Four years previously, a 56-year-old fisherman underwent thyroidectomy for cancer of the thyroid gland. He is now noted to have a single 4 cm lesion in the upper lobe of the left lung. There is no other evidence of disease, and he is in excellent health. Endobronchial biopsy confirms that the lesion is malignant but the organ of origin cannot be determined. What should he be given?

Although there is a history of previous thyroid cancer, the presence of a solitary nodule on chest x-ray is more likely to represent a primary carcinoma of the lung than a solitary secondary metastasis. In metastasis, the lesions are more often multiple, they frequently appear bilaterally, and they more commonly present in the lower area of the lungs. A CT scan would be helpful in delineating the pulmonary findings.