A feature of lung cancer, unlike all other malignant tumors, is the fact that tumor cells immediately go directly into the systemic circulation, bypassing biological filters, and can gain a foothold in almost any organ. Due to this extended

the geography of metastasis makes every patient conduct their intensive search. The results of research in this area largely determine the future strategy of the doctor.

The identification of distant metastases, and thus the exclusion of palliative surgical interventions, is of particular importance due to the fact that a significant proportion of the patients to whom they may be offered are patients over 60 years old, who usually have pronounced age-related changes in cardiovascular disease. , respiratory systems, liver, kidneys, and in some cases their chronic diseases.

At the same time, an analysis of the autopsies of patients who died from various postoperative complications during a period of 1– months shows that in some cases surgical interventions are performed in the presence of distant hematogenous metastases (Table 4).

According to the generalized data of thirteen domestic and foreign authors, approximately one in four of the seemingly “radically” operated patients has distant metastases. Moreover, all authors agree that the prevalence of the primary tumor, the state of the intrathoracic lymph nodes, the histological form of the neoplasm have a significant impact on the detection of distant metastases. Thus, our data showed that with locally advanced forms of lung cancer, the error in determining the M descriptor before the operation reaches 38%, and with poorly differentiated forms of the tumor, it can exceed even 40%.

It must be emphasized that even with the most thorough analysis of the patient’s complaints, the results of a physical and routine X-ray examination, only 13.4% to 3% of patients with distant metastases can be identified. In 10% of patients with lung cancer, asymptomatic foci of bone lesions are found in 20% of patients with brain metastases, there is no neurological symptoms in patients with secondary foci in the liver and more than 50% of cases with damage to the kidneys and adrenal glands are asymptomatic. Even more disappointing are the results of studies conducted at the clinic of thoracic surgery of the Military Medical Academy, which showed that the possibility of metastasis of lung cancer to the liver, kidneys and adrenal glands on the basis of physical examination data could be assumed only in 8.9% of histologically confirmed cases.Finally, under the mask of metastases, paraneoplastic syndromes and concomitant somatic diseases are often hidden, which can lead to an overestimation of the spread of the tumor. So according to R. Lamaze et al. (1985) neurological symptoms unrelated to metastases occur in patients with lung cancer in 50% of cases.

Therefore, in the course of further examination it is necessary to confirm or to reject clinical and radiological assumptions about metastasis to distant organs and tissues, to reveal hidden metastases occurring.