Metastatic adenocarcinoma refers to cancers that have spread to other parts of the body (affecting glandular tissue, such as most breast and colon cancers and some lung cancers).
Sometimes, these cancers are metastatic (stage 4) at the time of diagnosis, while at other times they represent the progression or recurrence of a previous early tumor.
Because these cancers have spread beyond the original region, local treatments such as surgery are less effective, and these cancers are no longer considered curable. That said, there are now many different treatments that can prolong the length and quality of life (sometimes very significantly) and the long-term control of transmission. So, although these tumors are not considered curable, they are treatable.
This article will look at the types of metastatic adenocarcinoma, the areas of the body where each type is most likely to spread, the causes of cancer spread, and treatment options.
What is metastatic adenocarcinoma?
Adenocarcinoma is a cancer that appears in glandular cells (mucus-secreting cells) such as the milk ducts and digestive tract.
Metastatic adenocarcinomas are tumors that have spread beyond the tissues they started with. For cancers such as breast and colon cancer, these are considered stage 4 tumors. For metastatic or stage 4 adenocarcinoma, the tumor can be of any size, involving (or not involving) any lymph nodes, but has spread or metastasized.
Adenocarcinomas may spread at any stage of the disease, but they may be more susceptible to metastasis if they are larger or have spread to nearby lymph nodes (in the more advanced stages). high) as well as other factors, they may also be more likely to spread.
How adenocarcinoma is transmitted
Adenocarcinoma can metastasize to other parts of the body in three ways:
·
In recent years, it has been established that lung cancer can also metastasize through the airways of the lungs.
Adenocarcinoma sometimes lies dormant for a long time and then recurs at a distance (now metastatic adenocarcinoma). Early-stage breast cancer is actually more likely to recur in the distance after five years than in the first five years after diagnosis. This is called. 5 It is not clear exactly why this happens.
Type of metastatic adenocarcinoma
Doctors use the term "" to describe the original tumor. For example, tumors that start with lung tissue are considered primary lung adenocarcinomas. Lung cancer that spreads to the liver will be called "lung adenocarcinoma that metastasizes to the liver," not liver cancer. Since the cells in the liver are lung cells, they are considered lung cancer, not liver cancer.
For some cancers, such as breast and colon cancer, most tumors are adenocarcinomas. In contrast, only about 40% of lung cancers are adenocarcinomas.
Metastatic adenocarcinoma can be broken down by the organ or tissue from which the cancer originated. Common primary adenocarcinomas include:
Unknown primary cancer
In some cases (about 3% – 5% of metastatic cancers), metastases are found, but the origin of the primary tumor cannot be determined. It is then called cancer at an unknown primary site.
This is because sometimes normal cells in specific organs. With the updated type of test, cancers with unknown primary sites were found less frequently in the past. However, when they occur, doctors are still able to treat the cancer.
Where adenocarcinoma spreads
While most cancers are able to spread to almost any part of the body (and sometimes do), each type of cancer has its specific organs or tissues that are most likely to spread. For each type of primary adenocarcinoma, the most common site of metastasis (other than lymph nodes) is
Less commonly, some adenocarcinomas may spread to other areas of the skin, muscles, and digestive tract)9
Another type of metastasis, that does not form a tumor. Instead, cancer cells circulate throughout the brain in cerebrospinal fluid. They are most often associated with breast and lung cancer.
What are the symptoms of metastatic adenocarcinoma?
Symptoms of metastatic adenocarcinoma may include (e.g., lung cancer cough) or general symptoms, including:
Current research is looking at the factors that may initiate the metastasizing process, how tumors manage to avoid the immune system initially and after metastasis to new sites, and where normal cells around tumors (tumor microenvironments) play a role in establishing new sites to grow.
How to diagnose metastatic adenocarcinoma
The diagnostic process for metastatic adenocarcinoma may vary depending on the type of primary cancer.
A careful understanding of the history of symptoms, past medical conditions, and family history of any disease is a critical first step in diagnosing these cancers. It is especially important to note any past cancer history.
Lab and testing
If metastatic adenocarcinoma is suspected, a number of laboratory tests are usually done. This includes (CBC) and . If there is liver metastases, elevated levels may be seen. Serum calcium is important because elevated calcium levels can be caused by different causes, and if it is very high, treatment should be carried out.
Tests may include tests that can include tests based on cancer type, such as cancer antigens 15-3 for prostate cancer or for breast cancer ( ).
Other tests, including histochemistry and molecular analysis (e.g., next-generation sequencing), may be performed depending on the primary tumor type.
Imaging studies
Imaging studies are often required in the diagnosis and staging of metastatic adenocarcinoma. Scans may include:
biopsy
Biopsy (taking a sample for examination in the laboratory) is important both to confirm the diagnosis and to perform further testing of cancer cells. The type of biopsy depends on the primary tumor (if known) and the location of the metastase.
Biopsies of the metastatic area may also be performed to confirm that it is associated with a primary tumor and not with a second primary cancer. For example, one study looked at breast cancer patients with lung nodules. 64% of new nodules are associated with the spread of primary breast cancer. But in 26 percent of study participants, nodules were an unrelated new primary lung cancer.
It may also be recommended that some people have fluids, a blood test that looks for tumor DNA circulating in the bloodstream, and usually detects DNA in metastatic adenocarcinoma.
Every cancer is different
Another reason to evaluate tissue at the site of metastasis is that cancer cells are constantly evolving and producing new mutations.
Take breast cancer, for example. In some cases, the initial breast tumor is estrogen receptor positive, but metastasis to the lungs may be estrogen receptor negative (and vice versa). This is known as inconsistencies and may affect how the cancer is treated after metastasis.
How to treat metastatic adenocarcinoma
The goal of treating metastatic adenocarcinoma is different from that of early tumors. For early tumors, the goal, if possible, is to cure the cancer. For this reason, aggressive treatments are often used to try to eradicate tumors and any lingering cancer cells.
For metastatic adenocarcinoma, the goal is to control the cancer with as little treatment as possible to minimize side effects and maximize quality of life. More aggressive treatments usually do not prolong survival, but increase side effects.
There are exceptions to this general rule. For example, if a new therapy is expected to be approved in the near future, a more aggressive therapy can be used to try to reach this point.
There are three main approaches to cancer treatment, including topical, systemic, and palliative care.
Topical treatment
Topical treatment aims to eliminate the tumor of its origin. This includes surgery, radiation therapy, and (e.g., treatment to cut off the tumor's blood supply).
While topical therapy is most commonly used to treat early-stage cancer, surgery or radiation therapy can be used to reduce tumor size and control symptoms.
A relatively new method, which can improve survival in some cases, is to treat isolated or oligostasis areas (cancer cells that have moved and formed a new tumor). For example, isolated (or a small) brain metastases caused by lung or breast cancer are sometimes passed through surgery or special forms of radiation therapy (or network knives).
Systemic treatment
Systemic therapy is used to treat cancer cells, no matter where they are in the body. These include:
· Chemotherapy: Chemotherapy uses cytotoxic (cell killer) drugs to remove tumor cells. It is most often administered intravenously, but some drugs can be taken orally. Because different chemotherapy drugs can interfere with cancer cells at different stages of the cell cycle, combinations of drugs are often used to remove as many cells as possible.
· Targeted therapy: Targeted therapy is a drug that targets a specific pathway involved in cancer growth. Because these drugs are more "cancer-specific," they tend to have fewer side effects than chemotherapy and have been shown to significantly improve survival in certain cases of metastatic adenocarcinoma. For example, the past life expectancy of stage 4 lung adenocarcinoma was only about one year. Now, a 2019 study found that the median survival was as recent as 6.8 years for some tumors with specific genomic alterations (ALK positive) and appropriate treatment (and response to) targeted therapy. 15
· Hormone therapy: For breast cancer, about 70% of tumors are estrogen receptor-positive, meaning that estrogen acts as a fuel for cancer by binding to these receptors. Hormonal therapies such as Nolvadex (tamoxifen) and, more recently, aromatase inhibitors reduce the risk of recurrence and prolong survival in patients with metastatic breast cancer. Hormone therapy is also used for prostate cancer.
· Immunotherapy: Immunotherapy is a therapy that uses the immune system or principles of the immune system to treat cancer. This category includes a wide range of treatments, from checkpoint inhibitors to CAR T-cell therapies to cancer vaccines and more. Checkpoint inhibitors have had a remarkable effect on cancers that are difficult to treat, such as metastatic lung adenocarcinoma, and some people use these drugs to achieve a "lasting response." Unfortunately, these drugs are not suitable for everyone.
· Clinical trials and new therapies: In addition to these therapies, many clinical trials are underway, looking at new drugs in these categories as well as drugs such as radiopharmaceuticals (drugs that inject, migrate to cancer areas and release micro doses of radiation).
Palliative care
It is the third category, used to control the symptoms of cancer and cancer treatment, but is not intended to address the cancer itself.
Topical therapies can be used to control the symptoms of cancer. Many cancer centers now offer palliative care counseling with a team dedicated to maintaining a person's quality of life through a variety of treatments, from pain control to mental support.
Prognosis and response: coexistence with cancer
While metastatic adenocarcinoma may not be curable, it is treatable, and treatment can often extend a patient's life expectancy and reduce cancer symptoms.
With the rapid improvement of treatment, it is difficult for anyone to grasp all the research. For this reason, obtaining a second opinion is often considered a standard of care. Many people choose a second opinion at one of the larger National Cancer Institute-designated cancer centers. Fortunately, many of these centers now offer remote counseling, so people don't need to travel unless they determine the treatment is right for them.
If you or someone you love has been diagnosed with metastatic adenocarcinoma or an early-stage cancer that has recurred in a distant place, dealing with an incurable disease can be challenging. The importance of having a support system in place during this period cannot be overemphasized.
While family and friends can be a great source, the opportunity to talk to others facing a similar journey is priceless. Many online communities are now available for advanced adenocarcinoma, or your healthcare team may refer you to a local face-to-face support group.
The economic toxicity of cancer is also very real for many people. Talking to a social worker at a cancer center may help you find financial support resources that would otherwise be overlooked.
wraparound
Metastatic adenocarcinoma is a type of cancer that originates in glandular cells (cells that secrete mucus) such as milk ducts, digestive tract, or lungs, and has spread or metastasized beyond the tissues on which it began. Adenocarcinomas can spread at any stage of the disease, or they can be dormant for a long time and then recur at a distance.
Symptoms may include general fatigue, unexplained weight loss, or general malaise, or symptoms may appear depending on where the cancer has spread. For example, if the cancer has spread to the bone, it can cause bone pain, or even minor injuries can increase the risk of fractures.
If metastatic adenocarcinoma is suspected, your healthcare provider will diagnose and stage it using blood tests, imaging studies, and biopsies (tumor tissue samples). While most metastatic adenocarcinomas are considered incurable, there are treatment options that can prolong survival and improve quality of life. Treatment options may include chemotherapy, immunotherapy, hormone therapy, and targeted therapy, depending on the type of adenocarcinoma you are dealing with.
summary
If you or someone you love has been diagnosed with metastatic adenocarcinoma, you may feel anxious and overwhelmed. Many people associate the term "metastatic" or "stage 4" cancers to terminal prognosis, but while these cancers are often incurable, some can be controlled over a long period of time.
Perhaps the best advice is to politely refuse to listen when friends and family share stories of others experiencing your illness. Every tumor and everyone is different, and even two years ago someone's treatment style may have little to say about the treatment options you'll get today.
Staying positive (while making sure to express your feelings) can help you face decisions more energetically. Be with someone who elevates you. When you hear those horror stories, try saying, "I'm going to have a different outcome myself." I hope you can support me in doing so. ”
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