Cancer spread to the lungs means a cancer that started elsewhere — bowel, breast, kidney, womb, ovary, or another site — has produced growths in lung tissue. The cancer is still named after where it started: bowel cancer that has spread to the lungs is still bowel cancer. Most patients in this position do not need lung surgery; treatment is usually with chemotherapy, immunotherapy, or hormone therapy aimed at the whole body. For a smaller group with limited spread and a controlled primary cancer, surgery to remove the spots — called pulmonary metastasectomy — can be a meaningful part of the plan, most often by keyhole or robotic technique with hospital stays of 1–5 days. The decision is always taken by the multidisciplinary team caring for your cancer. Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), reviews cases personally at London Bridge Hospital within 2–3 days. Self-referrals welcome.
Last reviewed: May 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
If cancer has spread to the lungs, treatment is usually with whole-body therapy — chemotherapy, immunotherapy, or hormone therapy. Lung surgery is for a smaller group of patients with limited spread and a controlled primary cancer.
For patients with a limited number of spots in the lungs, where the original cancer is under control, removing the lung spots can be a sensible part of treatment. Most operations are keyhole, with short hospital stays.
Whether surgery is right for you is decided by a multidisciplinary team that brings together oncologists, radiologists, and the surgeon. No surgical decision is made by one doctor in isolation.
AI summaries can tell you what pulmonary metastasectomy is, what the criteria are, and what the medical literature says. What an AI summary cannot do is look at your specific scan, read the multidisciplinary record from the team caring for your cancer, and tell you whether surgery is the right answer for your situation.
That is the work of the consultation, not the article. Dr Okiror reviews scans and the multidisciplinary record personally at the first appointment. If your case has not yet been considered surgically, or if you would like an independent view, it is presented to the London Bridge Hospital chest multidisciplinary team before any surgical decision is made. You are never asked to commit to surgery on the strength of one consultation. Private appointments at London Bridge Hospital within 2–3 working days. Self-referrals welcome.
When a cancer that started elsewhere in the body produces growths in the lungs, doctors call this pulmonary metastases — or, in more everyday language, secondaries, spread to the lungs, or shadows on the lungs from another cancer. The cancer is named after where it started, not where it has spread to. Bowel cancer that has spread to the lungs is still bowel cancer. Breast cancer that has spread to the lungs is still breast cancer. The cells in the lung spots are the same kind of cells as the original tumour.
The lungs are one of the commonest sites for cancer to spread to. Several common cancers — bowel, breast, kidney, womb, ovary, and others — can produce lung spots. Some cancers that have spread to the lungs cause symptoms (a cough, breathlessness, occasionally chest pain), but many do not. The spots are often picked up on a routine scan that is part of the follow-up of the original cancer, before they have caused any symptoms at all.
For most patients in this position, the treatment plan is led by the oncology team caring for the original cancer. Treatment is usually with chemotherapy, immunotherapy, hormone therapy, or targeted therapy — treatment aimed at the whole body, because cancer cells in the lung spots are part of the same disease as the cancer that started elsewhere.
For a smaller group of patients, however, surgery to remove the lung spots can be part of the plan. That is what the rest of this page is about.
Surgery may be considered if these things are broadly true. They are typical, not exhaustive — every case is decided by the multidisciplinary team caring for your cancer.
There is no fixed number above which surgery is no longer offered. The judgement is whether the surgeon can reasonably expect to remove all the spots and leave you with enough healthy lung to live well afterwards.
Operating on lung spots makes sense only if the cancer where it started is being controlled. Your oncology team confirms this from your records and recent scans.
Standard checks: lung function, heart function, fitness for general anaesthesia. The aim is for you to recover well and benefit from the operation. More on the fitness assessment →
Lung-only spread is the typical situation. The recognised exception is bowel cancer with spots in the liver as well as the lungs — managed in a coordinated pathway, usually with the liver treated first and the lungs afterwards.
Other treatments — local ablation, stereotactic radiotherapy, continued whole-body therapy — are weighed against surgery. Surgery is recommended only when the team judges it the most appropriate option for your specific situation. More on the surgical decision →
Surgery to remove cancer that has spread to the lungs has been performed for over fifty years. Many large international series report meaningful long-term survival in selected patients after this surgery. The largest of these — the International Registry of Lung Metastases, with data on more than 5,000 patients — remains the foundation of how we choose patients today.
There has been one randomised trial — the only kind of study that can prove cause and effect with certainty. It was called PulMiCC and ran in the UK for six years. It did not recruit enough patients to give a clear answer either way. Some thoracic surgeons believe the evidence supports the surgery; others, including the chief investigator of PulMiCC, argue the case is weaker than the international series suggest.
Our position is honest about this. The evidence is neither strong enough to prove the surgery does not help, nor strong enough to prove it does. Surgery is recommended when the multidisciplinary team agrees it is the best option for your specific situation, and when you and the team believe the trade-offs are right for you. We are open about this uncertainty at the first consultation, not after.
Most operations are keyhole — either VATS (using a small camera through the side of the chest) or robotic. The choice of approach depends on where the spots are in the lung, not on surgeon preference for one technique over another.
Spots at the edge
Keyhole wedge resectionA small wedge of lung containing the spot is removed through three small incisions of one to two centimetres each, using either a VATS or robotic approach.
Hospital stay: 1–2 days
Deeper spots
Lung-preserving laser resectionFor spots deeper in the lung, a small incision and a specialised laser allow the spot to be lifted out while preserving as much surrounding lung tissue as possible. Dr Okiror leads this technique at his hospitals.
Hospital stay: 2–3 days
Central spots
Robotic anatomical removalFor spots near the major airways or blood vessels, a slightly larger anatomical operation — usually robotic — is needed to remove the affected segment of lung.
Hospital stay: 3–5 days
Most patients are back to light activities within two to three weeks of surgery, and to normal activities progressively over six to twelve weeks. Recovery varies between people; the lengths of stay above are typical, not contractual minimums. Some patients go home faster and some need an additional day for pain control or drain management.
A common worry — voiced explicitly or carried silently into clinic — is that any further spread after the first operation would mean the end of treatment options. It does not.
If new spots appear in the lungs after a successful first operation, repeat surgery can usually be considered, provided the cancer remains otherwise controlled, you remain well, and the multidisciplinary team agrees. A number of patients in Dr Okiror’s practice have undergone more than one metastasectomy operation. The published evidence reports broadly comparable outcomes for repeat surgery in selected patients.
One of the reasons the first operation is performed in a lung-preserving way — including the laser-assisted approach for deeper spots — is precisely to keep this option available later. Every gram of healthy lung preserved at the first operation is lung available for a second operation if it is ever needed.
When spots are present in both lungs, each side is operated on as a separate keyhole or robotic procedure. The two operations are usually three to five weeks apart, and a CT scan is performed in that interval to confirm no new spots have appeared and to plan the second-side operation.
This staged approach is gentler on the body than operating on both sides at once, and it means the second-side plan can be revised if anything has changed in between. It also means that recovery from each operation is straightforward keyhole-surgery recovery, rather than the longer recovery that would follow a single larger operation.
Surgery takes place at London Bridge Hospital or The Lister Hospital Chelsea. Both hospitals have the da Vinci Xi robotic platform and the operating theatre infrastructure for keyhole and robotic resection. London Bridge Hospital is the primary base for more complex cases and for patients whose pathway involves further investigations or coordination with the chest multidisciplinary team. The Lister is the second operating base, suitable for many straightforward operations depending on convenience and case complexity.
First-appointment consultations and follow-up appointments are also available at the HCA outpatient clinics in Canary Wharf and the City of London. Surgery and overnight care take place at London Bridge Hospital or The Lister Chelsea.
Most private patients are seen within 2–3 days of contacting the practice. Self-referrals welcome — no GP letter needed before booking. Bring any existing CT scans, PET-CT scans, pathology reports, and a copy of the multidisciplinary team decision if one has already been made. Dr Okiror reviews the imaging personally at the first appointment.
If a multidisciplinary team caring for your cancer has already considered surgery and referred you, the case enters the surgical pathway directly. If you have not been referred and are reaching out yourself, the case is presented to the London Bridge Hospital chest multidisciplinary team before any surgical decision is made — this is part of how the service is run, and it is a safeguard, not a delay.
Request a second opinion → · Information for referring clinicians →
Questions most commonly asked by patients and families when cancer that started elsewhere has been found to have spread to the lungs.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
Self-referrals welcome. Private appointments at London Bridge Hospital within 2–3 days. Bring any existing scans and reports. Dr Okiror reviews everything personally and gives a clear, honest assessment at the first appointment.
Jo Mitchelson, Private PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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The full clinical guide — evidence, selection, surgical approach including laser metastasectomy, repeat surgery, and the multidisciplinary pathway
Specialist Second OpinionIndependent review of imaging, pathology, and MDT decisions before committing to a treatment plan
Shadow Found on Lung ScanFor patients who have just been told a CT shows shadows in the lungs — what it means and what comes next
Lung Cancer SurgeryFor patients whose cancer started in the lung itself — surgery for primary lung cancer, distinct from metastases
Lung Nodule AssessmentFor patients with a lung nodule of unknown cause — surgical assessment and treatment
For GPs and Referring CliniciansReferral information for primary care and specialist colleagues considering metastasectomy referral
Fitness for Lung SurgeryFor patients told they are not well enough for surgery elsewhere — the structured re-assessment that sometimes changes the answer