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Metastasis

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Metastasis is the process where a pathogenic agent spreads from a primary site to a secondary site within a host. In medical terms, this usually describes the spread of a cancerous tumor. The new locations where the cancer settles are called metastases, or "mets." This process is distinct from cancer invasion. Invasion is when cancer cells grow directly into neighboring tissues. Metastasis is more complex because it involves the movement of cells through the body.

Lymph node with metastatic melanoma
Lymph node with metastatic melanoma

To understand how this happens, we must look at how cancer cells change. Cancer begins when cells are genetically altered to multiply indefinitely through mitosis. As these cells grow, they undergo several changes: metaplasia, dysplasia, and eventually anaplasia. This progression results in a malignant phenotype. This malignancy allows cells to invade the body's circulation. Once in the circulation, they can travel to a second site to begin tumorigenesis.

Lymph node metastasis, squamous cell carcinoma bromchus
Lymph node metastasis, squamous cell carcinoma bromchus

There are several specific routes that cancer cells take to travel. One route is lymphatic spread, which is common for carcinomas. This involves the transport of cells to regional lymph nodes. Doctors often biopsy a "sentinel lymph node" near a tumor to check for this. Another route is hematogenous spread, which is the movement through the bloodstream. This is the typical route for sarcomas. Veins are often invaded more than arteries because they have thinner walls.

Metastasis sites for common cancers
Metastasis sites for common cancers

Other specialized routes exist for certain types of spread. Transcoelomic spread occurs when a malignancy penetrates body cavities like the peritoneal or pleural spaces. For example, ovarian tumors can spread transperitoneally to the liver. There is also canalicular spread. This happens when tumors move along anatomical spaces like bile ducts or the urinary system. Some cancer cells may even travel as circulating tumor cells, or CTCs. These cells can travel alone or in clusters. Evidence suggests that CTC clusters might stay together to increase their metastatic potential.

Secondary tumor deposits in the liver from a primary cancer of the pancreas
Secondary tumor deposits in the liver from a primary cancer of the pancreas

When cells reach a new location, they must establish a new tumor. It is important to note that the new tumor is made of the same cells as the original. If breast cancer moves to the lungs, it is called metastatic breast cancer, not lung cancer. The secondary tumor cells are similar to the primary ones. This spread is a key part of the TNM staging system. In this system, the "M" stands for metastasis. If metastasis is present, the cancer is classified as Stage IV.

Pulmonary metastases shown on Chest X-Ray
Pulmonary metastases shown on Chest X-Ray

Metastasis is a major challenge in medicine because it is linked to over 90% of cancer-related deaths. Common locations for these secondary tumors include the lungs, liver, brain, and bones. Each location can cause different symptoms. Lung metastasis might cause a cough or shortness of breath. Liver metastasis can cause nausea or jaundice. Bone metastasis often leads to pain or fractures. Brain metastasis can cause headaches or seizures.

Metastasis sites for common cancers
Metastasis sites for common cancers

Scientists are studying many theories to understand this enigma. They look at the epithelial-mesenchymal transition (EMT), which involves how cells change shape to move. They also study the cancer stem cell hypothesis and the macrophage–cancer cell fusion hybrid hypothesis. Researchers are also looking at tumor angiogenesis, which is the growth of new blood vessels. They are studying how endothelial progenitor cells influence this growth. By understanding these complex biological steps, scientists hope to find ways to block the spread of cancer.

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🖼️ Images & Media (5)
File:Lymph node metastasis, squamous cell carcinoma bromchus.jpg
Lymph node metastasis, squamous cell...
File:Secondary tumor deposits in the liver from a primary cancer of the pancreas.jpg
Secondary tumor deposits in the liver...
File:Lymph node with metastatic melanoma.jpg
Lymph node with metastatic melanoma.jpg
File:Metastasis sites for common cancers.svg
Metastasis sites for common cancers.svg
File:Pulmonary metastases shown on Chest X-Ray .jpg
Pulmonary metastases shown on Chest X-Ray .jpg
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