmonary site must be excluded.

The second malignant lesion must not represent a metastasis from the first lung lesion. Accepted criteria for this distinction include [4]:

              

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Literature review current through: Nov 2016. | This topic last updated: Fri Jun 24 00:00:00 GMT+00:00 2016.
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