Metastasis

Metastasis

Definition

Metastasis is the spread of cancer cells from the original site of the tumor to other parts of the body.

What is going on in the body?

As cancer grows and changes, cells lose their ability to stay in a single tumor mass. When cancer cells get into the lymph system or blood vessels, they break off. Cells can spread as a single cell or as many tiny cells. The cells circulate until they find a good place to grow.
Because the entire body is supplied by blood and drained by the lymph system, metastases can appear in almost any part of the body. A site for metastatic cancer must have a blood supply and an environment where it can grow. Common sites are the brain, lungs, liver, lymph nodes, bone, skin, and adrenal glands.
Some cancers already involve much of the body when they are first detected. This is common with cancers such as leukemia and lymphoma. Where and when a cancer will spread depends on many factors. These factors include the primary tissue type and the genetic abnormality of the cancer.

Risks

What are the causes and risks of the disease?

The particular genetic changes in the cancer may make it more prone to spread. Metastasis depends in part on how different the cancer is from surrounding tissue, whether certain genes are activated, and how close the cancer is to lymph nodes or blood vessels.
Other factors are the strength of the person's immune system and how long a malignancy has gone untreated. Anyone with a malignancy is at risk for metastases. There are a few cancers that rarely spread. These include primary brain tumors and basal cell or squamous cell carcinomas of the skin.

Prevention

What can be done to prevent the disease?

Prevention of metastasis depends on early diagnosis and treatment of cancer. Many people have tiny metastases that cannot be seen at the time of diagnosis. Treatments such as chemotherapy or radiation therapy are used as treatment. The prevention and control of metastases is an active area of cancer research.

Diagnosed

How is the disease diagnosed?

The diagnosis of metastasis begins with a medical history and physical exam. The healthcare professional may order various blood tests, including those for tumor markers. X-rays and other imaging studies are often used to diagnose a metastasis.
Special X-rays, such as MRIs, CTs, or PET scans, may be used. These can sometimes find tumors smaller than half a centimeter. Finding even smaller, microscopic metastases would be useful. Future tests may check for cancer genes in parts of the body where tiny metastases are suspected.
Some people are assumed to have microscopic metastases, even if they cannot be detected, because of the nature of the primary tumors. In this case, the individual is treated in an attempt to kill the tumor cells before they grow into visible metastases.
In other cases, no further therapy is given until a metastasis is detected, and a biopsy may be needed. Testing can involve removal of a lymph node, needle puncture of a tumor, or examination of a bone marrow sample.

Long Term Effects

What are the long-term effects of the disease?

Some cancers with metastasis can be cured. These include tumors that are highly sensitive to radiation therapy or chemotherapy. Following are some examples:
  • certain forms of leukemia
  • certain forms of lymphoma, a blood cancer
  • certain types of thyroid cancer
  • some sarcomas
  • testicular and other germ-cell cancers
People can live with metastases for many years. These cancers may include:
  • breast cancer
  • low-grade lymphoma and leukemia
  • low-grade sarcomas
  • prostate cancer
Metastasis usually leads to death if it cannot be removed or treated.

Other Risks

What are the risks to others?

Metastases are not contagious. They pose no risk to others.

Treatments

What are the treatments for the disease?

Some metastases can be removed surgically. This depends on the type of cancer, and usually works when there is just one or a few isolated metastases, in a place that can be easily reached surgically. Radiation therapy can also be useful for local tumor recurrence.
Most of the time, however, systemic therapy with medications is the best approach to metastatic disease. Some cancers respond well and are curable, even if there are multiple metastases. Systemic therapy includes chemotherapy and biological response modifiers. These treatments are administered intravenously or orally. They treat malignant cells wherever they are.
Much research is being done on treating metastases. Other approaches are experimental and anticoagulation of the blood, enzyme inhibitors, gene therapy, and growth factor inhibitors.

Side Effects

What are the side effects of the treatments?

Some people can have more than one brain or lung metastasis removed without many long-term problems. Any surgery involves risks. These include infection, bleeding, and reactions to anesthesia.
Radiation therapy for metastasis is usually directed to just one area. Any side effects will be related to the area being treated. In general, nausea, fatigue, and skin irritation can result. More serious effects, like bone marrow suppression or secondary cancers, are possible.
Chemotherapy and biological response modifiers have many side effects, depending on the medicines used. Side effects can be mild, such as nausea, temporary hair loss, and fatigue. More severe nausea and fatigue can be treated with new medicines. Side effects can also be life-threatening, such as severe infections, secondary tumors, severe blood clots, or organ damage.

After Treatment

What happens after treatment for the disease?

Some metastases are curable, while others are not. Some treatments have complications that occur some time afterward.

Monitor

How is the disease monitored?

The person is watched for any recurrence of metastases. Physical exams, blood chemistry tests, tests for tumor markers are done, chest X-rays, CT scans, bone scans, and MRIs may be done. In some cases, regular biopsies are performed. Routine screening for remaining cancer genes is being studied. Any new or worsening symptoms should be reported to the healthcare professional.

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