Other namesMetastatic disease
Illustration showing hematogenous metastasis

Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body;[1] the term is typically used when referring to metastasis by a cancerous tumor.[2] The newly pathological sites, then, are metastases (mets).[3][4] It is generally distinguished from cancer invasion, which is the direct extension and penetration by cancer cells into neighboring tissues.[5]

Cancer occurs after cells are genetically altered to proliferate rapidly and indefinitely. This uncontrolled proliferation by mitosis produces a primary heterogeneic tumour. The cells which constitute the tumor eventually undergo metaplasia, followed by dysplasia then anaplasia, resulting in a malignant phenotype. This malignancy allows for invasion into the circulation, followed by invasion to a second site for tumorigenesis.

Some cancer cells known as circulating tumor cells acquire the ability to penetrate the walls of lymphatic or blood vessels, after which they are able to circulate through the bloodstream to other sites and tissues in the body.[6] This process is known (respectively) as lymphatic or hematogenous spread. After the tumor cells come to rest at another site, they re-penetrate the vessel or walls and continue to multiply, eventually forming another clinically detectable tumor.[citation needed] This new tumor is known as a metastatic (or secondary) tumor. Metastasis is one of the hallmarks of cancer, distinguishing it from benign tumors.[7] Most cancers can metastasize, although in varying degrees. Basal cell carcinoma for example rarely metastasizes.[7]

When tumor cells metastasize, the new tumor is called a secondary or metastatic tumor, and its cells are similar to those in the original or primary tumor.[8] This means that if breast cancer metastasizes to the lungs, the secondary tumor is made up of abnormal breast cells, not of abnormal lung cells. The tumor in the lung is then called metastatic breast cancer, not lung cancer. Metastasis is a key element in cancer staging systems such as the TNM staging system, where it represents the "M". In overall stage grouping, metastasis places a cancer in Stage IV. The possibilities of curative treatment are greatly reduced, or often entirely removed when a cancer has metastasized.

  1. ^ "Metastasis", Merriam–Webster online, accessed 20 Aug 2017.
  2. ^ "What is Metastasis?". Cancer.Net. 2 February 2016.
  3. ^ Klein CA (September 2008). "Cancer. The metastasis cascade". Science. 321 (5897): 1785–7. doi:10.1126/science.1164853. PMID 18818347. S2CID 206515808.
  4. ^ Chiang AC, Massagué J (December 2008). "Molecular basis of metastasis". The New England Journal of Medicine. 359 (26): 2814–23. doi:10.1056/NEJMra0805239. PMC 4189180. PMID 19109576.
  5. ^ "Invasion and metastasis". Cancer Australia. 2014-12-16. Retrieved 2018-10-26.
  6. ^ Maheswaran S, Haber DA (February 2010). "Circulating tumor cells: a window into cancer biology and metastasis". Current Opinion in Genetics & Development. 20 (1): 96–9. doi:10.1016/j.gde.2009.12.002. PMC 2846729. PMID 20071161.
  7. ^ a b Kumar V, Abbas AK, Fausto N, Robbins SL, Cotran RS (2005). Robbins and Cotran pathologic basis of disease (7th ed.). Philadelphia: Elsevier Saunders. ISBN 978-0-7216-0187-8.
  8. ^ "O que é a metástase?" (in Brazilian Portuguese). Dr. Felipe Ades MD PhD—Oncologista. 2018-07-24. Retrieved 2018-10-23.

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