At the mercy of the tumor: why are metastases so difficult to stop?

Currently, doctors at leading clinics around the world are using innovative cancer treatment methods that increase the survival rate of patients with metastases. Oncologists at the Yusupov Hospital have achieved success in the treatment of metastatic cancer. The hospital uses modern methods of therapy and diagnostics, thanks to which the number of patients who managed to prolong life and improve its quality has increased in recent years. Doctors at the Yusupov Hospital use complex treatment, taking into account the general condition of the patient, the location of the tumor and the activity of its metastasis.

Symptoms of liver metastases

Symptoms of metastases begin to appear when they disrupt the functioning of the liver and gallbladder. With single metastases, they appear when the tumor reaches a size of 5-7 cm.

Signs of pathology:

• heaviness and dull pain in the right hypochondrium;
• cardiopalmus;
• constant slightly elevated temperature;
• gynecomastia – enlargement of the mammary glands in men;
• yellowness of the skin and whites of the eyes, dark urine and light feces.

You should notify your doctor if the patient simultaneously exhibits several symptoms from the list. If this is not done and measures are not taken, the symptoms increase and the patient’s condition worsens. This shows up:

• symptoms of intoxication - constant nausea and weakness;
• sudden weight loss;
• anemia;
• swelling in the legs and accumulation of fluid in the abdomen - ascites;
• a venous network on the abdomen, radiating from the navel;
• vomiting "coffee grounds" and tarry stools.

As the process progresses, the liver loses its functions. To identify metastases at an asymptomatic stage, it is advisable for patients with cancer to undergo an ultrasound of the liver once a month and an MRI with contrast once every 3 months.

Classification

Depending on the number, metastases are:

• sole, or solitary;
• single (up to 10);
• multiple (more than 10).

The sizes are small (up to 1 cm in diameter), medium (1-3 cm) and large (more than 3 cm). The speed of their appearance depends on the degree of aggressiveness of the primary tumor.

Metastatic tumors are not classified according to the TNM system. The presence of metastases in the liver itself indicates stage 4 of the primary tumor.

Malignant growth process

Cancer begins to actively progress after the production of cancer stem cells by a damaged cell that has a malignant phenotype. These cancer stem cells provoke uncontrolled cell division, under the influence of which the number of mutating cells in the affected area increases. When the accumulation of malignant cells in a pathogenic area reaches a certain number, a primary tumor begins to form in this place. Certain cancer cells have the ability to grow into surrounding healthy tissue, forming a tumor. Secondarily formed tumors in neighboring areas are called local metastases.

The invasion of cancer cells into organs does not always lead to the formation of a metastatic tumor. In organs and tissues distant from the lesion, quite viable affected cells without mutation are sometimes found. Greater and local tissue resistance is due precisely to the protective properties that block the growth of metastases.

Diagnosis of metastatic liver cancer

The diagnosis is made on the basis of laboratory and instrumental studies:

• Ultrasound of the liver
  - allows you to detect signs of metastases from 0.4-0.5 cm;
• CT and MRI with contrast
  , as well as
  radioisotope PET scanning
  - allow you to reliably identify metastases, their size and location, growth pattern and the degree of involvement of surrounding tissues in the process;
• portography
  - a type of CT with the introduction of contrast into the portal vein - allows you to detect micrometastases;
• biopsy of metastatic nodes
  under ultrasound control followed by histological analysis of the biopsy - allows you to determine the histological type of tumor and prescribe effective treatment;
• biochemical blood test and liver tests
  - help to identify functional disorders in the liver;
• tumor marker AFP
  is a marker of a malignant tumor in the liver.

Often, liver metastases are detected before the underlying cancer is diagnosed. And it is the biopsy that makes it possible to determine from which organ the cancer cells entered the liver.

Treatment methods for cancer metastases in the liver

The treatment regimen for metastatic lesions is developed taking into account a number of factors:

• single or multiple metastases have been identified;
• are there metastases in the lymph nodes;
• they are located on the periphery or near large blood vessels and bile ducts;
• histological type of tumor;
• general condition of the patient.

If the metastatic foci are histologically the same as the primary tumor, then the pathology is treated according to the same scheme as the underlying disease. Single and several small metastases with a capsular location are removed surgically.

This is possible in 5-20% of all cases. If the clinical situation allows, the operation is performed not laparotomically through an incision, but laparoscopically through punctures.

Together with the metastases, a small part of the liver is removed (segmental or lobar resection). In this case, the organ’s ability to self-regenerate plays a major positive role. Therefore, even with severe metastatic damage to the liver by cancer cells, it is possible to remove tumor foci in several stages. For metastases up to 1 mm in size, a laser cyber knife is used. In other cases, radiation and chemotherapy are indicated.

Modern methods of radiation therapy

are highly accurate – this increases the effectiveness of treatment and minimizes the risk of relapse. Their goal is to destroy cancer cells without affecting healthy ones. For liver metastases, strong focused radiation, isotope radiotherapy with hepatic vein bypass, or radiofrequency hyperthermia are used. Radiation therapy is often used at the palliative stage to reduce pain.

Chemotherapy

Cytostatic drugs for liver metastases block the division and growth of cancer cells, thereby slowing down or completely stopping the growth of a metastatic tumor. Often, the method makes it possible to reduce the volume of a tumor and make an inoperable metastatic lesion operable.

In clinical practice, the liver often deactivates many chemotherapy drugs. Then chemoablation is performed instead - a chemotherapy drug is injected into the metastasis vessel along with a drug to block the vessel.

If the clinical situation allows, radiofrequency ablation

– malignant structures are destroyed by high-frequency current supplied from a needle electrode through a puncture in the skin. In addition, immunotherapy with targeted drugs, for example, Sorafenib, approved in Russia, is effective. The drug acts on the target molecule, the death of which causes the death of the entire tumor.

A promising experimental treatment method is the destruction of liver metastases using ultrasonic waves

.
In approximately 50% of cases, palliative therapy
.

In addition to specific anticancer therapy for liver metastases, hepatoprotective treatment to prevent toxic damage to the organ. It is aimed at normalizing liver parameters - ALT and AST, GGTP, bilirubin and alkaline phosphatase. detoxification is also carried out

. If liver metastases disrupt protein synthesis, the body is supported by the administration of protein drugs.

Features of tumor recurrence and metastasis

Various clinical observations and results of statistical studies have proven that the frequency and characteristics of relapses and metastases, which determine the prognosis of the disease, are influenced by the following factors:

• Tumor stage at the start of specialized treatment

Theoretically, in patients who received radical treatment (surgery or radiosurgery) at the FIRST stage of the disease, tumor cells did not penetrate beyond the tumor into the vessels of the lymphatic or circulatory system. This means there is no reason to expect metastases or tumor recurrence.

Metastases to the skin, the primary tumor is gastric adenocarcinoma

However, there is no accurate information about whether single cells penetrated into the bloodstream/lymph flow, whether the tumor was completely excised, or whether a radiosurgical dose of ionizing radiation from CyberKnife or Gamma Knife was delivered to the full volume of the tumor lesion.

Therefore, patients who received treatment at the first stage of cancer are subject to mandatory examinations.

• Tumor localization

Modern treatment methods make it possible to achieve treatment effectiveness, for example (except for melanoma), of 70-80%. The same figure in patients at the first stage of non-melanoma skin cancer reaches 100%. In this case, the location (localization) of the primary tumor affects only the frequency of metastasis, but also the “targets” to which it “sends” metastases.

Examples of metastasis:

• cancer of the anal rectum - in the inguinal lymph nodes;
• tumors of the middle and upper ampullary parts of the intestine - up the mesentery and into the lymph nodes of the pelvic tissue;
• prostate cancer - in the skeletal system (pelvis, sacrum, spine).

Due to the peculiarities of the anatomical structure of each organ, even the location of the tumor in a certain part is a factor influencing the prognosis of spread. For example, if a breast tumor develops in the inner quadrant, the prognosis may be worse than if it is localized in the outer quadrant, etc.

• Form of tumor growth and histological structure of the tumor

Superficial forms of skin cancer grow slowly, without metastasizing for many years. Tumors of the infiltrative type grow quickly and metastasize early. Unfavorable results of treatment of patients with lung cancer were observed in poorly differentiated forms of cancer. Melanoma metastasizes extremely actively. Exophytic tumors of the gastrointestinal tract (polyp-shaped, mushroom-shaped) are less malignant than infiltrative forms of cancer of the same organ.

• Nature and scope of radical treatment

The way the patient received treatment for the primary tumor has a direct impact on the likelihood and nature of metastasis. Modern oncology has repeatedly proven that the greatest effect (including reducing the frequency of relapses and metastases) can be achieved through combined treatment, which uses a combination of methods: surgery, radiosurgery (CyberKnife, Gamma Knife), chemotherapy, targeted treatment, etc.

• Patient age

Tumor growth and metastasis in younger people, compared to older patients, proceeds similarly to other biological processes - faster and more intense.

Probability of relapse

In the first 2 years after achieving remission, 40-60% of patients experience relapses of the oncological process. By the end of the 3rd year, the number of patients with relapses reaches 70%. The prognosis for treatment of liver metastases and the likelihood of relapse are influenced by the malignancy of the primary tumor and metastases, their location, size and effectiveness of the treatment regimen.

The presence of metastases significantly worsens the course of the oncological process, but modern medicine allows us to achieve positive results in such difficult cases. For us at SM-Clinic there are no hopeless patients. We always fight for the patient - to either completely defeat the disease, or to prolong the patient’s life and improve its quality.

We treat liver metastases with a multidisciplinary team of specialists. Every year new technologies and drugs appear, which we are intensively mastering, that is, the capabilities of our doctors are constantly growing. To consult a specialist, please contact us.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

When to see a doctor

A reasonable question arises: when should you contact a specialized specialist without wasting precious time? After all, many types of cancer pathology are asymptomatic for a long time, not showing themselves in the first stages.

A reliable way to determine the first symptoms of cancer is regular preventive examinations.

They are especially important for people at risk of developing cancer. Risk factors include:

• genetic predisposition;
• detection of certain genetic mutations during diagnosis;
• frequent contact with carcinogens and other toxic substances (occupational hazards);
• unfavorable environmental conditions;
• age factor.

The medical community has developed special diagnostic programs - screening studies that determine the presence or absence of a malignant neoplasm. Timely detection of cancer symptoms and undergoing a screening examination makes it possible to carry out the most effective treatment, achieve stable remission or complete recovery.

Doctors recommend the following screening tests:

• Mammary cancer. Women at any age are at risk of developing breast cancer. Every representative of the fairer sex should conduct a self-examination of the mammary glands once every couple of months. It is advisable to consult a mammologist at least once a year. After 40 years, you will need to perform mammography (a type of radiography), and, if indicated, an ultrasound examination of the breast.
• Stomach cancer. Stomach problems are determined by fibrogastroduodenoscopy (FGDS). Using the endoscopic method, one can easily diagnose certain changes in the mucous membrane of the esophagus, stomach, and duodenum.
• Colon cancer. People of both sexes after 50 years of age should undergo fibrocolonoscopy. Examination of the mucous membrane with an endoscope reveals precancerous conditions (ulcerative colitis or Crohn's disease) or a cancerous tumor itself.
• Lungs' cancer. Medical experts recommend low-dose CT scans once a year for the following groups of people: ages 55 to 75 years; smokers aged 40 years and older; former smokers (quit within the last 15 years).
• Skin cancer. Alarming changes in moles, warts or birthmarks can be diagnosed by a dermatologist using dermatoscopy. It is advisable to undergo the procedure annually.

General diagnostics of oncopathology is also carried out. The examination involves performing a number of diagnostic measures:

1. Lab tests:
   Determination of the level of tumor markers in the blood.
2. Molecular genetic analysis. It allows you to identify specific mutations that predetermine the risk of developing an oncological process.
3. DNA diagnostics of closest blood relatives. The procedure makes it possible to find out the risk of the disease in all family members.
4. Ultrasound. The undoubted advantages of the method: it is carried out quickly, safely, and is affordable.
5. MRI, . An examination will be required if previous diagnostic results raise suspicions among the attending physician about the presence of an oncological process.
6. Endoscopic diagnostics. With its help, you can see the tumor with your own eyes through the optics of the endoscope.
7. Carrying out a biopsy. The purpose of the event is to analyze a tissue sample of the affected organ. This is followed by a conclusion about the presence or absence of atypical structures.