Pulmonary metastases from cervical cancer in Sri Lanka

Cervical cancer is the second commonest malignancy in Sri Lankan women. The records of 2075 patients treated for cervical cancer from 1989 to 1993 were reviewed. Thirty-eight patients (1.8%) developed pulmonary lesions consistent with metastases. The median age at the time of presentation with metastases was 49.8 (range 24-73) years. Ten patients (26.3%) had pulmonary metastases at presentation. Twenty-eight (73.7%) developed metastases during follow-up. By the end of 2 years 27 (96.4%) of these patients had developed pulmonary metastases. The median time from diagnosis of cervical cancer to the detection of pulmonary metastases was 9 months. The commonest histological cell type was the large cell non-keratinising squamous carcinoma. Nine (23.7%) of these patients were asymptomatic. Two patients had lung metastases on initial staging chest X-ray while the other seven were detected during routine 3-monthly surveillance chest X-rays as follow up of primary treatment. This emphasises the importance of incorporating routine surveillance chest X-ray as part of the regular follow up. All patients with pulmonary metastases had abnormal shadows in chest X-rays. Nodular lesions were the commonest radiological findings. Local disease was controlled in 17 (55.3%) of the patients who developed metastases during follow-up, while 11 (28.9%) had active disease. There were 24 patients with spread to other sites at the time of diagnosis of pulmonary metastases. The discovery of effective chemotherapy agents is anticipated.