What Is Metastatic Cancer
In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
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Stop Tumors In Their Tracks
Every melanoma has the potential to become deadly, but the difference between an in situ melanoma and one that has begun to metastasize cannot be overstated. There is a drastic change in the survival rate for the various stages of tumors, highlighting the importance of detecting and treating melanomas before they have a chance to progress. Its impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.
To be sure youre spotting any potential skin cancers early, The Skin Cancer Foundation recommends monthly skin checks, and scheduling an annual total-body skin-exam with a dermatologist. These skin exams can help you take note of any new or changing lesions that have the potential to be cancerous, and have them biopsied and taken care of before they can escalate.
Trust your instincts and dont take no for an answer, Leland says. Insist that a doctor biopsy anything you believe is suspicious.
If Treatment Does Not Work
Recovery from melanoma is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
New Hope For Beating Skin Cancers Deadliest Form
It starts as a tiny dark spot on your calf or the crook of your neck or your back. Its probably blotchy, like a Rorschach test, and if a doctor notices it, she is likely to take a second look. Id like to examine this one more closely, she might say about the mark on your skin that youd perhaps never even noticed. And its often good news to hear a doctor say that, because if you catch this little mass of dark, feisty cells before they spread, the inkblot cant seep into your body and stain your liver or bones or brain with cancer.
While relatively rare, with 21 new cases per 100,000 people in the United States each year, melanomas are the most dangerous form of skin cancer that humans develop. They begin when melanocytes, cells that produce and contain the pigment melanin and dictate the tone of a persons skin, mutate and start dividing too quickly, forming these telltale blotches. But once a melanoma has advanced from being an isolated group of cells on the skin and has sent scouts to other parts of the body, its notoriously hard to treat, despite its small size.
Gram for gram, melanoma is the most deadly form of skin cancer, says Stanford dermatologist and melanoma program director Susan Swetter, MD. Differences in survival drop dramatically with only a few millimeters of increased tumor thickness on the skin.
Your May Experience Side Effects
The vast majority of patients who receive immunotherapy will have little to no side effects, says Dr. Betof Warner. Its a huge change from the days when patients were on chemotherapy and were profoundly nauseous, vomiting, and had suppressed immune systems. Still, side effects can occur, including flu-like fever, aches, fatigue, and nausea. The risk of side effects with targeted therapy is a bit higher, but Dr. Betof Warner says they tend to disappear faster. These can include rashes, headaches, joint pain. And more seriously, kidney failure, bleeding, and heart and liver problems.
After A Skin Biopsy More Tests Are In Store
If a biopsy reveals melanoma, youll have additional tests to determine its spread, including a lymph node biopsy and some imaging tests. We routinely do either a PET scan or CT scan of the chest, abdomen, and the pelvis, says Allison Betof Warner, M.D., a medical oncologist at Memorial Sloan Cancer Center in New York City. And all patients with stage 4 disease should have an MRI of the brain. Your doctor may also order a blood test to measure your levels of an enzyme called lactate dehydrogenase. Elevated levels indicate a more extensive spread.
Can The Cancer Stage Change
Once diagnosed, a cancers stage never changes. Even if the patient improves or gets worse, their cancer is the same as when diagnosed.
Once diagnosed with stage 4 cancer, you will always have stage 4 cancer. That doesnt mean that you cannot sustain a long period of disease-free survival.
Part of the reason for this is statisticalstages help scientists track and reevaluate survival statistics and treatment protocols. But they also let doctors track the efficacy of treatments for your stage.
Doctors use cancer stages to compare patients with similar diagnoses, to more easily study the effectiveness of treatments, to track a persons cancer progression, and as a way to estimate survival rates for specific cancers.
Part of the confusion regarding staging status arises from the fact the disease is sometimes re-staged. Re-staging determines if there has been a progression or remission of the disease.
If cancer is re-staged or recurs , doctors keep the initial staging diagnosis and add a new stage to the patients diagnosis. New staging diagnoses get differentiated with letterslike c for clinical, p for pathological , or y for after treatment.
For instance, stage 2 breast cancer that suddenly spreads to the lungs is stage 2 breast cancer with lung metastases rather than stage 4 breast cancer. Similarly, if stage 4 breast cancer meets the definition of remission after treatment, they describe it as stage 4 breast cancer with no evidence of disease.
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Physical Emotional And Social Effects Of Cancer
Melanoma and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
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Squamous Cell Carcinoma Treatment
Squamous cell carcinomas detected at an early stage and removed promptly are almost always curable and cause minimal damage. However, left untreated, they may grow to the point of being very difficult to treat.
A small percentage may even metastasize to distant tissues and organs. Your doctor can help you determine if a particular SCC is at increased risk for metastasis and may need treatment beyond simple excision.
Fortunately, there are several effective ways to treat squamous cell carcinoma. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patients age and general health. Squamous cell carcinoma treatment can almost always be performed on an outpatient basis.
Advanced Skin Cancer Was Once A Death Sentence Immunotherapy Is Changing That
Most cancer patients are haunted by the same two questions:
Walton, 34, actually feels lucky advanced melanoma struck when it did.
If I had been diagnosed five years prior, who knows if I would be here,” she says.
Stage 4 melanoma used to be a death sentence. The disease doesnt respond to radiation or chemotherapy, and patients survived, on average, less than a year.
But over the last decade, doctors are successfully using a new approach, one significantly different than the treatment options available for the last 150 years.
Instead of burning or poisoning cancer cells, new medicines unleash the body’s natural defenses to fight them.
This treatment is called immunotherapy.
Beating the Odds
When Walton was 26, she found a mole on the back of her hip.
“It started morphing into this ugly, dark, bleeding thing,” she says, grimacing. “I just knew something was wrong.”
Doctors surgically removed her tumor. But a couple of years later, she discovered a tiny lump in her abdomen. It felt like a popcorn kernel, and within a few weeks grew to the size of a walnut.
A biopsy revealed she had stage 4 melanoma.
Walton searched online for information about the disease. She recalls the moment she discovered the average survival rate: six to nine months.
“I remember sort of losing my hearing, almost losing my vision to where I felt like I was in a tunnel,” she says.
But when she consulted with her oncologist, Dr. Adil Daud of UC San Francisco, he had consoling news.
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Five Types Of Standard Treatment Are Used:
Surgery to remove thetumor is the primary treatment of all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting may be done to cover the wound caused by surgery.
Sometimes, it is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node . It is the first lymph node the cancer is likely to spread to from the primary tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymphducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy. Sometimes, a sentinel lymph node is found in more than one group of nodes.
After the doctor removes all the melanoma that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after the surgery, to lower the risk that the cancer will come back, is called therapy.
Treatments For Stage I Melanoma
Your doctor will most likely treat stage 1 melanoma with surgery called wide excision, which cuts out the melanoma along with a margin of healthy surrounding skin. The amount of healthy skin removed is determined by the location and the thickness of the melanoma being treated.
While wide excision surgery is often the only treatment necessary, in some cases a doctor may also choose to check for cancer in nearby lymph nodes by performing a sentinel lymph node biopsy. If cancer cells are found in the lymph nodes, further treatment will become necessary, such as a lymph node dissection , chemotherapy, immunotherapy, or targeted therapies.
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Skin Color And Being Exposed To Sunlight Can Increase The Risk Of Basal Cell Carcinoma And Squamous Cell Carcinoma Of The Skin
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk factors for basal cell carcinoma and squamous cell carcinoma of the skin include the following:
- Being exposed to natural sunlight or artificial sunlight over long periods of time.
- Having a fair complexion, which includes the following:
- Fair skin that freckles and burns easily, does not tan, or tans poorly.
- Blue, green, or other light-colored eyes.
- Red or blond hair.
Although having a fair complexion is a risk factor for skin cancer, people of all skin colors can get skin cancer.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
What Tests Are Used To Stage Melanoma
There are several tests your doctor can use to stage your melanoma. Your doctor may use these tests:
- Sentinel Lymph Node Biopsy: Patients with melanomas deeper than 0.8 mm, those who have ulceration under the microscope in tumors of any size or other less common concerning features under the microscope, may need a biopsy of sentinel lymph nodes to determine if the melanoma has spread. Patients diagnosed via a sentinel lymph node biopsy have higher survival rates than those diagnosed with melanoma in lymph nodes via physical exam.
- Computed Tomography scan: A CT scan can show if melanoma is in your internal organs.
- Magnetic Resonance Imaging scan: An MRI scan is used to check for melanoma tumors in the brain or spinal cord.
- Positron Emission Tomography scan: A PET scan can check for melanoma in lymph nodes and other parts of your body distant from the original melanoma skin spot.
- Blood work: Blood tests may be used to measure lactate dehydrogenase before treatment. Other tests include blood chemistry levels and blood cell counts.
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