Cancer metastases Flashcards
What is metastasis?
- Primary cancer can spread to other areas of the body.
- Secondary involvement = metastases
- Cells in metastasis resemble those in primary tumour.
Main routes of metastatic spread
- Lymphatic system
- spreads to lymph nodes elsewhere. - Haematogenous spread
- via blood - Transcoelomic
- through body walls into abdominal/ chest cavities
Lymphatic spread
- Follows lymphatic system
- Lymphadenopathy
Lymphadenopathy
Spread and growth of cancer cells/ reactive hyperplasia
What is haematagenous spread?
- Spread of metastases via circulatory system
- Veins more readily invaded than arteries
- Can get:
Portal system invasion
Inferior vena cava invasion
BBB invasion
Portal system invasion
Liver metastases
Inferior vena cava invasion
Lung metastases
BBB invasion
- Cross BBB
- Brain metastases
What is transcoelomic spread?
- Across peritoneal cavity
- Affects surfaces/organs of the abdominal and pelvic cavities covered by the peritoneum
- Often associated with fluid build up – inflammatory response to presence of cancer cells in cavity
Name two types of cancer metastases that have arisen from transcoelomic spread?
- Ovarian cancer - across peritoneum
- Lung cancer - across pleural cavity
Primary cancer - Bladder
Metastases to:
- Bone
- Liver
- Lung
Primary cancer - Breast
Metastases to:
- Bone
- Brain
- Liver
- Lung
Primary cancer - Colon
Metastases to:
- Liver
- Lung
- Peritoneum
Primary cancer - Kidney
Metastases to:
- Adrenal gland
- Bone
- Brain
- Liver
- Lung
Primary cancer - Lung
Metastases to:
- Adrenal gland
- Bone
- Brain
- Liver
- Other lung
Primary cancer - Melanoma (skin)
Metastases to:
- Bone
- Brain
- Liver
- Lung
- Skin
- Muscle
Primary cancer - Ovary
- Liver
- Lung
- Peritoneum
Primary cancer - Prostate
Metastases to:
- Adrenal gland
- Bone
- Liver
- Lung
Diagnosis of metastases
- CT Scans
- X-ray
- Tumour markers
- Biopsy
- Cytology
Bone metastases
- Osteolytic activity leads to hypercalcaemia.
- Bisphosphonates
- To reduce calcium
- May lead to fractures
- Linked to spinal cord compression
Osteolysis
- Osteoclasts (cells in the bone) increase their activity.
- Break down the surrounding minerals.
- Associated with renal, breast and prostate cancers.
Spinal cord compression - treatment
- Dexamethasone, 8 mg BD with PPI.
- Radiotherapy to bone (rarely chemo - takes too long to work)
- Pain relief
- Laxatives
General treatment of brain metastases
- Dexamethasone PO 2-8mg OD (long term), with PPI.
- Anti-epileptics, as it often causes seizures.
- Anti-emetics, as it triggers chemoreceptor trigger zone.
- Anxiolytics
- Headaches and dizziness.
General treatment of lung metastases
- Dexamethasone 2-8mg OD, with PPI.
Minimise inflammation - Salbutamol
Open airways - Tranexamic acid
Haemoptysis = coughing up blood
Reduces bleeding.
What can lung metastases cause?
- Superior vena cava obstruction (SVCO)
- Small cell lung cancer
SVCO
Narrowing or blockage of the superior vena cava
General treatment - SVCO
- Dexamethasone 8mg BD with PPI cover
- Usually chemotherapy (especially if SCLC as very chemo-responsive)
- Radiotherapy if not chemo-sensitive
- Stent
- Pain relief
- Anticoagulants if clot suspected
Pain - Liver
- Dexamethasone 2-4 mg OD
Ascites - Liver
Drainage
Jaundice and pruritis - Liver
- Anti-itch creams
- Caution with anti-histamines due to sedation.
