Lung cancer often develops bone, brain, lung and liver and adrenal metastasis, and metastasis means a shorter survival period. But do different sites of metastasis have an impact on survival? To clarify the common metastatic sites of lung cancer and the impact on survival, Professor M Riihimäki et al. from Lund University, Sweden, used a new population-based approach to study the metastatic pathways of lung cancer patients from death certificates and national hospital admission data. The results found that metastatic site and survival of lung cancer were influenced by gender, histological subtype and age at diagnosis. The prognosis of liver and bone metastases was worse than that of neurological metastases. The study counted a total of 17,431 deaths from 2002-2010 based on mandatory reporting of lung cancer diagnosed in the Swedish National Cancer Registry. The effects of age at diagnosis, gender, and histological subtype on metastatic spread were studied. Survival of distant metastases from lung cancer was assessed by histology and metastatic site. It was found that the most frequent sites of lung cancer metastasis were the nervous system, bone, liver, respiratory system, and adrenal glands. Small cell lung cancer most frequently metastasized to the liver (35%) and the central nervous system (47%). Adenocarcinoma most frequently metastasized to bone (39%) and the respiratory system (22%). Neurological metastases were more frequent in women (43% vs. 35%) and in younger patients. The above results show that the pattern of metastasis in lung cancer depends on histological staging, gender, and age at diagnosis of lung cancer. Patients with squamous cell carcinoma were less likely to have metastases than other histologic subtypes. Small cell lung cancer was more likely to have liver and neurological metastases, while patients with adenocarcinoma were more likely to have bone and respiratory metastases. Younger age at diagnosis increases the chance of metastasis in addition to respiratory and hepatic metastases. Women are more likely to develop neurological metastases. Lung cancer survival was shorter with liver and bone metastases and longer with neurological metastases. In conclusion, this study suggests that more attention should be paid to patients with specific metastatic sites and encourages research on the mechanisms of metastasis.