BENGALURU: Cancer is one of the major non communicable diseases affecting world population. It can affect any age group, though increasing age is a major risk factor. In India, cancers including lung, breast, cervix, prostate, stomach are common. Bollywood actor, Sonali Bendre was recently dianosed with metatistic cancer and is undergoing treatment in New York.
‘Metastasis’ literally means displacement. It usually is synonymous to final, stage IV cancer, wherein the cancer has spread to single or multiple different organs of body from site of origin. It can originate in any organ and spread to any organ of the body. Blood and lymph fluid is the usual route of spread. Initial presentation as metastatic cancer is as such rare, but is a common scenario with cancers of lung, breast, prostate, kidney, and bone.
Depending on the organ involved by metastases, symptoms and signs vary, viz breathlessness, blood in sputum, sudden onset persistent bony pain, fractures with minimal trauma, generalised weakness, loss of appetite, abdominal bloating, seizures and vomiting. A thorough history and clinical examination by a physician along with appropriate imaging studies and visualisation of luminal organs by scopes narrows differentials. A biopsy, wherein a small representative tissue from the suspected origin and metastatic tissue is taken from the body and studied by pathologist usually confirms diagnosis. Rarely after all above, tissue of origin might still be in question. Newer diagnostics including immunohistochemistry, nuclear medicine imaging techniques is of help.
Initial presentation as metastases is usually rare and treated with palliative intent, to treat symptoms and improve quality of life. Chemotherapeutic drugs are classical standard forms of treatment where in drugs which act against cancer cells are injected or used orally at intervals to control disease. Tumor biology, patient’s performance status, organs involved and ironically financial status are the factors involved in outcome.
Research has made great progress in treatment of metastatic cancer. It has been almost two decades since ‘Imatinib’, a drug which specifically targeted tumor cells of chronic myeloid leukemia was introduced, this ‘targeted therapy’ is one of the important forms of treatment of metastatic cancer. Specific genetic alteration in cancer cells are confirmed by immunohistochemistry, fluorescent in situ hybridisation and other genomics, are targeted with these tumor antibodies and tumor specific enzyme inhibitors. Quality of life, survival benefits are very obvious in metastatic lung, kidney, liver cancer including other cancers with this modality.
Commonly in a known patient of cancer, metastases can occur after appropriate treatment at later date based on stage at initial treatment and organ of origin. In such a scenario, if the metastases are few in one organ or involving few organs, definitive therapy including surgical removal of metastases or radiation therapy might be used along with chemotherapy.
Colon cancers spreading to liver, bone tumors spreading to lung, prostate cancers spreading to bone are common in this scenario. Noninvasive high dose focused radiation modalities (cyber knife, stereotactic radio therapy) are useful in treatment of intricate areas of brain, pancreas. General public awareness regarding cancer symptoms and signs, ease of access to medical help, will help in overcoming fear and denial related to cancer. Adoption of healthy life style, right attitude to life should help in keeping it at bay. Early diagnosis and treatment is mainstay to cure cancer.
The author is a consultant-surgical oncologist