Metastasis



Metastasis (pronounced meh-TAS-ta-sis) means the spread of cancer. Cancer
cells can break away from a primary tumor and travel through the bloodstream
or lymphatic system to other parts of the body. The plural is metastases
(pronounced meh-TAS-ta-seez).

Cancers are capable of spreading through the body by two mechanisms:
invasion and metastasis. Invasion is the direct migration and penetration by
cancer cells into neighboring tissues. Metastasis is the ability of cancer
cells to penetrate into lymphatic and blood vessels, circulate through the
bloodstream, and then invade normal tissues elsewhere in the body.

Depending on whether or not they can spread by invasion and metastasis,
tumors are classified as being either benign or malignant. Benign tumors are
tumors that cannot spread by invasion or metastasis; hence they only grow
locally. Malignant tumors are tumors that are capable of spreading by
invasion and metastasis. By definition, the term "cancer" applies only to
malignant tumors. When patients are diagnosed with cancer, they want to know
whether their disease is local or has spread to other locations.

In large measure, it is this ability to spread to other tissues and organs
that makes cancer a potentially life-threatening disease, so there is great
interest in understanding what makes metastasis possible for a cancerous
tumor.

Cancer cells may spread to lymph nodes near the primary tumor (regional
lymph nodes). This is called nodal involvement, positive nodes, or regional
disease. Cancer cells can also spread to other parts of the body, distant
from the primary tumor. Doctors use the term metastatic disease or distant
disease to describe cancer that spreads to other organs or to lymph nodes
other than those near the primary tumor.

When cancer cells spread and form a new tumor, the new tumor is called a
secondary, or metastatic, tumor. The cancer cells that form the secondary
tumor are like those in the original tumor. That means, for example, that if
breast cancer spreads (metastasizes) to the lung, the secondary tumor is
made up of abnormal breast cells (not abnormal lung cells). The disease in
the lung is metastatic breast cancer (not lung cancer).

Factors involved in metastasis

Metastasis is a complex series of steps in which cancer cells leave the
original tumor site and migrate to other parts of the body via the
bloodstream or lymph system. To do so, malignant cells break away from the
primary tumor and attach to and degrade proteins that make up the
surrounding extracellular matrix (ECM), which separates the tumor from
adjoining tissue. By degrading these proteins, cancer cells are able to
breach the ECM and escape. When oral cancers metastasize, they commonly
travel through the lymph system to the lymph nodes in the neck.

Cancer researchers studying the conditions necessary for cancer metastasis
have discovered that one of the critical events required is the growth of a
new network of blood vessels. This process of forming new blood vessels is
called angiogenesis.

Tumor angiogenesis is the proliferation of a network of blood vessels that
penetrates into cancerous growths, supplying nutrients and oxygen and
removing waste products. Tumor angiogenesis actually starts with cancerous
tumor cells releasing molecules that send signals to surrounding normal host
tissue. This signaling activates certain genes in the host tissue that, in
turn, make proteins to encourage growth of new blood vessels.

Metastasis and primary cancer

Metastatis theoretically always coincides with a primary cancer. It is a
tumor that started from a cancer cell or cells in another part of the body.
However, over 10% of patients presenting to oncology units will have
metastases without a primary tumour found. Studies have shown that if simple
questioning does not reveal the cancer's source (coughing up blood
-'probably lung', urinating blood - 'probably bladder'), complex imaging
will not either. In some of these cases a primary will appear later.

The use of immunohistochemistry has permitted pathologists to give an
identity to many of these metastases. Imaging of the indicated area only
occasionally reveals a primary however.

Diagnosis of primary and secondary tumors

The cells in a metastatic tumor resemble those in the primary tumor. Once
the cancerous tissue is examined under a microscope to determine the cell
type, a doctor can usually tell whether that type of cell is normally found
in the part of the body from which the tissue sample was taken.

For instance, breast cancer cells look the same whether they are found in
the breast or have spread to another part of the body. So, if a tissue
sample taken from a tumor in the lung contains cells that look like breast
cells, the doctor determines that the lung tumor is a secondary tumor.

Metastatic cancers may be found at the same time as the primary tumor, or
months or years later. When a second tumor is found in a patient who has
been treated for cancer in the past, it is more often a metastasis than
another primary tumor.

In about 10% of cancer patients, a secondary tumor is diagnosed, but no
primary cancer can be found, in spite of extensive tests. Doctors refer to
the primary tumor as unknown or occult, and the patient is said to have
cancer of unknown primary origin (CUP). In rare cases (e.g. of melanoma) no
primary tumor is found even on autopsy. It is therefore thought that some
primary tumors can regress completely, but leave their metastases behind.

Treatments for metastatic cancer

When cancer has metastasized, it may be treated with chemotherapy, radiation
therapy, biological therapy, hormone therapy, surgery, or a combination of
these. The choice of treatment generally depends on the type of primary
cancer, the size and location of the metastasis, the patient's age and
general health, and the types of treatments used previously. In patients
diagnosed with CUP, it is still possible to treat the disease even when the
primary tumor cannot be located.

Cancer - List of Famous Cancer Patients - Medical Topics - Medical_Terms - Medicine - Alternative Therapies -