Primary lung cancer can metastasize by a direct local extension, hematogenous dessemination, and lymphatic spread. However, it less commonly metastasizes via a transbronchial invasion. A pproximately half of all patients with lung cancer have metastases at the initial presentation. Autopsy data showed that there are an average of 4.8 metastatic sites. The most common sites for metastases include the lymph nodes, liver, adrenal gland, bone, and brain. However, clinically significant metastases isolated in the small bowel seldom occur.