Features of metastasis
Colon cancer is one of the ten most common malignant tumors. It occurs during malignant degeneration of the epithelial tissue that lines the intestinal walls. Oncologists still cannot answer the question: “What is the cause of cancer and its metastasis?” The only known risk factors that can lead to this disease are:
excess of meat products and animal fats in the diet; insufficient amount of fiber consumed, which moves waste products through the intestines; chronic diseases of the large and small intestines; heredity.
Colon cancer has its own characteristics. It grows slowly. It can take about two years from the oncological focus to its growth. In a patient who does not receive medical care on time, cancer cells spread through the blood and lymph and affect nearby organs. The third stage gives metastases most often to the liver, lungs, and lymph nodes.
By the fourth stage, the most severe, an extensive tumor process has formed, which involves bone tissue (pelvis) and the lymphatic system.
Symptoms characteristic of the fourth stage:
loss of performance; aversion to food and food smells; ribbon-shaped feces with admixtures of mucus, blood, pus; persistent abdominal pain, radiating to the lumbar region, sacrum, perineum; sensation of a foreign body in the abdomen.
The prognosis for the fourth stage is the most unfavorable. Only surgical intervention in this case will not give a successful outcome. The doctor chooses the following tactics: chemotherapy, surgery, repeated chemotherapy. Such actions will alleviate the patient’s condition and slow down the tumor process.
Symptoms of pulmonary metastases
Clinical manifestations of lung damage caused by a secondary tumor process can be divided into specific and nonspecific. The first group includes symptoms that are directly related to damage to the respiratory system:
- A cough that often bothers you at night is not associated with infection and does not go away for a long time.
- Hemoptysis, that is, the release of blood after a cough, is observed when the tumor disintegrates, when its thin-walled small vessels easily “burst.”
- Shortness of breath, which occurs when a neoplasm grows into the pleura or immediately affects an entire lobe of the lung, as well as when fluid accumulates in the pleural cavity.
In addition, as the cancer progresses and the volume of damage to the lung tissue increases, patients may develop associated complications, including:
- Perifocal pneumonia (inflammation of the lungs around the node).
- Spontaneous pneumothorax (accumulation of air in the pleural cavity).
- Hypoventilation of a segment or lobe of the lungs (due to compression of the bronchus).
- Pneumonia with abscess formation (with the addition of a bacterial infection).
- Pleurisy and pleural empyema (when pus spreads into the pleural cavity).
Nonspecific symptoms are observed with all types of cancer. They are caused by the toxic effect of the tumor on the body, the disintegration of metastases, dysfunction of vital organs, etc. This group includes clinical manifestations such as increased body temperature, loss of appetite, marked loss of body weight, weakness, etc. The patient may also be bothered by recurring infections respiratory tract. In this case, a dry cough becomes wet and purulent sputum is released, although most often the cough and slight fever are associated not with inflammation, but with paraneoplastic syndrome, which occurs with any malignant formation.
Most often, the initial forms of intestinal cancer are asymptomatic. Likewise, there may be no symptoms of metastatic lung disease. For this reason, secondary lesions may be discovered accidentally when examining a patient for the underlying disease.
Damage by metastases
In case of intestinal cancer, metastasis occurs along the chain: lymph nodes, liver tissue, lung tissue, pelvic bone tissue.
The lymphatic system, as the main one in the immune reaction, takes the blow of the degenerated cells. Lymph not only becomes inflamed and does not sufficiently perform protective and hematopoietic functions, but also carries cancer cells to other organs (lymphogenous pathway).
The second blow is delivered to the liver.
The liver is a large unpaired glandular organ that has several functions.
First: it neutralizes all toxic substances that enter the bloodstream. Second: the liver is an organ that synthesizes proteins, glycogen and bile. Third: lymph-forming function.
When cancer develops, it is the liver that bears the brunt. Transport fluids of the body (blood, lymph) carry tumor cells to the liver and metastases begin to form. A persistent pain syndrome develops.
Liver metastasis significantly worsens the general condition of the patient and leads to profound disability.
To treat intestinal cancer with liver metastases, drug and surgical methods are used. With their help, the general condition of the patient is significantly improved and life is prolonged.
In addition, metastases to the liver carry a number of dangerous complications. This may be compression of the inferior vena cava, the most powerful in the body, which accounts for more than half of the total blood flow. Venous stagnation causes persistent swelling of the lower extremities and phlebitis. Obstruction of the bile ducts causes obstructive jaundice, which in cancer gives a disappointing prognosis with the impossibility of treating the underlying disease.
Bilirubinemia leads to severe intoxication and death.
Surgical treatment (stenting, duct drainage) will only provide temporary relief to the patient. Treatment uses radiation and chemotherapy. The prognosis is unfavorable.
The lungs are in second place in terms of damage to metastases of intestinal cancer. The lungs are penetrated by a network of blood vessels with lymph nodes. It is with lymph that cancer begins to spread to the lungs. The complication is often asymptomatic, and the patient has no complaints. Therefore, a late visit to a doctor does not provide an opportunity to obtain a satisfactory prognosis. Five-year survival was not recorded. Patients with lung metastases die within two to three years.
The pelvic bones are the last to be affected. This indicates that the disease has entered its final stage. Half of patients die before reaching the five-year mark,
In case of intestinal cancer, distant metastasis is likely to the lymph nodes of the retroperitoneal space, peritoneum, uterine appendages, other pelvic organs, rectum, bladder and brain.
Oncology of areas of the digestive system is characterized by slow progression; therefore, metastases in intestinal cancer can develop over a long period of time. Tumor formations form over several years of life, increase in size, and during the period of complete filling of the intestine, their cells break off and begin to grow deep into its walls, reaching the blood and lymphatic vessels. Spreading throughout the intestine, they act as secondary foci of a malignant tumor.
Treatment methods for metastatic lung tumors
Usually, at the fourth stage of colorectal cancer, patients are considered incurable, that is, it is not possible to completely get rid of all foci. However, the patient's condition can be improved to varying degrees through palliative treatment. It can be carried out using different methods.
When determining indications for surgical treatment, the doctor takes into account the characteristics of the primary tumor: its histological structure and the number of distant metastases.
The extent of surgery may vary. If possible, the surgeon removes the secondary tumor, and if there are several metastases, then it is possible to remove one or more of them. Radical removal of the primary tumor in late stages is impossible in most cases, but the surgeon can remove some of it and thereby eliminate some symptoms. Palliative surgery may also be performed if complications occur.
The general principles of surgical treatment of colorectal cancer with metastases in the lungs are as follows:
- Be sure to remove the primary tumor in the large intestine.
- A secondary lesion in the lungs is resected if the histological type is accurately determined (and it coincides with colorectal carcinoma).
- Resection of a segment or lobe of the lung is performed only if other organs and intrathoracic lymph nodes are not affected.
- The risk of deterioration in general condition after surgery should not be high so that respiratory function is not affected.
Treatment can also be carried out using conservative methods using chemotherapy and radiation therapy. These methods can be combined with surgical treatment or used separately from them. The exact plan is always selected individually for each patient, taking into account the characteristics of a particular clinical case.
Process description
In oncological processes, metastases in the intestine develop if the disease is not detected at its first stage and the necessary therapy is not promptly applied. Secondary cancer foci spread to organs located near the affected area using lymph and blood. The process of metastasis formation begins with the appearance of cancer cells in the intestine and goes through several stages, which depend on the degree of the disease:
Stage 1 - the absence of malignant processes, a small tumor penetrates the intestinal mucosa. Stage 2 - the cancer grows, but does not extend beyond the intestinal cavity, a single appearance of metastasis is possible in the nearest lymph nodes. Stage 3 - the number increases oncological cells beyond the boundaries of the intestine and secondary foci in the lymph nodes. Stage 4 - oncological processes spread to tissues, pelvic and other organs, metastases are characterized by widespread distribution in the body.
What tests will need to be taken?
If metastases in the intestine are suspected, the patient will need to undergo the following tests:
Blood biochemistry:
The doctor studies such biochemical indicators as hemoglobin level, protein concentration in the blood, urea level, haptoglobin. During a malignant process, the hemoglobin level drops below 70–80 units, the protein level decreases, and the amount of urea in the blood and haptoglobin increases.
General blood analysis:
In cancer, the number of leukocytes increases, the erythrocyte sedimentation rate increases, and the amount of hemoglobin decreases.
Blood test for tumor markers:
Such an examination is more reliable and serves to determine the degree of malignancy of the neoplasm, the stage at which the cancer process occurs, and the degree of the body’s response to the presence of malignant cells in it. Each organ has its own specific antigen.
Important to know: Intestinal tumor markers
Fecal occult blood test:
It is carried out several times. Its appearance indicates developing internal bleeding.
Pathways of metastasis in colorectal cancer
Malignant cells, having penetrated healthy organs, poison the entire body.
The identification of stages and severity of the disease is due to the fact that intestinal cancer with metastases is characterized by a sequential distribution of tumors to different parts of the abdominal cavity. When malignant cells penetrate healthy organs, the functioning of the latter is destabilized and the disease as a whole is complicated, which can then be cured by necessary surgery. In order to predict the dynamics of the development of intestinal metastases, you need to contact oncologists.
Lymph nodes
First of all, the lymph nodes closest to the intestine suffer from secondary cancer foci. Inflammation of the main organs responsible for the protective function generally affects the human immune system. Infection of the lymph nodes leads to disruption of the purification of the fluid surrounding the tissues of the organs, and contributes to the further spread of malignant foci with the movement of lymph.
Liver and metastases
As they move through the body, metastatic formations from the main negative focus are directed to the liver. When an organ performs filtration work, metastases are retained in it and cancerous foci are formed. In this case, there is a violation of the removal of dangerous microelements and harmful substances from the body, which leads to its weakening and loss of the ability to independently fight the disease.
Lungs and metastases
Gradually progressing, intestinal cancer affects the lung tissue. Due to circulation through the blood vessels surrounding the organ, the lymphatic fluid infected with metastases penetrates into it without pain for the person. In this regard, pulmonary malignant neoplasms are difficult to diagnose and in some cases are detected too late for possible therapy.
Pelvic bones
A severe form of intestinal cancer provokes bone destruction.
In severe cases of intestinal cancer, metastases reach the pelvic bones. The movement of secondary foci of cancer to the pelvic organs occurs last, when the disease approaches a critical point of development. During the process of metastasis, bone experiences a lack of tissue renewal and its destruction. At the same time, metastatic lesions affect the spine, severe pain in which may indicate oncology in the area of the digestive system.
Bone metastases: life expectancy, symptoms, diagnosis
Category: Oncology
Bone metastases are an unpleasant and life-threatening situation, but they are not a death sentence.
With timely detection of metastases, the patient’s chances of saving life and the possibility of full functioning are increased.
Cancer metastases to bone are complications of cancer. When diagnosed, the pathology is in the last stage. If the disease is in an advanced form, when metastases are deep in the bones, then the patient’s life expectancy ranges from several months to a year.
Experts say that in most cases, bone metastases are formed due to cancerous tumors in the digestive system, cervix, ovaries and soft tissues.
The process of metastasis is the penetration of cancer cells and reaching any organs and tissues, including bone, through the blood supply (lymphatic vessels).
Symptoms of bone metastases
In the first stages, the development of secondary bone tumors occurs without obvious signs. But over time, the following symptoms appear:
- hypercalcemia;
- tendency to pathological fractures;
- spinal compression.
Hypercalcemia is a dangerous complication, found in approximately 40% of patients with bone metastases. This condition may occur due to increased activity of osteoclasts, which increase the level of calcium in the blood, and as a result cause an abnormal increase in the excretory capacity of the kidneys.
In addition to hypercalcemia, hypercalciuria may develop, and impaired reabsorption of fluid and sodium may occur, which leads to polyuria.
Due to such changes, the patient experiences disruption of the functioning of many organs and systems:
- Nervous system. In the nervous system activity, signs are noted in the form of lethargy and mental disorder, as well as confusion in consciousness.
- Cardiovascular. The occurrence of arrhythmia and low blood pressure, decreased heart rate and increased risk of cardiac arrest.
- Digestive system. Nausea, vomiting, intestinal obstruction, and lack of appetite are observed.
In the case of bone metastasis and destruction of more than half of the cortical layer, pathological fractures occur. They are usually found in the bone tissue of the spine and hip bones. A fracture can occur even in low-traumatic situations, such as an awkward turn or a weak blow.
In most cases, such fractures occur for no externally visible reason. With a pathological fracture, bone fragments are displaced, which leads to impaired functionality of the limbs (if the fracture is localized on a long tubular bone) and neurological disorders (if localized on a vertebral structure). All this significantly affects the patient’s quality of life.
With tumor compression, the following symptoms are observed: increasing pain, weakness in muscle tissue, impaired sensitivity, dysfunction of pelvic organs, paralysis (in later stages).
If metastases have penetrated into the spinal tissues, patients sometimes experience spinal compression. A similar phenomenon is observed with metastases in the thoracic vertebrae. Disorders caused by compression can develop acutely (if the bone or its fragment is compressed) or gradually (if it is compressed by metastasis).
Signs of compression appear suddenly. If these symptoms are detected at the initial stage of development, then reversibility is possible (in most cases, partial). If you do not act on compression, the paralysis will become irreversible.
Treatment of bone metastases
If metastases are treated on time, malignant foci form less frequently, which increases the patient’s survival.
Also, skeletal complications such as pain, pathological fractures, spinal cord compression and hypercalcemia occur less frequently, and the patient's life becomes much easier, which is an important achievement.
Systemic drug therapy includes antitumor treatment (the use of immunotherapy and hormonal therapy) and supportive therapy (the use of bisphosphonates and analgesics). Local treatment is also possible using radiation therapy, surgery, radiofrequency ablation and cementoplasty.
Treatment tactics for patients with bone metastases are determined on an individual basis. The choice depends on the course of the disease, the age of the patient and the location of the metastases.
Main symptoms
Every change in the body caused by the growth of a malignant tumor in the intestine is associated with a decrease and final cessation of the functioning of the affected area. Signs accompanying intestinal metastases depend on the location and degree of development of the disease. Common symptoms of secondary cancer lesions include:
the appearance of bloody and purulent discharge in excrement; intestinal disorders: constipation and diarrhea; a feeling of fullness in the intestinal tract; a feeling of discomfort in the abdomen; digestive problems; nausea and vomiting; lack of appetite; an increase in the size of the abdomen and the appearance of a disproportionate bulge in its area; weight loss; constant fatigue; pain in the spine; causeless appearance of jaundice; persistent fever.
If such symptoms occur, you should pay attention to your health condition and seek advice from an oncologist. In most cases, accelerated weight loss is perceived as a sign of normal weight loss. At the last stage of growth, the tumor formation takes up the entire space in the intestine and interferes with the passage of feces. The symptom of intestinal obstruction is life-threatening and requires immediate medical attention.
How are intestinal metastases determined?
The symptoms listed above may indicate the presence of malignant tumors in the intestines. Therefore, you need to consult a doctor in time to carry out diagnostics and clarify the diagnosis.
During the initial diagnosis, the patient submits stool for analysis to find out whether there are blood elements in it. Such an analysis can detect the disease even in the early stages. Those who are at risk should undergo such testing regularly, especially in old age.
The next stage of diagnosis is digital examination. It reveals a tumor in the last part of the rectum. The doctor feels the intestine, and if the tumor is located near the anus, it will be detected. The moral side of the issue should not become an obstacle to the examination. This is a relatively simple and gentle method of diagnosis, and there is nothing shameful about it.
A more complex version of the study is to insert a flexible tube with a camera into the intestine. Sigmoidoscopy (this is the name of the method) allows you to examine the lower parts of the intestine for the presence of cancerous tumors on the mucous membranes.
Survey
Inserting a flexible camera through the anus allows for viewing of the colon from the inside.
If at least one of these symptoms occurs, consultation with a specialist is recommended. Prompt diagnosis will help determine the degree of cancer and take measures to treat it. Timely tests will make it possible to make a favorable prognosis for the survival of a cancer patient. In the examination course, a special place is occupied by primary diagnostics, with the help of which malignant cells are identified in the damaged organ through colonoscopy. The method used to check for the presence of blood in the stool makes it possible to detect cancer in the first stage of development. Determining the location of metastases will allow you to avoid surgery, as well as reduce the risk of their further penetration into organs.
Subsequent stages of the examination may include the following methods:
digital examination of the lower parts of the intestinal tract, as a result of which it is possible to determine tumor formation near the anus; sigmoidoscopy - makes it possible to check the internal surfaces of the intestinal mucosa for the development of secondary foci; colonoscopy - aimed at examining all intestinal sections; sigmoidoscopy - allows you to examine up to 30 cm of the intestine; biopsy — study of organ tissue for the presence/absence of cancer cells.
When confirming symptoms and establishing a diagnosis, the following additional examination methods are used:
computer or magnetic resonance imaging; ultrasound examination of the abdominal organs; x-ray or fluorography of the chest; laboratory tests for tumor markers of the digestive system. Maintaining a healthy lifestyle and proper nutrition have a positive effect on a cancer patient.
Diagnosis of metastatic lesions is associated with their prevention. Oncopathology can be prevented, first of all, by maintaining a healthy lifestyle and proper nutrition. During medical examinations, it will be possible to determine the duration and stage of the disease, predict intestinal metastases and prevent their spread in the body.
What to do if there are metastases in the abdominal cavity?
In case of ovarian cancer with preserved mobility of the tumor conglomerate in the small pelvis, they will definitely offer cytoreductive surgery, in which all the tumor that can be removed is removed, and the metastatic nodules are literally cut off from the peritoneum. The goal of cytoreduction is to remove as much of the malignant tissue as possible; nodules smaller than a centimeter are effectively destroyed by drugs. Next, the patient will undergo long-term chemotherapy with platinum derivatives and taxanes.
In other nosological forms of cancer, metastasis cuts off the path to radical surgery, only palliative interventions for complications and the creation of paths bypassing the tumor for the unhindered movement of food or feces, the patient will have systemic and local chemotherapy - inside the abdominal cavity.
Therapy for metastases
The answer to the question of how long people living with malignant tumors in the intestinal area live depends largely on their timely contact with an oncologist for help. The leading method of treating metastases is surgical, in which an operation is performed to remove tissue damaged by cancer and the cancer focus. The duration of recovery of the body after surgical therapy depends on the individual characteristics of the patient, his age and the degree of the disease. Treatment in the final stages of cancer also includes chemotherapy and radiotherapy, which affect pathological changes in intestinal cells.
Life expectancy according to reviews of patients and their families
Metastases are a very unfavorable sign. The life expectancy upon diagnosis of metastases in the abdominal cavity rarely exceeds 1-3 years. Many relatives of people suffering from metastases in the peritoneum note that patients in severe cases are able to live for a whole year or even more after diagnosis. However, such a life will be associated with unbearable pain and constant use of potent medications.
Abdominal metastases have no substantiated causes or factors, and symptoms in the initial stages are so nonspecific that patients may ignore them. With timely diagnosis and treatment, the patient can expect a partial recovery.
Where does cancer metastasize?
Rectal cancer is most dangerous due to its metastases. There are three ways for cancer cells to spread throughout the body in oncopathology of the rectum and colon:
- Direct tumor infiltration of the walls of nearby organs.
- Metastasis through the bloodstream (occurs in a quarter of cases).
- Lymphogenic route (most common).
Most often the tumor metastasizes to:
- Spine. One of the most common localizations of secondary tumors. The lumbosacral spine is most often affected, and somewhat less commonly the thoracic spine. Metastases are manifested by focal symptoms, which can be falsely mistaken for intervertebral hernia or osteochondrosis.
- Liver. Metastases from rectal cancer to the liver about the picture of the development of intestinal oncology. Rectal cancer with metastases to the liver gives a characteristic picture with pain and heaviness in the right side (hypochondrium), obstructive jaundice (develops as a result of obstruction of the bile ducts by the tumor), burning sensation and itching of the skin.
- Lungs. Such localization of secondary tumors leads to breathing problems.
Less commonly, a malignant process affects the brain in the region of the neurohypophysis and hemispheres.
