Most patients, whom doctors have diagnosed with stage cancer and metastases, ask mainly about what are the chances of getting rid of the problem. It is the stages of cancer and metastases that determine life expectancy. For example, in stage 4 cancer, when metastases are widespread and considered incurable, patients tend to prepare only for the worst. In fact, the answer to the question is far from clear; the stage of cancer and metastases of the disease may not always mean death.
In some cases, primary formation can become a significant problem, in which it is difficult to predict a favorable prognosis. Conversely, cancer stage and metastases can be significantly mitigated by many factors, because There are many nuances that affect the prognosis of tumor spread:
- Ki67 index, - cell differentiation, - mutations, - tumor localization in the body, - features of detected metastases and other points.
Metastatic cancer - what is it?
Almost any late-stage cancer is called metastatic. From Greek metastasis means – meta stateo – “I stand at a distance.” In this case, damage to organs somewhat distant from the main tumor is observed; this is due to the spread of malignant cells from the tumor through the lymphatic or blood vessels.
This can be illustrated with the following example. The woman was diagnosed with breast cancer; she has a tumor in her right gland. After some time, repeated examination shows that secondary formations have appeared in the liver. It is incorrect to consider this the appearance of cancer in the liver - in this case, the progression of breast cancer is observed. After such a phenomenon is detected, the diagnosis of “breast cancer” is changed to “metastatic breast cancer.”
Tumor metastases - symptoms and treatment
Tumor metastases are cancer cells that have spread throughout the body and become established in one or more internal organs. In 90% of cases, it is metastases that cause the death of a cancer patient [1][2]. Any malignant tumor can metastasize; this is one of the properties that distinguishes them from benign tumors.
It is now known that metastasis is a complex, dynamic process. It plays a role in the mutational load of the tumor (the number of mutations in the genetic code of cancer cells), the interaction between cancer and normal cells, and signaling molecules that are located in the intercellular substance (they interact with cells and control their growth and reproduction).
Probability of developing metastases
Whether metastases occur or not depends on several factors:
- Type of cancer. For example, basal cell carcinoma metastasizes extremely rapidly, and melanoma is a highly aggressive neoplasm in which metastases develop very quickly.
- Molecular genetic features of cancer. For example, triple negative breast cancer is more likely to metastasize than tumors that have estrogen receptors, progesterone receptors, or those associated with overexpression of the HER2 protein.
- The degree of malignancy of the tumor. The higher it is, the more aggressive the cancer and the higher the likelihood of it metastasizing.
- Features of localization. For example, breast cancer in the inner quadrant of the breast metastasizes more often than tumors in the lateral quadrants.
- Features of growth. Tumors with infiltrative growth metastasize more often and faster than tumors growing superficially. For example, fungal tumors of the colon and stomach are less malignant than infiltrative forms of cancer of these organs.
What affects the rate of spread of metastases?
The rate of spread of metastases also depends on the type of cancer, the degree of malignancy of the tumor and its molecular genetic characteristics. For example, high levels of TGF beta protein may increase the rate of metastasis.
However, more often in clinical practice, the rate of spread of metastases throughout the body is associated with the type of cancer and its location. For example, poorly differentiated tumors metastasize earlier than highly differentiated ones, and lung cancer, due to its good blood supply, spreads much faster than prostate cancer.
Once metastasis has occurred, it becomes very difficult to fight a malignant tumor; this is the last stage of cancer development . From this point on, treatment is palliative in nature: it helps to slow down the progression of cancer, prolong life and improve the condition, but not cure the patient [3].
Most often, malignant tumors metastasize to the bones, lungs, liver and brain. In some types of cancer, tumor cells spread along the surface of the peritoneum.
The complex chain of events, as a result of which a malignant cell breaks away from the mother tumor, migrates in the body and forms a secondary focus in another organ, is not fully understood, and work in this direction continues [1]. Some theories attempt to explain the causes of metastasis .
One of them says that due to accumulated mutations, an epithelial-mesenchymal transition : tumor cells begin to resemble those found in the body of the embryo and are involved in wound healing. They are irregular in shape, do not stay in place and can migrate in the body.
According to another theory, metastases occur from stem cells , which normally should replace cells that die as a result of damage or naturally. This theory is supported by the fact that tumor and stem cells have a number of common features in structure and biochemical processes.
It is believed that macrophages (“eater cells”), which normally should eliminate foreign particles, help spread metastases of a malignant tumor. In cancer, they support inflammation and angiogenesis (the process of forming new blood vessels). This promotes the migration of tumor cells.
In cancer patients, millions of cancer cells enter the bloodstream every day. But only a few of them can give rise to metastases. This depends on the histological type of the tumor (from which tissue it originated), the degree of aggressiveness of the tumor (stage of cancer), and cell differentiation (how much they have lost their normal features).
First stage of pathology
The first stage of cancer development is the presence of a tumor node. At the same time, the lymph nodes are not yet affected and there are no metastases in the body. Recently, the number of detected and treated tumors has increased significantly. This indicates an increase in people's awareness of this issue and their ability to take care of their health. Competent treatment helps in most cases.
Classification
Depending on the number, metastases are:
- sole, or solitary;
- single (up to 10);
- multiple (more than 10).
The sizes are small (up to 1 cm in diameter), medium (1-3 cm) and large (more than 3 cm). The speed of their appearance depends on the degree of aggressiveness of the primary tumor.
Metastatic tumors are not classified according to the TNM system. The presence of metastases in the liver itself indicates stage 4 of the primary tumor.
Development of metastases
When the problem develops to the level of stage 3 cancer with metastases, the tumor becomes very active, quickly increases in size, growing into nearby tissues. In most cases, screenings are observed in distant lymph nodes. The prognosis takes into account factors such as the degree of differentiation and location of the tumor, and the general condition of the patient. These moments can both aggravate and reassure the patient’s situation. Successful treatment here is still quite possible.
Diagnostics
Since the formation of secondary tumors in the brain causes the death of the patient, it is important to identify the presence of a pathological formation as early as possible. If cancer is present, the patient must be diagnosed continuously to monitor the situation and timely identify secondary tumors in the brain. If the tumor in the head is small, it usually already has a pronounced clinical picture, however, it can be diagnosed at the earliest stages using computed tomography (CT) or magnetic resonance imaging (MRI). A biopsy is important to establish the metastatic process and clarify all the nuances of pathogenesis. The presence of metastases can be suspected even with a biochemical blood test.
Mechanisms of malignant growth
Cancer development begins when a cell with damaged genes reproduces. Subsequently, the cancer cells undergo uncontrolled division ( abnormal mitosis ), leading to a rapid increase in cell clumps that can be detected when the patient is examined during preventive cancer screening . The collection of cancer cells at the site of the beginning of the tumor process is the primary tumor . Further growth of the tumor can lead to its invasion into surrounding tissues and organs. Such germinations are usually called local metastases .
As the tumor process continues, detachment of individual cells is observed with their further spread through the blood and lymph flow, which is why, under certain conditions (reduced general or local immunity), the development of metastatic tumors occurs. In patients with good body resistance, the transfer of tumor cells to other organs does not lead to the development of metastatic lesions.
Methods of biochemical and cytogenetic studies help identify undifferentiated cells when the presence of a tumor is suspected.
Methods to suppress pain with metastases in the spine
Obsessive and radiating pain sensations physically exhaust the patient. They can appear spontaneously or be permanent. A common way to treat moderate pain is to take non-steroidal anti-inflammatory drugs. For more severe cases, opioid medications are used. According to the doctor's opinion and the patient's condition, glucocorticoids may be prescribed. There is another method from the field of vertibrology for metastases in the spine - injections of medical cement. This procedure has no medicinal properties and does not reduce the size of tumors, but it can relieve pain due to severe destruction of the vertebrae. Such manipulations allow you to maintain the normal functioning of organs, the ability to move and lead a normal life.
What not to do if you have cancer
For any type of cancer and in the presence of metastases, baths, saunas, and massages are prohibited without first consulting a specialist. They stimulate physical activity on the body and organs, which accelerates blood circulation. The consequence of massage is the intensive spread of cancer cells throughout the body. For an existing tumor, the risk of it growing increases. As a result, the cancer patient’s well-being worsens and general intoxication may increase. For this reason, any thermal procedures and massages are prohibited for pain in the back and spine.
Stage 4 cancer and multiple metastases in the spine cannot provide a favorable prognosis for a complete cure for cancer. On average, survival varies from 3 to 10 months when it comes to complex and inoperable cases. The sooner you contact when suspicious symptoms appear, the better the prognosis. Life expectancy after diagnosis can be 10-12 years. The result depends not only on the patient’s condition, but also on the therapy methods used in combination with new technologies.
You can consult and undergo diagnostics at an oncology center with world-class treatment standards. The advantages of the clinic are not only technical equipment and experienced doctors, but also the provision of psychological assistance for cancer patients and their relatives, social adaptation, and rehabilitation. Health is urgent, so we need to pay attention to cancer prevention and find time to undergo follow-up examinations.
Probability of relapse
In the first 2 years after achieving remission, 40-60% of patients experience relapses of the oncological process. By the end of the 3rd year, the number of patients with relapses reaches 70%. The prognosis for treatment of liver metastases and the likelihood of relapse are influenced by the malignancy of the primary tumor and metastases, their location, size and effectiveness of the treatment regimen.
The presence of metastases significantly worsens the course of the oncological process, but modern medicine allows us to achieve positive results in such difficult cases. For us at SM-Clinic there are no hopeless patients. We always fight for the patient - to either completely defeat the disease, or to prolong the patient’s life and improve its quality.
We treat liver metastases with a multidisciplinary team of specialists. Every year new technologies and drugs appear, which we are intensively mastering, that is, the capabilities of our doctors are constantly growing. To consult a specialist, please contact us.
The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.
HOW TO UNDERSTAND IF THERE ARE REALLY METASTASES IN THE LUNG?
Sometimes the differential diagnosis of secondary lung lesions can be very difficult and requires in-depth knowledge of chest x-ray. This is done most professionally in specialized pulmonary institutions, for example at the St. Petersburg Research Institute of Phthisiopulmonology. Therefore, when in doubt about the diagnosis, doctors recommend obtaining a Second Opinion - a repeated description of the disc by CT, MRI or radiography in order to confirm or refute the diagnosis, as well as a more accurate and detailed assessment of the changes. Such advice can be obtained using the NTRS consultation service, which unites well-known diagnosticians from specialized centers in Russia.
Radiation signs of pulmonary metastases are discussed in detail below.
Efficiency forecast
Timely therapy gives positive results in most cases. Conservative treatment may be complicated by the sensitivity of the organ to the drug. The administered antitumor drugs destroy actively dividing cells and slow down tumor growth. Therapy allows you to reduce the size of the tumor for subsequent surgery. Single cancer metastases are removed surgically. Proper nutrition, lifestyle, daily routine are components of complex therapy.
The prognosis for the effectiveness of treatment largely depends on the phenotype, the nature of the lesion, the number of metastatic nodes and the location of the primary tumor. Metastases are dangerous due to the risk of internal bleeding, compression of blood vessels, a toxic increase in bilirubin levels, and impaired bile outflow.
The presence of extrahepatic metastases and multiple advanced liver lesions, unfortunately, give an unfavorable prognosis.
Symptoms of metastases in the spine in stage 4 cancer
The statistics are inexorable; half of the diagnoses in our country are made at stage 4 of cancer. There may be no symptoms until this critical point. The first warning sign is pain. It is deep and intrusive in nature, can radiate into the radicular plexuses and increase at night. Symptoms of metastases in the spine include the following:
- radicular disorders (lumbosacral or cervicobrachial radiculitis);
- microfractures, hemorrhages;
- vertebral compression fractures;
- erectile dysfunction, defecation and urination;
- paresis and paralysis;
- redness of the distal extremities;
- hyperhidrosis (increased sweating), etc.
Features of pain syndrome
The mechanisms of metastasis are different, so the nature and manifestation of the pain syndrome may differ. The growth of a tumor in the spinal column provokes an inflammatory process. Tension of the soft tissues occurs, under the influence of which pain occurs. Metastases in the spine show symptoms of varying intensity. They are especially troublesome at night. Often the symptoms are correlated with osteochondrosis, so the diagnosis requires careful verification. If the nerve roots are compressed, a sharp and shooting pain occurs. Muscle weakness, tingling and numbness may occur. With sharp and severe pain, vertebral destruction or pathological fracture is usually diagnosed. It is typical for this case that the symptom manifests itself in a sitting position.
