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Medical Forum / Diseases and Disorders / Breast Cancer / December 2003Question about mets--and how they spread
Just pondering this.... If one develops mets in one location (lungs), without any problems, and doesn't immediately start chemo, would those mets be likely to subsequently travel to another location as well? In other words, do cancer cells break away from a metastasis and travel via the bloodstream or lymph to the bones or liver? Or....do the cancer cells break away only from the primary tumor and lie dormant for awhile before growing? (or NOT growing.) If mets eventially show up in several places were they there all along, perhaps for years, from the original tumor or is there a progression of mets from one location to another because the mets keeps shedding cancer cells that travel? Tim has always said that with mets it is not necessary to start the chemo trail immediately, but rather better to wait until it's needed for palliative reasons. I've also read many times that is doesn't change length of survival....that chemo(s) usually only buy a few months at a time. I'm personally much more comfortable with not doing chemo for mets if I'm feeling fine and am quite functional, but then again, does this attitude bode for more mets in more locations? Kathie >Just pondering this.... If one develops mets in one location (lungs), >without any problems, and doesn't immediately start chemo, would those [quoted text clipped - 16 lines] >if I'm feeling fine and am quite functional, but then again, does this >attitude bode for more mets in more locations? Kathie, I think just about any tumor can - and eventually will - shed cells if left alone. One develops lung mets because cancer cells are running about loose in one's bloodstream. They can be shed by the primary tumor or any secondary tumor in your system. I agree with Tim for the most part - if chemotherapy is gonna be effective it'll be effective pretty much as long anytime as you're not in end-stage disease.  Signatureallan spammers can reach me at abuse@localhost humans can reach me at wizard at pointbeing dot com > Just pondering this.... If one develops mets in one location (lungs), > without any problems, and doesn't immediately start chemo, would those > mets be likely to subsequently travel to another location as well? In > other words, do cancer cells break away from a metastasis and travel via > the bloodstream or lymph to the bones or liver? This probably happens, but it is not generally significant because these 'tertiary' cancers generally don't get time to grow big enough to compete with the mass of secondaries already there. Remember how slowly these things grow. With detectable tumours we are always looking at a causation several years ago. > Or....do the cancer cells break away only from the primary tumor and lie > dormant for awhile before growing? (or NOT growing.) If mets eventially > show up in several places were they there all along, perhaps for years, > from the original tumor This is I think the generally accepted mechanism for the main spread of mets. There is some evidence that the presence of one or more large tumours suppresses the growth of others, and this tends to defeat treatment in stage IV. Whatever you do to reduce the detected tumour burden tends to encourage the growth of others to detectable size. > Tim has always said that with mets it is not necessary to start the > chemo trail immediately, but rather better to wait until it's needed for > palliative reasons. I've also read many times that is doesn't change > length of survival....that chemo(s) usually only buy a few months at a > time. That is indeed what I have said. I would just add the caution that the statistics on which this is based were taken before Herceptin was introduced. For those patients for whom that is effective, I think there is some evidence that it does buck the trend in that it can buy a bigger chunk of time and may be more effective earlier, than regular chemotherapy. So it is historically true, but will not necessarily remain true as new treatments are introduced. > I'm personally much more comfortable with not doing chemo for mets > if I'm feeling fine and am quite functional, but then again, does this > attitude bode for more mets in more locations? I don't think so. Tim Tim, Forgive me for not re-posting the entire original post with your replies interspersed, but thank you for your informative replies. So many things to wonder about, knowing full well that there are no direct roads from point A to point B. I forgot to mention that I'm now 64 so I'm also hoping that those cancer cells have slowed down as much as the body carrying them has. BTW, I don't think Herceptin would work well for me because I was HER2++ by the IHC testing. I've read that you really need to be 3+ to get much benefit from Hercepin, but you make a valid point that things are always changing and hopefully progressing. Now.....I must confess that I've never completely understood why it's said that, concerning mets, treatment does not have much effect on overall length of survival. Kathie > Now.....I must confess that I've never completely understood why it's > said that, concerning mets, treatment does not have much effect on > overall length of survival. It is said because people have recorded the dates of surgery, diagnosis of mets, and death etc. along with the treatment regime used, for example under the US SEER program. Analysing these statistics shows that in most cases treatment for mets mainly improves the quality of life during the illness, but does not prolong it much. It is not based on theories about the treatment but on historical patient data. From there theories are put forward as to why this should be the case. First of all, it is known that chemotherapy is not very effective against bone mets. I am not sure why but presumably the chemicals do not easily travel to the site of the tumour. Similar problems occur with brain tumours. Localised radiation works against these, but can only be used against large, detectable tumours. So there is really no treatment except hormone therapy that can stop the majority of mets from growing until they get big, and hormone therapy has in most cases already been defeated by the time mets are diagnosed. One theory, as I mentioned is that tumours have some property of mutual suppression, and so as one is attacked, another grows to take its place, and quite possibly in a more dangerous place. This perhaps explains why knocking down the biggest tumours as they become symptomatic does not often improve overall survival. Hopefully devising models for cancer growth which explain statistical phenomena such as this will lead to improved treatment methods in future. Tim Tim, You're so great! Thanks. Kathie Tim wrote:<< Analysing these statistics shows that in most cases treatment for mets mainly improves the quality of life during the illness, >> Then why bother treating mets in the first place--why wait until it is 'too late' before some of the newer, harder drugs are used. Chemotherapy basically doesn't do much in terms of 'quality of life' improvement. If it isn't going to increase survival time, why give medications that are going to negatively impact one's life if it won't increase survival time--why give anything that is going to ruin those days that one has left? << First of all, it is known that chemotherapy is not very effective against bone mets. I am not sure why but presumably the chemicals do not easily travel to the site of the tumour. >> That might be because once the cancer affects the bone marrow maybe it's kind of like what happens if it is in the bloodstream--can travel throughout and doesn't necessarily form tumors, per se. I think that might also happen if in lymphatics as well, although one does generally see swollen lymph nodes and not all test positive--but am assuming that if in lymphatics that it has the potential to travel throughout. << One theory, as I mentioned is that tumours have some property of mutual suppression, and so as one is attacked, another grows to take its place, and quite possibly in a more dangerous place. This perhaps explains why knocking down the biggest tumours as they become symptomatic does not often improve overall survival. >> Latest research suggests that surgical resection can increase survival time and give greater chance for what was reported to be 'cure.' However, if chemotherapy has the potential of doing what you suggest, than it seems to me that neoadjuvent theory would be less effective than surgery. That is not what latest studies are showing for the majority, though, who have neoadjuvent treatment. << Hopefully devising models for cancer growth which explain statistical phenomena such as this will lead to improved treatment methods in future >> Perhaps, but then again, each persons pattern is quite different...and there may not be a single working model to explain each... I just heard a doctor talk about the fact 1 year of chemo - ages your body by 10 years on average. With Adj. chemo given with the chance of reccurence 20- 35 % how much of your life are you willing to risk considering you have a 70-80% of not having the cancer return. I thought that was an interesting presceptive. ALex Alex wrote<< I just heard a doctor talk about the fact 1 year of chemo - ages your body by 10 years on average. >> I can believe that! However, at the same time I am in better shape because I started exercising (walking and joined a gym) at time of dx, just before chemo. In addition I am taking Celebrex -- all of which allows me to move like a much younger person. The way I can tell is that I used to feel very uncomfortable getting out of the car after driving for any distance. I no longer have any difficulty. I can't say that my body doesn't show that aging, but I don't feel it. I do have to exercise daily though or I will feel 'it' more. |
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