A Doctor Decodes Metastatic Cancer: Diagnosis & Treatment Options

The symptoms largely depend on the size and location of the metastatic tumour.

(Photo: iStockphoto)

(Actor Sonali Bendre recently revealed that she is suffering from a high-grade cancer that has metastasised. Here’s a doctor explaining what exactly is metastatic cancer.)

According to the World Health Organisation, lung, prostate, colorectal, stomach and liver cancer are the most common types of cancer in men, while breast, colorectal, lung, cervix and stomach cancer are the most common among women.

However apart from these there are also certain types of cancer which are not much known to people.

Metastatic cancer is one such kind of cancer. It is an advanced cancer which is caused by uncontrolled cells that breach the basement membrane of the cancer affected organ and spread to other organs such as the lung, bone, liver or brain through the lymph nodes and blood vessels.

Signs & Symptoms of Metastatic Cancer

Headaches, dizziness, seizures are some of the symptoms that can help recognise Metastatic cancer.(Photo: iStockphoto)

While metastatic cancer cannot be easily diagnosed, there are certain signs and symptoms that can help recognise the disease such as:

• Difficulty in walking and sudden fractures (bone metastasis)
• Headaches
• Dizziness, seizures
• Even visual problems (brain metastasis)
• Shortness of breath (lung metastasis) &
• Random swelling in the belly or diseases like jaundice (liver metastasis)

The symptoms largely depend on the size and location of the metastatic tumour.

Possible Cure for Metastatic Cancer

In certain metastatic cancers, with radiation and immunotherapy, long term survival is possible.(Photo: iStockphoto)

The treatment for metastatic cancer is often different from the ones used for a normal tumour. Metastatic cancer is difficult to control once it spreads and treatment depends on the original site of cancer, how much it has spread, the patient’s age and medical history.

That said, in certain metastatic cancers, with radiation and immunotherapy, long term survival is possible.

Tumour markers can be picked up by a blood test called liquid biopsy and can indicate the type of metastatic cancer like Ca 125, Ca 19.9, CEA, Beta HCG, alpha feto protein, circulating tumour cells CTCs and especially lung cancer.

There are variety of treatment for metastatic cancer, the most important being chemotherapy, radiation, surgery and immunotherapy.

Chemotherapy

Chemotherapy shrinks tumours faster than hormone therapy.(Photo: Flickr)

The primary benefit of chemotherapy is response time and it works very well for metastatic breast cancer. Chemotherapy shrinks tumours faster than hormone therapy. If the first chemotherapy drug stops working with hormone therapies, and the cancer begins to grow again, a second or third drug can be used.

In chemotherapy, the use of each type of drug for metastatic breast cancer is called a “line” of treatment meaning that the first chemotherapy used is called the “first-line” treatment and the second is called the “second-line” treatment.

Radiation

Radiation is an important treatment to control and sometimes cure brain metastases as it can disrupt the blood-brain barrier to facilitate drugs to penetrate the brain tumours. Radiation can shrink and help control specific spots where the cancer has spread.

This helps in decreasing pain, lowering the risk of broken bones in areas that may be weakened from cancer, decrease bleeding, improving breathing by opening up blocked airways and taking pressure off a pinched nerve that might be causing pain or weakness.

The radiation dose and schedule for metastases depends on a number of factors such as the urgency of the situation, frequency of radiation and scheduled other ongoing treatments if any.

Surgery

Surgery is generally advised to be conducted among patients suffering from spinal cord compression caused by metastatic cancer. (Photo: iStockphoto)

Surgery is generally advised to be conducted among patients suffering from spinal cord compression caused by metastatic cancer.

Patients with metastatic spinal cord compression can be treated with direct decompressive surgery along with post-operative radiotherapy to retain and regain the ability to walk longer as compared to patients treated with just radiotherapy.

Immunotherapy

Post decades of research on solid tumour immunology, immunotherapy has shown effectiveness in patients with metastatic solid cancers.

The most effective form of immunotherapy which is by far, capable of eradicating large tumour burdens in melanoma patients, is the ACT of TIL given to patients after lymphodepletion.

With this approach, tumour regression is now being reported for cancers, but success remains constrained by the identification of antigens expressed with high specificity by cancer cells and not by normal tissues.

(Dr Tejinder Kataria is Chairperson, Radiation Oncology of Cancer Institute at Medanta)

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