13.01.2013

Metastases- These are secondary foci of growth of almost any malignant tumor. Most cancers lead to the appearance of secondary lesions in local and regional lymph nodes, liver, lungs, and spine.

Modern concepts of the development of metastases are based on the fact that metastases develop almost immediately as soon as the malignant tumor itself appears. Individual cells detached from it first penetrate into the lumen of the blood vessel (hematogenous dissemination path) or lymphatic vessel (lymphogenous dissemination path). Then they are transported with the blood or lymph flow, stop at a new place, after which they leave the vessel and grow, forming metastases. At first, this process is slow and imperceptible, since cancer cells from the maternal lesion suppress the activity of secondary lesions.

What causes metastases?

Will individual cells break away from the mother tumor and form metastases? Tumor cells are coming off and will always come off. Local factors The body's immune system is very for a long time protect the body from the rapid growth of tumor cells.

Tumor cells, having spread, can remain inactive for a very long time (or grow very slowly) for a number of years. Precise trigger mechanisms quick quantity metastases in the body have not been studied.

Another fact is important: as the number of cells in the metastasis increases, they begin to secrete growth factors that stimulate the formation of a vascular and capillary network around the tumor cells, which provides the cancer cells with all nutrients to the detriment of other tissues of the body.

What determines the rate of spread of metastases throughout the body?

Time required for clinical manifestation the first metastases, is largely determined by the type of tumor and the degree of differentiation of its tissues. Highly differentiated tumors, as a rule, metastasize much less frequently and later than poorly differentiated tumors. Sometimes metastases appear very quickly, following the appearance of the primary tumor node. In many patients, metastases are detected after 1-2 years. Sometimes latent or “dormant metastases” are discovered many years after surgery to remove the tumor. Various types of treatment ( radiation therapy, chemotherapy, arterial embolization, including chemoembolization, help reduce the incidence of metastasis or more late appearance metastases.

There is a misconception that metastases occur due to procedures performed. However, removing part of the tumor or biopsy (taking tumor tissue for examination) does not increase the incidence of metastases.

How different types of cancer metastasize

Most often metastases are found in lymph nodes, metastases in the liver, lungs, much less often - in the heart muscle, skeletal muscles, skin, spleen, pancreas. Intermediate place in the frequency of detection of metastases in various types cancer occupy the central nervous system, skeletal system, kidneys, adrenal glands.

The most common types of cancer and the most typical places detection of metastases

Breast cancer - lungs, liver, bones

Ovarian cancer - peritoneum, liver, lungs

Stomach cancer - liver, peritoneum, lungs

Intestinal (colon) cancer - liver, peritoneum, lungs

Colon cancer - liver, lungs, adrenal glands

Cancer prostate gland- bones, lungs, liver

Uterine cancer - liver, lungs, peritoneum

Kidney cancer - lungs, liver, bones

Lung cancer - adrenal glands, liver, second lung

Melanoma - lungs, skin/muscle, liver

Pancreatic cancer - liver, lungs, peritoneum

Cancer thyroid gland- lungs, liver, bones

A certain pattern of metastasis of cancer, for example, stomach cancer to certain lymph nodes, has led to the emergence special terms. Thus, metastases to the ovaries are called “Kruckenberg’s”, metastases to the pouch of Douglas are called “Schnitzler’s”, metastases to the lymph nodes of the left supraclavicular region are called “Virchow’s”.

Why are metastases dangerous?

Metastasis of most tumors occurs in cases where the body's reserves in the fight against the tumor are exhausted. Metastases significantly disrupt the functioning of all vital important organs and systems. The vast majority of deaths of cancer patients are caused by metastases of the main cancer.

In addition, metastases significantly worsen the general condition, often accompanied by unbearable pain requiring constant pain relief.

How do metastases manifest themselves?

Clinical picture metastatic cancer determined by the location of metastases.
So, peritoneal lesion (peritoneal carcinomatosis) leads to ascites, which requires laparocentesis.
Pleural damage (pleural carcinomatosis) causes the development exudative pleurisy which requires thoracentesis.

Metastases in tubular bones skeleton and spine can cause severe pain in the body, lead to easy education fractures. Prescribing bisphosphonates in addition to the main treatment significantly improves the condition of patients.

Basic symptoms of brain metastases - changes in character, severe headaches, convulsions, changes in the level of consciousness, and so on. In addition, toxins released during the constant death of tumor cells cause cancer intoxication of the body.

Due to the rejuvenation of cancer, in some patients the diagnosis of cancer is established only when symptoms caused by metastases appear.

How are metastases diagnosed?

Survey radiography, ultrasonography, radioisotope research, CT scan, magnetic resonance imaging, positron emission tomography - all these techniques are essential in recognizing metastases. These techniques make it possible to clarify the size, prevalence and growth pattern of metastases, their disintegration, suppuration, and germination into neighboring organs and tissues. In addition, these same diagnostic techniques make it possible to monitor the effectiveness of treatment based on the degree of regression of metastases.

Is it possible to cure metastases and what does it give?

The main goal of active chemotherapy and radiation therapy is to prevent the occurrence of cancer metastases as much as possible. early stage.

Treatment is based on general principles tumor treatment, including chemotherapy, radiation therapy, surgical treatment(for single metastases).

Treatment of cancer metastases has certain difficulties, since most metastases, unlike maternal tumor cells, are little sensitive to chemotherapy. Therefore, in some cases, treatment of metastases is carried out with the aim of relieving symptoms and, in some cases, prolonging life. For this purpose it is used systemic therapy(chemotherapy, hormone therapy, targeted therapy), local therapy(surgery, radiotherapy).

Abroad, the most commonly used techniques are percutaneous transhepatic radiofrequency ablation of metastatic foci in the liver. This technique became available in Russia.

As mentioned above, treatment in such cases is a means of alleviating the patient’s condition. The likelihood of achieving remission is very low.

The European clinic also uses a technique such as embolization of arteries feeding large metastases in various organs, in order to reduce negative influence cancer metastases on the patient's body.

Additionally, patients of the clinic undergo treatment in other medical institutions in Russia and abroad, including proton beam therapy, cyber-knife and a number of others in Israel, Germany, Austria, Russia.

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topic tags: cancer, cancer treatment, metastases

If metastases appear. Is it possible to cure metastases?

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The development of metastases can be prevented by radical treatment of cancer in the early stages.

What are metastases

Metastases are secondary foci that form during malignant tumors Metastases often appear in the lymph nodes, liver, lungs and spine.

According to modern ideas, metastases appear almost immediately as soon as the main tumor appears. Some malignant cells enter the bloodstream and lymph flow, due to which they can move throughout the body and become fixed in a specific place.

It is worth noting that cells are constantly detached from the main tumor focus. The immune system over a period of time (possibly over a period of years) prevents fast growth tumors. At the same time, the number of cells in the metastasis, quickly or slowly, will increase steadily. As tumor cells increase in size, the amount of growth factors they secrete increases proportionally. These growth factors promote the formation of a network of blood vessels around the tumor, allowing malignant cells to access nutrients.

How quickly do metastases spread?

Clinical manifestation of the first metastases can occur in different time, depending on the type of tumor and a number of other factors. Often the first metastases make themselves felt after 1-2 years. In some cases, decades pass. Current types of cancer therapy (radiation therapy, arterial embolization, etc.) reduce the incidence of metastasis or contribute to their later manifestation.

Clinical data accumulated to date show that the incidence of relapse and metastasis depends on the following factors:

Stage of cancer at the time of treatment. Theoretically, radical treatment of stage 1 cancer minimizes the likelihood of relapses and metastases. At the same time, such patients after treatment should be examined every 3 months for the first 2 years.
Forms of growth of a malignant tumor. For example, it is known that superficial forms grow much slower than infiltrative ones.
Localization of the tumor.
From the features of the conducted radical treatment.
From the age of the patient. IN at a young age metastases develop earlier and are more severe.

What is the danger of metastases?

As a rule, metastases in most cases make themselves felt when the body’s reserves to fight a malignant tumor are exhausted. When metastasis occurs, the activity of almost all vital organs is disrupted. In most cases, the death of cancer patients is due to developing metastases. Metastases are often accompanied by very strong , that require pain relief.

Reader Questions

18 October 2013, 17:25 Hello! My sister has sarcoma (on the upper part of her thigh in soft tissue) and had 2 surgeries. The tumor is growing again. The inguinal lymph node is involved - the leg is swollen. Metastases have started to spread to the liver. As a result, difficulties with the toilet began. What to do? Tell me. They refused to operate for the third time (in Vinnitsa). My sister is 39 years old.

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Diagnostics

To detect metastases in oncological diseases radiography, ultrasound, computed tomography, radioisotope studies, MRI and positron emission tomography are used. Data diagnostic methods provide information about the size, prevalence and growth characteristics of metastases. These methods are also used in treatment in order to monitor the effectiveness of the use of certain therapeutic agents.

Treatment

Chemotherapy and radiation therapy used in the early stages of cancer are mainly aimed at preventing the occurrence of metastases.

It is worth noting that the treatment of metastases has certain difficulties, since often metastatic cells are little sensitive to chemotherapy drugs. In this regard, treatment for metastatic cancer is often aimed at prolonging the patient’s life and alleviating symptoms.

Metastases in the bones are a secondary phenomenon cancer, in which cancer cells migrate to bone tissue and form malignant tumors. Metastasis occurs on late stages development of cancer and is accompanied by pain, increased calcium levels in the blood plasma, impaired blood flow and fractures.

Causes

The appearance of mts (metastases) in the bones is caused by the spread of cancer cells through the blood vessels from the primary affected organ into the bone tissue, developing into malignant tumors. Most often they migrate from primarily affected thyroid and mammary glands, lungs, kidneys, as well as with Sarcomas, etc. Less common are metastases from the cervix, ovaries, gastrointestinal tract and soft tissues and very rarely from other organs. Most frequent localization have metastases in bones with abundant blood supply: the bones of the pelvis, arms, legs, chest, scull, Bone marrow and in the ribs. Metastases are often found in hip joint, shoulder and knee joints. With breast cancer in women, kidney and lung cancer, metastases can go to the xiphoid process, the body and manubrium of the sternum, as well as to ilium, ribs, pelvic, pelvis femurs and shoulder bones.

Tumors disrupt the work of osteoblasts and osteoclasts - large multinucleated cells responsible for regulating the structure and destruction of bone tissue in the process of cellular renewal.

Surgery, pathological fractures and other complications of metastasis can cause chylostasis (stagnation of lymph), which leads to edema. Bone metastases can cause severe pain, for example, with melanoma of the spine or tumor ischium which can compress the nerve.

The main symptoms are caused by hypercalcemia, pathological fractures and spinal compression. Also noted elevated temperature due to an active metabolic process and accelerated cell division.

Hypercalcemia

In one third of patients, bone metastases cause hypercalcemia. Calcium, which is part of the bones, is released during bone erosion and enters the blood. Hypercalcemia causes a number of symptoms:

Nervous system:

Mental instability;
Lethargy;
Depression;
Mental activity disorder.

The cardiovascular system:

Lack of appetite;
Nausea;
Vomit;
Ulcerative formations.

Urinary system:

Increased urine production;
Kidney failure;
Intoxication.

Pathological fractures

The area of bone affected by metastases becomes fragile due to a malfunction of osteoblasts and osteoclasts, which leads to pathological fractures. Pathological fractures appear if more than half of the outer bone layer is damaged. A fracture can be caused by a slight blow or obvious reason may be completely absent. Metastatic lesions most often affect the femur, chest and lumbar region spine.

Spinal compression

Up to 5% of patients with mts in the spine develop spinal compression, of which in more than half of cases metastases are found in the thoracic spinal region. A growing tumor or bone fragments from a fracture can compress the spinal cord, often leading to irreversible paralysis if the disorder is not detected in time. In the case of already developed paralysis, only one out of ten patients manages to restore motor function.

If compression was facilitated by a gradual increase in tumor, then signs of compression spinal cord sometimes go unnoticed for a long time, unlike the case when a displaced vertebral fragment leads to compression.

Kinds

Osteoblasts and osteoclasts are the main cells involved in normal bone tissue renewal. With metastases in the bones, allostasis is disrupted (the body’s ability to respond to atypical changes and carry out homeostasis - self-regulation), due to which the cells begin to work with a pathological bias, the body cannot cope with the regulation of cellular processes and subtotal damage occurs in the bones.

Osteoblastic

Osteoblasts are the building cells of the skeleton that fill empty areas, produce intercellular substance (matrix) and turn into bone cells (osteocytes). If, due to metastases in the bones, osteoblasts malfunction, then osteoblasts are formed in the bones. osteosclerotic lesions(otherwise sclerotic, i.e. compactions) - such disorders are called osteoblastic or blastic, and the formation of compactions is an osteoblastic process.

Osteolytic

Osteolytic disorders are bone disorders in which bone tissue is destroyed. What it is? Osteoclasts destroy bone tissue to allow new bone cells to form. Failure in their work leads to an uncontrolled destructive process in which holes are formed in the bones. Bones become brittle and brittle, easily broken and cracked.

Bone metastases that lead to one single type of damage are rare and the manifestation of damage is most often mixed type, with signs of both tissue compaction in certain areas and destruction.

Diagnostics

To check for metastases, there are a number of diagnostic procedures available for different stages development of the disease:

Scintigraphy - examination by entering radioactive isotopes to obtain a two-dimensional image where the affected areas appear as white spots. Helps to recognize the presence of metastases on early stage their development;
X-ray - allows you to identify the nature of the lesion, noticeable only in the later stages;
Computed tomography or magnetic resonance imaging provides a three-dimensional image of the skeleton;
Biochemical blood test to check the level of calcium in the blood plasma and diagnose hypercalcemia;
Biopsy allows you to accurately determine the malignancy of tumors and make a final diagnosis.

Treatment

Treatment is prescribed by an oncologist based on blood test data, the location of primary and secondary cancers, the stage of destruction and the type of bone damage (osteoblastic and osteolytic are treated differently). The main focus of treatment is to eliminate severe complications to improve the patient's quality of life. If the spine and bones hurt, then they resort to pain relief. The oncologist determines how to treat metastases after all the necessary diagnostic procedures.

Treatment consists of using medications, such as hormonal drugs, bisphosphonates, drugs to enhance immunity and procedures local impact: irradiation and surgical operations. To relieve pain, painkillers are prescribed. Folk remedies include herbal decoctions, poultices, including folk remedies for pain, for example, ointment from comfrey root, which is treated by applying to a sore spot.

Operation

Surgical intervention is performed if severe complications such as a fracture, spinal compression, loss of limb mobility, or paralysis. Operationally tumor-like formations are removed. If it is necessary to restore the bone structure, supporting pins and plates are installed. The operation is indicated for a favorable picture of the disease and good general condition patient. In other situations, it is recommended to use fixation devices to support the bones.

For osteosynthesis surgery (bone fusion using metal alloys), it is recommended to use titanium to avoid metallosis - oxidation of the metal and penetration of its particles into muscle tissue. In case of severe bone deformation after tumor removal in some clinics plastic surgeon conducts plastic surgery on bone or joint replacement.

Chemotherapy

Chemotherapy and radiation therapy are prescribed to kill cancer cells and prevent further development metastases. and radiation prepares the patient for surgery and supports it after it. called exposure to ionizing radiation, which destroys cancer cells, or the introduction of drugs strontium-89 or samarium-153. Post-radiation complications require rehabilitation at the end of the course.

Treatment with bisphosphonates

Bisphosphonate drugs provide significant assistance in slowing down secondary cancers in general and bone destruction in particular by suppressing the uncontrolled functioning of osteoblasts and providing a balance between the destructive and regenerative processes.

Bisphosphonate drugs include:

Bisphosphonates containing nitrogen:

Pamidronate;
Ibandronate.

Nitrogen-free bisphosphonates:

Tidronate;
Clodronate;

Medicines containing nitrogenous compounds have greater therapeutic effect than bisphosphonates without nitrogen.

Immunotherapy

Enhancing immunity is used to recognize and fight cancer cells. Immunity enhancing drugs increase the amount immune antibodies and increase their ability to recognize and kill cancer cells.

How long do people live with bone metastases?

Life expectancy for bone metastases directly depends on the location of the foci from which the cancer cells were transferred. In general, a time corridor for life expectancy has been determined for each type of cancer, but this period is not a death sentence, since in some cases the situation depends on the presence and degree of complications and it is possible to stop the destructive processes.

Also, depending on the location, tumors in the bones can be curable, so among patients with metastases there are those who have overcome the disease. The question of how long to live is raised during the already irreversible process of development of metastatic tumors, when bone destruction is irreparable.

Is it possible to cure bone metastases? Early detection of metastases and strict adherence to the treatment and recommendations prescribed by the doctor increases the chances of defeating the disease and saving the patient’s life.

Video: Metastases in bones

Anonymous reviews

Anonymously. A friend was first diagnosed with breast cancer, then with lytic metastases. The doctor told her that they live with MTS for a long time, her friend goes every month to take Zometa and overall feels good.

Anonymously. The doctor also told me that the survival rate for mts in the bones is higher than if it is in the organs. I had two chemotherapy treatments, now I take bisphosphonates regularly and continue to live a full life, so there is no need to despair.

Anonymously. The grandmother lived with metastases for 10 and a half years, but there was pain and several fractures, she was active and did not sit still. She took morphine for pain.