Cancer disease, considered one of the most important health problems of our age, maintains its seriousness, although there are promising medical developments and studies. In recent years, significant advances have been made in the early diagnosis and treatment of cancer, and it has been successfully applied in some patients. On the other hand, the desired progress could not be made towards some of the most feared mechanisms of cancer and which significantly affect the clinical approach. One of these mechanisms is known as metastasis. Frequently asked “What does metastasis mean?” It is very important to answer the question in terms of effective fight against this health problem.
Metastasis; It is the growth of the cells belonging to the tumor tissue that develops in a certain tissue to reach a different body tissue from the region where they are located by passing to the closest vascular circulation as a result of various processes and continue their development here. In this respect, metastasis results in the development of tumor cells in various parts of the body, in other organs and tissues that are completely different from the tissue it originated from.
Newly developed tumor tissues after metastasis cause destruction in the body area they reach, and also negatively affect the functioning of the relevant tissue. In this regard, in addition to the clinical picture of severe cancer caused by increased tumor cells, complaints and findings related to the affected tissue begin to develop in the patient.
In the current clinical approach, the ultimate point that cancer tissues can reach is metastasis. Since the diagnosis and treatment of cancer is considered specific to the patient with the tissue it originates from, the general condition of the patient and the treatment approach in the clinical approach are determined according to the prevalence of the cancer case in the patient. In this approach known as staging, the final stage of cancer is considered to be metastasis.
How does metastasis develop?
Cancer is basically a condition where cells, which are a natural part of the body, gain the characteristic of uncontrolled cell division as a result of genetic changes due to various genetic and environmental factors. As the affected cells begin to multiply rapidly, the gene structure undergoes more and more changes. As a result of these changes, the cells that gain new properties cause damage to the body tissue they are located in, while they can escape from the body immune system and trigger the development of vascular structures in the surrounding tissues.
Cancerous cells, which become tumor tissue by proliferating in particular, increase vascularization and benefit more from the body’s nutrients and oxygen. Over time, the genetically changed cells gain characteristics that can leave the tissues in which they are located, and leave the vascularized tumor tissue and enter the circulatory system.
Cancer cells in circulation become able to attach to other tissues with new genetic changes and depending on the characteristics of the cancer cell, they settle in different body tissues by acting more selectively. For example, while breast cancer cells tend to bone tissues; Cancer cells originating from bone tissue tend to settle more in lung tissue. As a result, cancer cells that settle in new body tissue multiply here, form new tumor clumps and metastasis occurs.
Some types of cancer instead of blood circulation; It passes to the lymph vessels of the tissue it originates from and primarily reaches the lymph nodes through the lymph vessels. Cancer cells that continue to proliferate here can metastasize to distant body tissues via the lymph circulation.
Some special types of cancer, such as lymphoma (lymphoma), can seep into the bloodstream and turn into leukemia (blood cancer) instead of forming tumor clumps. In this case, instead of forming tumor tissue, it is possible to find common cancer cells in the bloodstream.
What symptoms can metastasis occur with?
The metastasis state develops depending on the origin of the cancer cell, its genetic characteristics and the patient’s personal characteristics. While some types of cancer gain the ability to metastasize rapidly; In some cases, cancer cells do not have the ability to metastasize distantly. However, cancers that metastasize can have very different clinical pictures depending on the distant body tissue affected. As a result of metastasis, there may not be any obvious clinical symptoms in the person and the person can get the cancer diagnosis at the metastasis stage. Besides; The following symptoms may occur in a patient who developed metastasis during cancer:
• Problems such as widespread bone pain after metastasis to the bone, deformity in the bones, tendency to fracture, constipation due to increased blood calcium and phosphorus levels, heart rhythm disturbances, kidney failure
• Shortness of breath, cough, chest pain, blood in the mouth, respiratory failure and various heart problems after lung metastasis
• Swelling, pain, and inflammatory fluid in the affected body parts after metastasis to lymph nodes
• Signs of stroke after metastasis to the nervous system, loss of feeling or strength in various parts of the body, loss of balance, loss of vision, loss of speech ability, personality disorders, altered state of consciousness
• Jaundice after liver metastasis, abdominal pain, tendency to bleeding, abdominal swelling and fluid collection, weakness – fatigue
• Damage to the affected body tissues, amputation of the limbs, heart attack or stroke after the vessels become blocked with tumor cells
Regardless of the body tissues affected by metastasis, cancer cells that spread in the body by metastasis can also be observed with the following clinical symptoms:
• Weakness – tiredness
• Severe Weight Loss
• Swelling or anatomical deformity in the affected area due to the originated tissue
• Bleeding or inflammatory fluid coming from affected tissue
• Pain felt in the affected tissue
How is metastasis diagnosed?
For the diagnosis of metastasis, patients should be carefully examined and evaluated by a specialist physician with a detailed disease history and detailed physical examination. In a patient diagnosed with cancer, the patient is evaluated with various methods at regular intervals during treatment planning. In patients who are examined for cancer for the first time, the physician may apply for additional imaging and laboratory examinations. In the light of the data obtained from all these examinations, cancer can be diagnosed with metastasis. Post-metastasis tumor clusters; Depending on the tissue affected, it can be evaluated with x-ray, computed tomography, ultrasound or magnetic resonance (MR) methods. Again, some blood tests can be useful in evaluating recurrence and metastasis, especially in previously treated cancer cases. In patients diagnosed with cancer, it is possible to examine the whole body in terms of metastatic cancer tissues with nuclear medicine methods known as PET-CT and PET-MR. Since cancer diagnosis can be confirmed after biopsy examination; whether the detected clumps of metastatic tumors belong to another cancer type; Otherwise, it may be necessary to use biopsy to understand whether it is caused by the first cancer case diagnosed.
What can be done in the treatment of metastasizing cancer disease?
Since cancer disease is a wide disease definition that develops depending on various factors such as the tissue it originates from, its genetic structure, and the personal characteristics of the patient; treatment planning is also determined specifically for the patient. In this respect, it is not possible to talk about a single treatment method defined for cancer or metastasis.
Although metastasis is accepted as the final stage in cancer cases; It is known that effective treatment methods can be applied after metastasis in selected cases. However, in the clinical approach, the primary purpose of treatment methods for metastasis is to increase the patient’s quality of life and survival. In this respect, the following methods are frequently used in a patient with metastasis:
Antibiotics developed against cancer cells are known as chemotherapy in the society. Chemotherapy drugs prevent the proliferation of cancer cells through various mechanisms, enable them to be killed or facilitate their removal by the immune system. Since it is widespread in the body and causes damage to tissues, the first choice is chemotherapy in cases of metastasis that cannot be removed by surgery.
Radiotherapy method using X-rays for metastatic tissues that develop in some special tissues such as bone can be beneficial. In this method, reinforced radioactive rays are sent by focusing on the cancer tissue and significant regressions can be achieved in cancer tissues as a result of a few sessions.
Nuclear medicine applications:
Various nuclear medicine applications aimed at killing cancer cells by intravenous administration of radioactive drugs to the patient and accumulation in cancer tissues can be applied in selected cases.
Some special types of cancer can be treated with various hormone drugs, as they are sensitive to hormones
Immunotherapy method, which aims to improve the immune system to clear cancer cells, can be applied in some patient groups.
Some special interventional methods such as radiofrequency or gamma knife can be used to remove selected metastasis tissues outside of surgery.
In some selected cases, surgical removal of metastasis tissues may be considered to improve the quality of life of the patient and increase survival. The method, also known as metastasectomy, can be performed in some types of cancer and suitable patients.