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
What is the treatment of choice for brain metastases?
Treament depends upon the Loction, stage, grade, biomarkers, biopsy, but can include:
* Surgery
* Radiotherapy
* Systemic Anti Cancer Treatment
What supportive care might be given for a patient being treated with brain metastases?
- Anti inflammatory - Dexamethasone 2-8mg OD
- Protect GI lining from dexamethasone effect - Proton pumo
- Anti-epileptic - Tegretol
- Anti emetic - Dopamine 2 antaognist - Metoclopramide, consider adding additional 5Ht3 and
Neurokinin 1 inhibitor, if required.
What are the signs and symptoms of lung metastases?
- Persistant cough for more than 3 weeks
- Cough up blood
- Haemoptysis
- Dyspnoea
What is the Tx of choice for lung metastases?
Treament depends upon the Loction, stage, grade, biomarkers, biopsy, but can include:
* Surgery
* Radiation
* SACT
* All 3
Main Vein
What complication might lung metastases cause in the vascalature?
Superior Vena Cava Obstruction
What is the Tx of choice for the management of superior vena cava obstruction?
Treatment depends upon the location of the obstruction but include:
* Surgery
* Insertion of a stent
* Radiotherapy
* SACT
What supportive care might be given to a patient receiving Tx for a suprior vena cava obstruction
Dexamethasone 8mg OD
* ↓ Inflammation
PPI
* ↓ potential GI side effects of Dexamethasone 8mg OD
Analgesia ladder
* Pain relief
Anti – Coagulant
* Direct oral anticoagulant (DOAC)
* e.g. Rivaroxaban - Xarelto
Liver Metastases signs and symptoms?
Bile forms under the skin because liver is not clearing the bile normally leading to
* Jaundice
* Pruritis
Liver metastases tx of choice
Treatment depends upon the location, stage, grade, biomarkers but can include:
* Surgery
* Radiotherapy
* SACT
What supportive medicaction might be given to a patient receiving treatment for LIver metastases?
Dexamethasone 2-4mg OD
* ↓ Inflammation
PPI
* ↓ potential GI side effects of Dexamethasone 2-4mg OD
Creams
* ↓ itching
* Caution with antihistamines, because if the liver is not functioning normally you might get prolonged sedation.
Ascites main need to be drained.
