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What is Metastasis? Print E-mail
Written by Amanda Wattson, MD   
Tuesday, 27 October 2009

Metastasis is the spread of cancer cells from the original site 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. 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. Cancer cells may travel throughout the body and take hold in certain locations. 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.

What are the causes and risks of the disease?
The particular genetic changes in the cancer may make it more prone to spread. Metastasis in part depends 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 carcinoma of the skin.

What are the treatments for the disease?
Some metastases can be removed surgically. This depends on the type of cancer and its location. This is usually the case when there are very few metastases or the metastasis is isolated.

Medical treatment is the usual approach. Some cancers respond well and are curable, even if there are multiple metastases. Radiation therapy can be useful for local tumor recurrence. Otherwise, systemic therapy is needed. This 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 being tried. These include anticoagulation of the blood, enzyme inhibitors, gene therapy, and growth factor inhibitors. Such treatments are experimental.

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 allergic reaction 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.

What happens after treatment for the disease?
Some metastases are curable, while others are not. Some treatments have late complications.

How is the disease monitored?
The person is watched for any recurrence of metastases. Physical exams, blood tests, and tests for tumor markers are done. Chest X-rays, CT scans, bone scans, and MRIs may also 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 provider.


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