6.2 Wk 4 - Metastatic Cancer Flashcards
What is metastasis?
The process of cancer spreading from a primary site to a secondary site
What are metastases?
Secondary tumours found in other parts of the body
What is metastatic breast cancer?
A primary tumour in the breast with a secondary in another part of the body e.g. Liver.
What are the 3 steps of local cancer spread?
Infiltration - Cancer cells move into local tissues
Invasion – Cancer cells establish themselves in local tissues by adapting to the local micro environment
Destruction – Cancer cells start to destroy local tissues
What are the 7 steps involved in metastasis?
Invasion:
* Cancer cells invade local tissues and breakthrough basement membranes of blood vessels or lymph nodes
Circulation:
* Entering the bloodstream or lymphatic system
* If the cancer cells survive in the bloodstream or
lymphatic system
**Arrest and Extravasation: **
* The cancer cells reach distant organs,
* Adhere to vessel walls
* and expand into surrounding tissue.
**Microenvironment Adaptation: **
* The cancer cells adapt to the microenvironment.
Angiogenesis:
* New blood vessels develop by the process of angiogenesis to sustain tumour growth.
**Formation of secondary tumours: **
* Metastatic cells may then proliferate to form a secondary tumour.
**Inactivity and reactivation: **
* or remain inactive at a distant site for years before growing again, it at all
What are the 3 routes by which cancer cells might spread?
Many cancer cells are destroyed in transit for the site of the primary tumour to the site of a secondary tumour.
The 3 mechanisms of spread include:
Lymphatic spread
* Spreads through the lymph in the lymphatic system to the lymph nodes
* The lymph nodes become swollen – Lymphadenopathy
Haematological spread
* Spreads through the bloodstream
* More common in Veins than arteries
* If it enters the portal system, may result in liver metastases
* If it enters the inferior vena cava, may result in Lung metastases
Transcolaemic spread
* Moves through the abdominal wall into the abdomen or chest cavities
What is the seed and soil principle?
Seed (Cancer Cells):
* Break off from the primary tumour and travel via the lymph system, the hematological system, or via Transcolaemic spread
**The Soil **
* Microenvironment where the seed (Cancer cells) lands.
Analogy
* Seeds fly off a flower, get carried in the wind, deposit in soil elsewhere and grow, if the conditions are right.
BBLL
What are the 4 sites where metastases are most commonly found if the patient has primary
* breast cancer,
* kidney cancer,
* lung cancer
* Melanoma
Bone, Brain, Liver, Lung
BLL
What are the 3 sites where metastases are most commonly found if the patient has primary
* Prostate cancer
* Ovary cancer
Brain/Liver/Lung
LL
What are the 2 sites where metastases are commonly found if the patient has primary
* Bladder cancer
* Colon cancer
Liver/Lung
How are metastases diagnosed?
Imaging Tests:
Computed Tomography (CT) Scan:
Magnetic Resonance Imaging (MRI):
Positron Emission Tomography (PET) Scan:
Bone Scan
Biomarker tests
Cytology
Biopsy
What are the signs and symptoms of bone metastases?
- Hypercalcaemia which can be fatal
- Pain
- Fractures +++
- Spinal compression
Bone Cancer Tx of choice?
- Radiotherapy
- i.e. Chemotherapy can find it difficult to penetrate bone
What supportive care might be given to a patient receiving radiotherapy for bone cacer.
- ↓ Calcium Levels - Bisphophonates
- ↓ Pain - Analgesia Ladder
- ↓Inflammation and spinal compression - Dexamethasone
- ↓ potetial GI side effects from Dexamethasone - Proton Pump inhibitor
- Lost urge to go to the toilet and side effects of analgesia - Laxatives
What are the signs and symptoms associated with brain metastases?
- Nausea and Vomiting
- Seizures
- Behavioural changes
- Dizziness
