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Metastatic cancer is the spread of tumor cells from the site of origin to other parts and organs of the patient’s body. How does cancer or spread or metastasize? There are two ways: along the vessels of the lymphatic system and through the vessels of the circulatory system.
Metastatic cancer cells have detached from the primary tumor and have begun their “journey” through the vessels. Usually, tumors metastasize at a later stage, so it is essential to determine whether the detected tumor is primary. If not, you should carefully examine the body in search of the source of metastasis.
Metastatic cancer, like the disease itself, requires treatment. The following methods are used:
- Radiation therapy (or radiotherapy);
- Surgical treatment (in particular, low-traumatic surgery – laparoscopy); and
Malignant Growth Mechanisms
Cancer development begins at the moment when a cell with damaged genes reproduces. Subsequently, cancer cells undergo uncontrolled division (abnormal mitosis), which leads to a rapid increase in cell clumping. This can be detected during a patient examination during preventative cancer screening. The collection of cancer cells at the site of the onset of the tumor process is the primary tumor. Further tumor growth is what happens when cancer metastasizes. Such sprouting is usually called local metastases.
With the continuation of the tumor process, detachment of individual cells is observed with their further spread through the bloodstream and lymph flow, due to which, under certain conditions (reduced general or local immunity), metastatic tumors develop. In patients with good body resistance, the introduction of tumor cells into other organs does not lead to the development of metastatic lesions.
Tumor cells enter the vessels of the lymphatic and circulatory systems after the place of contact with the tumor (in the vessel) is violated. Suppose a tumor cell circulating in the blood or lymph manages to attach itself to the vessel wall or to the organ through which the vessel passes. In that case, it penetrates beyond its “transport corridor” and continues uncontrolled reproduction.
Thus, another metastatic tumor is formed, which can be detected during clinical diagnosis. When examined in detail, the cell type of this new tumor (metastasis) matches the cell type of the primary tumor. Thus, the structure and metabolism of the metastatic cells, in most cases, correspond to the cells of the primary tumor. For example, breast cancer most often metastasizes to the lungs. Therefore, if a tumor consisting of abnormal breast cells is found in the lungs, the oncologist must take action to detect the primary tumor.
Metastasis is the primary (but not the only) sign of tumor malignancy. However, the ability to metastasize in different types of cancer is different. For example, of two skin tumors, melanoma is an extremely aggressive metastasis, and cases of metastasis of basalioma (basal cell carcinoma of the skin) are sporadic.
Relapses and metastases of a malignant tumor are a severe complication that is more dangerous for the patient’s life than the primary tumor. Early detection of these complications and specialized treatment are the main directions of the struggle for the life expectancy of cancer patients.
Recurrence and Metastasis of Tumors
Various clinical observations and results of statistical studies have shown that the following factors affect the frequency and characteristics of the occurrence of relapses and metastasis, which determine the cancer has metastasized:
- The stage of the tumor at the start of the specialized treatment: Theoretically, in patients who receive radical treatment (surgery or radiosurgery) at the first stage of the disease, tumor cells do not penetrate the vessels of the lymphatic or circulatory system. This means there is no reason to expect metastases or tumor recurrence. However, you can look for precise information about whether single cells have penetrated the bloodstream/lymph flow, whether the tumor was excised entirely, and whether a radiosurgical dose of ionizing radiation was delivered to the full volume of the tumor lesion.
- Localization: Modern methods allow achieving the effectiveness of treatment, for example, (except for melanoma), at 70-80%. The same indicator in patients at the first stage of non-melanoma skin cancers reaches 100%. In this case, the location (localization) of the primary tumor affects only the frequency of metastasis but also those “targets” to which it “sends” metastases. Due to the peculiarities of the anatomical structure of all organs, even the placement of the tumor in a certain part is a factor influencing the spreading prognosis. For example, with the development of a breast tumor in the inner quadrant, the prognosis may be worse than with localization in the outer quadrant, etc.
- Form of tumor growth and histological structure of the tumor: Simple forms of skin cancer grow slowly without metastasizing for many years. Infiltrative tumors grow rapidly and metastasize early. Unfavorable results of treatment of patients with lung cancer were observed in poorly differentiated forms of cancer. Melanoma is extremely active metastasized. Exophytic tumors of the gastrointestinal tract are less malignant than infiltrative forms of cancer of the same organ.
- Nature and extent of the radical treatment: How the patient received treatment for the primary tumor has a direct impact on the likelihood and nature of metastasis. Modern oncology has repeatedly proved that the greatest effect (including reducing the frequency of relapses and metastasis) can be achieved with combined treatment, which uses a combination of methods: surgery, radiosurgery, chemotherapy, targeted therapy, etc.
- Age: Tumor growth and metastasis in younger people, in comparison with older patients, proceed similarly to other biological processes – faster and more intense.
Typical Metastatic Tumor Routes
TheLymphogenous route is the transfer of tumor cells that have grown through the wall of a lymphatic vessel with lymph flow into regional (nearby) lymph nodes or distant lymph nodes. The most common lymphogenous metastases are tumors such as:
- Esophageal carcinoma
- Stomach cancer
- Colon cancer
- Laryngeal cancer
- Cervical cancer
- Malignant tumors of lymphatic and hematopoietic tissue
The main “target” of this metastasis are the lymph nodes of the neck, through which the lymph flow passes both from the upper part of the body (head, chest organs, and upper extremities) and from structures and organs of the lower half of the human body (abdominal organs and lower extremities).
Due to the peculiarities of the topography of the lymphatic system, the most frequent “routes” of lymphogenous metastasis are as follows:
- Cancer of the lower lip, anterior parts of the tongue and oral cavity, upper jaw metastasizes, first of all, to the chin and submandibular lymph nodes;
- Tumors of the posterior parts of the tongue, the floor of the mouth, pharynx, larynx, and thyroid gland – in the lymph nodes along the neurovascular bundle of the neck;
- Lung cancer and breast cancer metastasize to the supraclavicular region – to the lymph nodes located outside of the sternocleidomastoid muscle.
- Cancer of the abdominal cavity metastases to the supraclavicular area, to the lymph nodes located inward from the sternocleidomastoid muscle, between and behind its legs; and
- Metastases of gastric cancer spread so significantly that metastases to each of the targets have their classification depending on the “target”: metastases to the lymph nodes of the left supraclavicular region, to the lymph nodes of the pelvic area, lymph nodes in the armpit, metastasis to the ovaries, and to the navel.
In contrast to lymphogenous, hematogenous metastases are often multiple and are located at a considerable distance from the primary tumor. The most common sources of hematogenous metastases in the lungs are malignant tumors of the ovary, breast cancer, kidney cancer, osteosarcomas, and soft tissue sarcomas. Cancer of the stomach and pancreas, rectal cancer, lung cancer, and kidney cancer often metastasize to the liver.
Symptoms of Metastatic Cancer:
For metastases with various “targets,” there are characteristic signs by which the doctor or the patient can determine the presence of a metastatic process:
- Lymph nodes: lymphadenopathy
- Lungs: cough, hemoptysis, and shortness of breath
- Liver: hepatomegaly (enlarged liver), nausea, and jaundice
- Bones: bone pain, fractures of the affected bones
- Brain: Neurological symptoms such as headaches, seizures, and dizziness occur later.
- Compression of the laryngeal nerve (hoarse speech, whispering, and voice change) may indicate a primary tumor of the esophagus, thyroid gland, or lung;
- Pain in the spine, pelvic bones, and long bones may be signs of metastases of breast, thyroid gland, prostate, or lung cancer.
When observing patients who have received treatment for a malignant neoplasm, one should pay attention not only to the development of possible metastases but also to the relapse of the disease – the resumption of growth from tumor cells remaining after surgical treatment or after radiation treatment. Relapse can start from a single tumor cell. As a rule, relapses occur after radical treatment, in which outdated technologies of radiation treatment were used, and surgical intervention was performed in a reduced volume due to the peculiarities of the location of the tumor or the patient’s condition.
However, the problem of timely detection of tumor recurrence should be solved not only by the attending physician. As a rule, the patient is the first to notice the previously suffered symptoms. Unfortunately, the psychological aspect of not accepting the likelihood of a recurrence of the disease and the associated treatment often leads to an untimely visit to the oncologist.
The attention of family members, friends, and relatives of the patient who received radical treatment plays an essential role in the early diagnosis of a possible recurrence of a tumor disease. Symptoms such as weakness, swollen lymph nodes, local tenderness, mental disturbances, depression, etc. are a signal for an unscheduled visit to an oncologist and an appropriate examination.
Rehabilitation of a patient after the treatment of malignant tumors is an essential component of comprehensive oncological care. Correct development and implementation of a plan for physiological and psychological rehabilitation – this task should be solved simultaneously with the end of the treatment phase and the beginning of observation to identify possible relapses or metastases. Part of this plan may include care to make you more comfortable. If you are dealing with metastatic cancer, reach out to All American Hospice for a free consultation. Our experts can manage your physical and emotional pain, provide companionship, and assist with personal care.