Multiple primary lung cancers
- Thomas E Stinchcombe, MD
Thomas E Stinchcombe, MD
- Associate Professor
- University of North Carolina, Chapel Hill
- Shamus Carr, MD, FACS
Shamus Carr, MD, FACS
- Assistant Professor of Surgery
- University of Maryland School of Medicine
- Billy W Loo Jr., MD, PhD
Billy W Loo Jr., MD, PhD
- Associate Professor and Thoracic Radiation Oncology Program Leader
- Stanford University
- Section Editors
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
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 .
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.
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 :
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- DIAGNOSTIC CRITERIA
- Synchronous MPLC
- Metachronous MPLC
- TNM staging system implications
- EPIDEMIOLOGY AND RISK FACTORS
- SYNCHRONOUS MPLC
- Diagnostic and staging evaluation
- - Surgery
- - Nonoperative local therapy
- METACHRONOUS MPLC
- ADJUVANT CHEMOTHERAPY FOR RESECTED NSCLC
- SUMMARY AND RECOMMENDATIONS