Metastasises – the secondary malignant tumors of various bodies and fabrics which resulted from hematogenic, limfogenny or implantation distribution of malignant cages of primary new growth. Can be found in any body. At early stages proceed asymptomatically. In the subsequent clinical manifestations depend on localization of a metastasis. The diagnosis is established taking into account the anamnesis, complaints, the given objective survey, results of analyses and tool researches. Treatment – chemotherapy, radiotheraphy, surgical interventions.
Metastasises – the remote centers of oncological process which arose when moving malignant cages on an organism. Come to light at persons of any age, however the greatest number of defeats are found in patients 50 years are more senior. Can appear at the majority of malignant tumors and strike any bodies. Most often malignant new growths spread in lymph nodes, lungs and a liver. Slightly less often metastasises in bones, adrenal glands, kidneys and the central nervous system meet. Metastatic damages of a pancreas, spleen, skin, skeletal muscles and a cardiac muscle are seldom diagnosed.
The malfunction of various bodies caused by growth of metastasises are the leading reason of mortality at oncological diseases. Emergence of the secondary centers worsens the forecast and makes impossible radical treatment of a malignant tumor or creates essential restrictions at the choice of methods of therapy. Diagnostics and treatment of metastasises are performed by experts in the field of oncology and other specialties (depending on localization of the secondary center).
Etiology and pathological anatomy of metastasises
Without the corresponding treatment over time metastasises arise almost at all malignant tumors, however terms of their emergence can significantly vary. Sometimes metastasises are found in several years after development of primary process, sometimes – in several months, and sometimes at all become the first display of an oncological disease therefore the time interval between development of primary tumor and emergence of metastasises does not manage to be established even approximately.
Experts consider that in certain cases malignant cages can migrate in various bodies, forming "the sleeping centers" which in the subsequent become more active and begin to grow quickly. However the reasons for which metastasises at the same disease appear and develop with a different speed are not established yet. It is only possible to list a number of the factors promoting bystry emergence and progressing of secondary educations.
Among such factors – a large number of small vessels around primary new growth, feature of an arrangement and a histologic structure of primary center, immune frustration and age of patients (at young people metastasises arise and progress quicker, than at elderly). Antineoplastic therapy is of great importance – after such therapy difficultly to predict probability and possible time of emergence of metastasises. Sometimes the secondary centers arise several years later after passing of a course of treatment, against the background of change of some vital conditions or without any visible reasons.
Cells of primary tumor can extend on an organism in three ways: limfogenny (on lymphatic vessels), hematogenic (on blood vessels) and implantation. Implantation metastasis becomes possible after destruction of the capsule of body and an exit of malignant cages in this or that natural cavity. For example, ovary cancer cells through an abdominal cavity can migrate on the surface of a liver, and a cell of primary lung cancer through a pleural cavity – on the surface of a pleura.
The prevailing way of metastasis is defined by an origin and degree of a zlokachestvennost of a tumor. Cages of soyedinitelnotkanny and epitelialny new growths migrate on lymphatic ways more often. At tumors of high degree of a zlokachestvennost hematogenic distribution prevails. In most cases limfogenny metastasises appear before hematogenic. First of all regionarny lymph nodes suffer. Then malignant cages can extend further on lymphatic system.
Knowledge of features of a lymph flow in this or that anatomic zone allows to define possible ways of metastasis and to reveal secondary congestions of malignant cages (except for micrometastasis cases). Hematogenic metastasises arise on considerable removal from the body struck with primary process therefore for their detection it is necessary to conduct comprehensive examination taking into account the most probable areas of metastasis.
Different types of cancer with various frequency spread in these or those bodies. So, the breast cancer, cancer of kidneys, a prostate cancer and cancer of a thyroid gland most often give metastasises in lungs, bones and a liver. At stomach cancer, ovarian cancer, a colon cancer, cancer of a body of a uterus and a pancreatic cancer the liver, a peritoneum and lungs are surprised. Cancer of a rectum and cancer of a lung extend in a liver, adrenal glands and lungs (at cancer of a lung the second lung suffers). The melanoma gives metastasises in a liver, lungs, skin and muscles.
Among secondary new growths solid nodal forms prevail, ulcer surfaces (for example meet less often, at damage of skin), slizeobrazuyushchy volume educations (Krukenberg's metastasises) and other types of tumors. The size of metastasises can vary from several millimeters to 20 and more centimeters. Perhaps single defeat of a certain body, multiple defeat of a certain body, and also single or multiple secondary centers in several bodies. Separately it is worth mentioning so-called "dust" metastasises – the multiple small centers in an abdominal cavity provoking development of ascites.
On the histologic structure secondary new growths usually correspond to primary tumor. At the same time, in some cases metastasises can have the histologic structure different from a structure of primary cancer. Usually such differences come to light at metastasis of a tumor of hollow body in parenchymatous body (for example, at the metastatic cancer of a liver which arose owing to primary colon cancer). Sometimes because of distinction in structure of primary and secondary centers there are difficulties at a differentiation of metastasises and multiple cancer.
Symptoms of metastasises
At initial stages metastasises usually proceed asymptomatically. In the subsequent clinical manifestations depend on localization of a secondary new growth. The local symptomatology is combined with the general symptoms of an oncological disease: a hyperthermia, appetite loss, reduction of body weight up to a cancer kakheksiya, the general weakness and anemia. At metastasises in lymph nodes the increase in their size defined at a palpation or in the course of visual survey is observed.
Knots are usually painless, soft consistences. Most often metastasises are localized in cervical, inguinal, axillary and supraclavicular lymph nodes. At rather big size such centers can be found already at a stage of usual survey. Identification of metastasises in some lymph nodes (zabryushinny, paraaortal, knots of an abdominal cavity, sredosteniye knots) is possible only when carrying out tool researches as these anatomic educations are inaccessible for objective inspection. Suspicion on existence of such metastasises can arise at their significant increase causing a sdavleniye of nearby anatomic educations.
Manifestations of hematogenic metastasises are defined by their localization. At the secondary centers in a brain there are dizzinesses which are holding apart headaches, nausea, vomiting and focal neurologic frustration. At metastasis in a spinal cord there are pains, bystry fatigue at physical activity, violations of activity of pelvic bodies, the progressing disorders of the movements and sensitivity. At metastasises in lungs a frequent recurrence of inflammatory diseases is observed (bronchitis, pneumonia, flu, a SARS), in the subsequent short wind and cough with blood impurity in a phlegm joins.
Metastasises in a liver are shown by weight and pains in the right podreberye, violation of hepatic functions, increase and a bugristost of a liver. At late stages jaundice, ascites and the progressing liver failure come to light. Secondary new growths in bones cause painful pains, a giperkaltsiyemiya and pathological changes. Perhaps sdavleny spinal cord, nervous and vascular trunks. At metastasises in a peritoneum there is an ascites caused by violation of regulation of process of allocation and absorption of liquid peritoneum fabrics.
Metastasises in skin represent the dense, quickly growing single or multiple knots of corporal, bluish or pinkish color. In the subsequent their disintegration and an ulceration is observed. At some primary new growths (for example, at a carcinoma of a mammary gland, cancer of a large intestine, cancer of an ovary and cancer of a bladder) symptoms of secondary skin tumors can imitate a clinical picture of an erysipelatous inflammation. Less often (usually – at tumors of a mammary gland) sklerodermopodobny metastasises come to light.
Diagnostics of metastasises
The diagnosis is established on the basis of clinical yielded and results of additional researches. Because of high tendency to development of metastasises any malignant new growth is the indication for expanded inspection (even if signs of defeat of other bodies are absent). The patient with suspicion on metastasises appoint the general blood test, biochemical blood test and blood test to cancer markers. Patients are directed to a X-ray analysis of a thorax, ultrasonography of abdominal organs, ultrasonography of bodies of a small pelvis, KT and MPT of a brain, KT and MPT of a spinal cord, a stsintigrafiya of bones of a skeleton, a X-ray analysis of bones of a skeleton and other researches.
Existence of metastasises is finally confirmed when carrying out a histologic or cytologic research of the changed fabric. The intake of histologic material from soft fabrics is carried out by intsizionny, a core or a plucked biopsy. At a superficial arrangement of metastasises use a skarifikatsionny biopsy, at damage of bones – it is frayed - a biopsy. Material for a cytologic research is received by capture of usual prints or dabs prints. For an intake of liquid carry out an aspiration biopsy.
Differential diagnostics of metastasises is performed with primary new growths and with multiple cancer (at simultaneous or almost simultaneous detection of several centers in one or different bodies). In certain cases the differentiation with degenerate and dystrophic and inflammatory processes is required. So, symptomatic pneumonia at metastasises in lungs needs to be differentiated with usual pneumonia, small metastasises in a backbone against the background of the previous osteoporosis – with age changes of a backbone etc.
Treatment of metastasises
Tactics of treatment is defined individually with a type of cancer, a condition of primary tumor, the general condition of the patient, sensitivity of cages to this or that type of medical influence, quantity, localization and the size of metastasises. Use of radiotheraphy, chemotherapy, immunochemotherapy, hormonal therapy, classical surgical interventions, radio surgeries, cryosurgeries and embolization of the feeding arteries is possible. As a rule, at metastasises the combination of several methods of treatment is applied (for example, chemotherapy and radiation therapy, chemotherapy and an immunotherapy, radiation therapy and surgical intervention etc.). Indications to expeditious treatment and intervention volume also depend on quantity and localization of metastasises.
At metastasises carry usually out a limfadenektomiya in combination with removal of primary new growth to regionarny lymph nodes. At controlled primary tumors and single metastasises in the remote bodies in certain cases perhaps radical excision of the secondary centers. At multiple metastasises surgical intervention is, as a rule, not shown. An exception are situations when palliative operation can delay a lethal outcome or improve quality of life of the patient (for example, a kraniotomiya for decrease in the dangerous intra cranial pressure caused by a metastatic tumor of a brain).
The forecast at metastasises
Until recently existence of metastasises was considered as the evidence of fast death of the patient. Now the situation gradually changes though existence of secondary tumors is still considered as extremely adverse predictive sign. Use of new methods of diagnostics and treatment in some cases allows to increase average life expectancy of patients. Under certain conditions radical treatment of metastasises of some localizations, for example, of the single centers of metastatic cancer of liver or metastatic cancer of a brain became possible.
In general the forecast at metastasises is defined by degree of neglect of oncological process, opportunities of concrete medical institution (some medical and diagnostic techniques are available only in the large centers), a look, localization and a stage of primary tumor, age of the patient, a condition of its immune system, exhaustion degree, level of violation of functions of various bodies and so forth. Average life expectancy at metastatic cancer of a liver makes about half a year, damage of a brain – several weeks, at metastasises in a bone – several years, at secondary new growths in kidneys – 1-3 years.