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Metastatic Disease

Specialties > Cancer

Background Knowledge 🧠

Definition

  • Spread of cancer cells from the primary site to distant organs.
  • Occurs via blood, lymphatic system, or direct extension.
  • Leads to secondary tumours (metastases).
  • Common in advanced stages of cancer.

Epidemiology

  • Most common cancers causing metastases: Breast, lung, prostate, and colorectal.
  • Metastases responsible for 90% of cancer-related deaths.
  • Bone, liver, and lungs are frequent sites of metastasis.

Aetiology and Pathophysiology

  • Genetic mutations leading to uncontrolled cell growth.
  • Angiogenesis supporting tumour growth and spread.
  • Invasion through basement membrane into surrounding tissues.
  • Circulating tumour cells (CTCs) spread via bloodstream or lymphatics.
  • Establishment of microenvironment in distant organs.

Types

  • Lymphatic spread: Commonly seen in breast cancer.
  • Haematogenous spread: Typical in sarcomas and renal cell carcinoma.
  • Transcoelomic spread: Involves peritoneal, pleural, pericardial cavities.
  • Bone metastases: Frequently from prostate, breast, and lung cancers.
  • Liver metastases: Common from colorectal cancer.
  • Brain metastases: Often from lung, breast, and melanoma.

Clinical Features 🌡️

Symptoms

  • Bone pain in skeletal metastases.
  • Dyspnoea and cough in lung metastases.
  • Jaundice and abdominal pain in liver metastases.
  • Headache, seizures in brain metastases.
  • General symptoms: Fatigue, weight loss, anorexia.

Signs

  • Palpable mass in bones or soft tissues.
  • Neurological deficits in brain metastases.
  • Hepatomegaly in liver metastases.
  • Pleural effusion or ascites on physical exam.
  • Lymphadenopathy in lymphatic spread.

Investigations 🧪

Investigations

  • Blood tests: FBC, LFTs, tumour markers (e.g., CEA, CA 15-3, PSA).
  • Imaging: X-ray, CT, MRI, PET scans to identify metastases.
  • Biopsy: Confirmatory histology and molecular profiling.
  • Bone scan: For suspected skeletal metastases.
  • Lumbar puncture: If CNS involvement suspected.

Management 🥼

Management

  • Surgical resection for accessible metastases.
  • Radiotherapy for local control and symptom relief.
  • Systemic therapy: Chemotherapy, targeted therapy, immunotherapy.
  • Bisphosphonates for bone metastases.
  • Palliative care to improve quality of life.

Complications

  • Pathological fractures in bone metastases.
  • Spinal cord compression in vertebral metastases.
  • Hypercalcaemia from bone metastases.
  • Pleural effusion causing respiratory distress.
  • Brain oedema leading to increased intracranial pressure.

Prognosis

  • Generally poor, varies by cancer type and extent of spread.
  • Median survival: Months to few years depending on response to treatment.
  • Better prognosis with isolated metastases and good performance status.
  • Regular follow-up and supportive care essential.

Key Points

  • Early detection and treatment of primary cancer is crucial.
  • Multidisciplinary approach improves outcomes.
  • Ongoing research into targeted therapies and immunotherapy.
  • Patient-centered care focusing on quality of life.

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Cancer