The metastasis and diffusion of lung cancer have always been the heaviest burden on patients and their families. Among all metastatic sites, adrenal glands are particularly common. What is even more troublesome is that early adrenal metastases often occur silently and painlessly, and are only occasionally discovered through routine examinations, making them highly susceptible to being overlooked.
In this issue, we have invited Professor Yang Nong, a specially-appointed expert from Hainan Cancer Hospital, to provide a detailed analysis of issues that patients are concerned about, helping everyone to cope with them calmly.
Q: Is adrenal metastasis common in lung cancer patients?
Professor Yang Nong: The adrenal gland is one of the most common distant metastatic sites of lung cancer. Clinical data show that about 15%-20% of lung cancer patients will develop adrenal metastasis, and some patients' first distant metastatic lesion appears in the adrenal gland.
It is worth noting that the vast majority of early adrenal metastases do not exhibit any typical symptoms. This is because the initial metastatic lesions are small in size, do not compress surrounding tissues and organs, and do not affect the normal physiological functions of the adrenal gland. As a result, patients do not experience any discomfort, making the condition highly concealed.
Q: What physical abnormalities should alert us to the possibility of adrenal metastasis from lung cancer?
Professor Yang Nong: It is precisely because of the early asymptomatic stage that most patients with adrenal metastasis of lung cancer are diagnosed through regular imaging examinations during follow-up.
As the metastatic lesions gradually enlarge and the disease progresses, patients will gradually develop abnormal symptoms, which can be mainly divided into two categories:
Category I
Symptoms of local compression: These often manifest as soreness, distension, and dull pain in the lower back and bilateral subcostal regions. The pain is mostly dull and tends to worsen significantly after exertion.
Category II
Symptoms of endocrine disorders: When cancer cells invade the adrenal gland, they can disrupt the normal function of the gland, leading to systemic abnormalities such as persistent fatigue, significant loss of appetite, rapid weight loss in a short period of time, unstable blood pressure fluctuations, dizziness, and palpitations. A small number of patients may also experience darkened skin and lower limb edema.
Reminder to all patients: Do not ignore the above symptoms as minor issues such as ordinary strain or physical weakness. Seek medical attention and diagnosis in a timely manner. Even if adrenal metastasis occurs, active cooperation with doctors in undergoing standardized treatment can still effectively control the condition, prolong survival, and improve quality of life.
Q: Which lung cancer patients are prone to adrenal metastasis?
Professor Yang Nong: Whether lung cancer is prone to metastasis and the speed of metastasis are primarily related to core factors such as tumor staging, pathological type, and genetic characteristics. Specifically, it can be divided into four points:
I. Tumor staging serves as the fundamental basis for diagnosis. Patients with stage I and stage II lung cancer typically have lesions primarily confined to the primary site in the lungs, with no distant metastasis yet present. Patients with stage III often exhibit multiple mediastinal lymph node metastases, significantly increasing the risk of distant metastasis. By the time patients with stage IV are diagnosed, most have already developed distant organ metastases, including to the adrenal glands.
II. The pathological type determines the probability and speed of metastasis. Small cell lung cancer is extremely malignant, with the highest risk of distant metastasis and the fastest disease progression among all types of lung cancer, and it is more prone to adrenal metastasis. Although squamous cell carcinoma of the lung may also metastasize to the adrenal glands, bones, liver, brain, and other sites, its overall probability of metastasis and rate of progression are much lower than those of small cell lung cancer. This is an inherent pathological characteristic of different subtypes of lung cancer.
III. the degree of tumor differentiation needs to be comprehensively judged in conjunction with genetic testing. In the past, it was generally believed that poorly differentiated tumors are more prone to metastasis. However, with the advancement of medical technology, this singular approach to judgment is no longer applicable. In clinical practice, it is necessary to combine the patient's genetic testing results to jointly assess the risk of tumor metastasis, resulting in more accurate judgments.
IV. the state of gene mutations affects the effectiveness of disease control. Patients with sensitive gene mutations are relatively more fortunate, as targeted therapy can precisely target the lesion, effectively inhibit systemic tumor progression, significantly reduce the risk of metastasis and diffusion, and stably control the disease.
Expert Introduction
Yang Nong, Chief Physician, Doctoral Supervisor
Long-term employed experts from Hainan Cancer Hospital/Affiliated Cancer Hospital of Hainan Medical University and Hainan Chengmei Hospital
He currently serves as Vice President of the Second People's Hospital of Hunan Province, head of the oncology department, and director of the "Yang Nong Famous Doctor Clinic" / "Yang Nong Famous Doctor Expert Team Clinic". He is also a chief expert of the National Major Scientific and Technological Special Project, a member of the Lung Cancer Special Committee of the National Tumor Quality Control Center, the director of the Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment of Lung Cancer, and the director of the Hunan Provincial Respiratory Tumor Clinical Medicine Research Center. He has been dedicated to precision targeted therapy for lung cancer and gastrointestinal tumors, as well as to challenging, recurrent, and drug-resistant clinical cases, scientific research, and teaching for nearly 30 years.
He has been honored with the title of "National Famous Doctor - Excellent Style" in the 6th edition, and has been recommended as "Annual Good Doctor" by patients across the country for 8 consecutive years, as well as being awarded the title of "First Brain Doctor - Famous Doctor". He has authored national guidelines, boasts over 500,000 followers across the internet, and has achieved over 120 million views in cancer prevention and treatment science popularization.
Medical expertise
Specialties: Precision treatment of lung cancer, breakthrough in refractory, recurrent, and drug-resistant cases with brain metastasis; individualized and precise treatment of brain metastases from lung cancer; early diagnosis of pulmonary nodules and lung cancer; personalized and comprehensive diagnosis and treatment of solid tumors; clinical trials of the latest immunotherapy/targeted therapy drugs.
With nearly 30 years of experience in precision immunotherapy for lung cancer, he has led nearly 400 Phase I-III clinical trials of new anticancer drugs (including Class 1 national new drugs), and is particularly skilled in treating complex cases such as refractory, recurrent, and drug-resistant conditions, as well as brain metastases.
He is also proficient in the comprehensive diagnosis and treatment of multiple cancer types, individualized, and interdisciplinary, covering a wide range of solid tumors (such as stomach, intestine, brain, etc.).
[Visit Information]
1. Clinic Hours and Location
August 9th, 08:00-12:00
Sixth Consultation Area of Hainan Cancer Hospital
2. [Appointment registration]
Follow the official account of Hainan Cancer Hospital for "appointment registration"
3. Health consultation
18976324546
[Friendly Reminder]
To help the expert understand your condition quickly, please bring the following:
1. ID card, medical insurance card, and mobile phone
2. Accompanying direct relatives (with decision-making authority)
3. Relevant previous examination results, organized chronologically
4. Paper medical records from previous consultations
5. Surgical case slides, wax blocks, or 20-30 glass slides
6. Pathological diagnosis report
7. Hospitalization medical records
8. Recent relevant examination results
9. The patients current treatment plan
10. The most urgent questions to consult