Internal Medicine

Metastases in colon cancer

introduction

Metastases can occur in the context of colon cancer. Around a third of patients already have metastases in other organs when they are first diagnosed with colon cancer. The metastases can occur in various other organs. These metastases are most common in the liver and the second most common in the lungs (around 15% of metastases). Furthermore, in rarer cases, metastases can occur in the brain or in the bones (in the bone marrow). If this is the case, there are often metastases in other organs.

What is the life expectancy with metastases

In cancer, metastases generally indicate an advanced stage of the disease. Metastases mean that cancer cells detach themselves from the original site of the degeneration and spread to other organs in the body either via the lymph vessels or via the blood vessels.

In the other organs, the cells multiply unchecked and lead to masses there. Since metastases limit the functionality of other organs and weaken the body in addition to the primary tumor, life expectancy with metastases is drastically reduced in contrast to early cancer stages.

In colorectal cancer, metastases in distant organs mean that less than 10% of those affected are still alive 5 years after the diagnosis, provided that no therapy is initiated.

However, if the cancer is diagnosed in stages in which there are no metastases, the probability of being alive after 5 years is considerably higher and can be up to 90%.

Read more on the topic: Life expectancy in colon cancer

Formation of metastases

The spread and formation of metastases occurs in different ways. First, colon cancer can spread through the lymphatic system. Depending on the location of the colon cancer, this is then along the large abdominal artery (aorta), in the lymph nodes and vessels of the pelvic wall or the groin area.

If the colon cancer has progressed so far that it has broken into the blood vessel system, colon cancer cells can also be spread in this way. The blood outflow of the colon (Colon) first goes to the liver via the portal vein. For this reason, metastases are the quickest and most likely to be found here. Only after the blood has passed the liver does it flow back towards the heart and then the lungs, which is the second most common metastasis.

If the colon cancer is in the rectum, the blood does not flow through the liver but directly back to the heart and lungs. In this way, cancer cells can reach the lungs directly without going through the liver and form metastases here.

If the colon cancer breaks through into the abdominal cavity, the cancer cells can also spread directly here and form metastases. These then lie in the abdominal cavity and infiltrate the abdominal wall from the inside or other organs that are also located in the abdominal cavity.

Depending on the location of the metastases, these are divided into three groups. A distinction is made between local metastases (close to the place of origin of the colon cancer), regional metastases (in the lymph nodes close to the original tumor) and distant metastases (in distant organs such as the liver and lungs via the bloodstream).

Symptoms

Depending on the location of the metastases, different symptoms can occur.

With liver metastases, the symptoms are very unspecific. Often the symptoms only appear later in the disease. There may be general weakness with loss of appetite and weight loss. In general, the liver metastases are not yet painful. Depending on the location of the metastases in the liver, the skin may turn yellow (Jaundice = Jaundice), as the bile pigment is then no longer properly broken down in the liver.

In the case of lung metastases, there are hardly any clear symptoms. Lung metastases are more likely to be discovered by chance during X-ray examinations. Often the metastases are more in the edge area (Periphery) of the lungs. Occasionally they can cause symptoms such as coughing attacks or pneumonia. Coughing up blood can also occur in the context of lung metastases, but this does not necessarily have to be the case.

Symptoms of brain metastases only appear at a very advanced stage. Symptoms only become apparent in these advanced stages or when the metastases are in central areas of the brain. Often unspecific symptoms initially appear, which are triggered by the increased intracranial pressure. This can lead to headaches, nausea and supposed circulatory problems with dizziness. The headache usually lasts for a long time and does not respond well to pain medication. In general, however, these intracranial pressure signs are very unspecific and do not necessarily indicate brain metastases!

In advanced cases, brain metastases can also lead to epileptic seizures, sudden paralysis or speech disorders. Since metastases in the brain are generally rare in colon cancer, these advanced symptoms are also rather rare.

Bone metastases do not really give clear symptoms either. Warning signals would be, for example, pain in the back, arms or legs, or broken bones that have no clear explanation. Depending on the location and extent of the metastases, i.e. if they press on nerves, for example, sensory disturbances such as tingling or numbness can occur. If the metastases are in the vertebral bodies of the spine, paralysis or disorders of the bowel and bladder function can occur.

As with brain metastases, it also applies to bone metastases that these occur rarely in colon cancer and when they occur in very late stages of the disease!

Read more on the topic: Colon cancer symptoms

Metastases in the lymph nodes

The intestine is connected to a dense network of lymphatic vessels, which are used to transport the fluid that cannot be removed through the veins. In the gastrointestinal tract there are still protein-fat complexes in the lymph. So fats ingested with food are absorbed into the body via the lymph.

In the course of the lymph vessels there are lymph nodes that filter the lymph and serve to ward off disease. Degenerate cells, i.e. cancer cells, tend to break out of the cell structure. Individual cells can thus be transported away through the lymphatic vessels. However, they often get stuck in the first lymph nodes, as these act like a kind of filter.

Since the cancer cells do not die and can multiply very quickly, they nestle in the lymph nodes and multiply. The lymph nodes become larger and firm. When removing colon cancer, a large number of lymph nodes must always be removed to ensure that there are no cancer cells in them. Only when this is the case can one speak of a complete distance.

Read more on the topic:

Lymph Gland Cancer - Everything You Need To Know!
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Metastases in the spine / bone

Metastases in the bones occur relatively late. However, colon cancer patients survive longer and longer due to the better treatment and so it happens that with an increasing number of colon cancer patients, bone metastases also develop.

The metastases are problematic because they weaken the bone structure and fractures occur more frequently, which further restrict the quality of life. If metastases occur in the skeleton, life expectancy is shortened compared to colon cancer without bone metastases.

Treatment of bone metastases can be attempted with chemotherapy.

Read more on the topic:

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Lung metastases

With 15%, lung metastases are the second most common metastases in colon cancer after liver metastases. The method of choice in the treatment of lung metatastes is surgical removal.

Surgical removal makes sense if the colon cancer can also be removed. In addition, the metastases in the lungs must be accessible for an operation. In the meantime, other methods, such as a laser, can also be used to remove metastases that are difficult to reach without damaging the surrounding tissue too much.

Another option for non-operable lung metastases is chemotherapy.

Read more on the topic: MRI of the lungs

Liver metastases

Liver metastases are the most common form of metastasis in colon cancer.

The cause of the frequency of liver metastases is in the blood outflow of the intestine. The blood from the intestine is passed through the portal vein into the liver, so that food components ingested here can be processed and pollutants can be processed. This direct connection between the intestine and liver allows cancer cells to enter the liver relatively easily and unhindered and to implant there.

This can only be a single metastasis or a widespread metastasis that affects the entire liver. The liver function may be normal for a long time. The blood values, which provide information about the function of the liver, can also remain normal for a long time.

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Liver metastases can be easily visualized using ultrasound or computed tomography.In the case of isolated metastases, treatment of the metastases consists of surgical removal. The prerequisite for an operation is that there is still enough liver tissue after the operation to maintain its function.

Read more on the topic: Liver resection

Other methods consist of thermal or chemical destruction of the metastases. The appropriate treatment in each case depends on the distribution and spread of the metastases. By removing the metastases, provided that the colon cancer is always removed, a complete cure can be achieved.

In some cases, however, the metastases reappear.

Read more on the topic: Liver cancer therapy

Metastases in the peritoneum

A colonization of the peritoneum with cancer cells, too Peritoneal carcinosis called, is a dreaded complication of colon cancer. Peritoneal carcinosis arises from a local spread of cancer cells; it usually shows up in a very advanced cancer disease.

Read more on the topic:

Peritoneal cancer
Water in the stomach

The symptoms can be very unspecific at the beginning and constipation or urinary retention can only occur at an advanced stage. The Peritoneal carcinosis is dreaded because the treatment methods are very limited. An operation is usually not possible because invisible cancer cells can develop new foci.

In the past, patients with peritoneal carcinosis were only treated symptomatically, as conventional chemotherapy methods are ineffective due to the poor blood circulation in the peritoneum.

Read more on the topic: Palliative therapy

Recently, a measure has been introduced that is supposed to help contain peritoneal carcinosis and, in the best case, even cause a cure. For this purpose, a chemotherapy solution heated to approx. 41 ° Celsius is introduced into the abdomen. The high temperature increases the blood flow to the peritoneum and enables the chemotherapy to penetrate better.

Metastases in the head

Metastases to the head are not particularly common in colon cancer. However, brain metastases are particularly dangerous because they cause the brain tissue to be displaced and thus lead to neurological failures.

Most brain metastases occur in patients who have already had a long history of disease and who have metastases in several organs. Some of the metastases can be removed surgically, if this is not possible, radiation therapy can be considered.

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diagnosis

If colon cancer has been diagnosed, it is also important to clarify whether, and if so, where and how far the cancer has spread in the body. Various examinations are available for this.

First of all, an ultrasound examination, particularly of the liver, can be carried out. The vessels and the structure of the liver are assessed and examined for changes. Lymph nodes in the abdomen can also be examined and assessed using ultrasound.

X-rays can also be taken. In particular, a chest image is taken, i.e. an image of the chest. During this, special attention is paid to the lungs and any changes. If the findings are unclear or questionable, computed tomography (CT) be made. Cross-sectional images of the body and thus of the organs are made, which allow a reliable assessment. The brain and bones can also be assessed with a CT scan.

Magnetic resonance tomography (MRI) can also be performed for the diagnosis of metastases.

In addition, and depending on the location of the metastases, tumor markers in the blood can also be determined. These include, for example, certain liver values. Further colonoscopy can also be performed to look for scattering in the intestine.

Read more on the topic: Detect colon cancer

therapy

The choice of form of therapy depends on the location and extent of the metastases, as well as the presence or treatment of colon cancer.

In general, surgical therapy is possible for lung metastases; the same applies to metastases in the liver. Here an attempt is made to remove the metastases with the help of resection of liver segments. For example, if there are only a few metastases in the liver and if the colon cancer can also be completely operated on, the prognosis is quite good.

The operation of lung and liver metastases depends on how much functional tissue would remain after the operation and that no metastases are already present in other organs. The underlying colon cancer should also be treated and the corresponding metastases in the lungs or liver should be easily accessible for an operation.

If an operation is no longer possible due to the spread of the metastases, chemotherapy can alleviate the symptoms and thus improve the quality of life. It can also lengthen life a little; one speaks here of a palliative therapy.

In the case of bone metastases, you can also choose between different forms of therapy. Radiation therapy, drug therapy or surgical options are available here. The choice of therapy depends on the extent of the metastases and the general health of the patient.

In the case of brain metastases, general symptom relief and the maintenance of quality of life are just as important as the actual treatment of the metastases. The therapy is mainly about the treatment of brain edema and the prevention of seizures. On the one hand, corticosteroids come into question (decongestant effect) and osmodiuretics (dehydrating effect). Against seizures in the context of brain metastases, the same drugs are used as in epilepsy (anticonvulsants).

Read more on the topic:

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Radiation therapy for colon cancer

forecast

In general, the prognosis for metastatic colon cancer (stage IV colon cancer) is rather poor. A complete cure is the exception.

However, therapy has evolved in recent years and there are advances in the quality of life of patients with metastatic colorectal cancer.

It is important that colon cancer is detected and treated early, preferably before the development of metastases. Like colon cancer, metastases can also be better treated and cured in their early stages, i.e. when they are even smaller and not quite as widespread.

You might also be interested in the following article: Life expectancy in colon cancer at different stages.

Can metastasis cure?

Although metastases in colon cancer indicate an advanced stage, an experienced doctor can cure colon cancer that has metastasized.

The chances of recovery depend heavily on the organ in which the metastases are located and how badly it is affected.

If the primary tumor and all metastases can be removed, the patient is considered cured. Intensive follow-up care is necessary, however, in order not to miss any newly developed metastases.

In some cases complete cure is not possible, this is the case when the metastases cannot be completely removed by the available methods. In the case of inoperable metastases, chemotherapy is used to improve quality of life. Chemotherapy can also provide good control of the cancer and, under certain circumstances, metastases can be reduced in size so that an operation is possible.

Read more on the subject at: Is Colon Cancer Curable?

What does the end stage look like?

It is difficult to determine what the end-stage looks like in metastatic colorectal cancer as symptoms always depend on the organs affected.

Cancer diseases generally lead to a weakening of the organism, since the metabolism of the cancer cells consumes energy unchecked. This weakening also makes the body more susceptible to infections, which make the physical condition even worse.

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Pain is a dreaded complication of the final stage, but nowadays nobody in Germany has to suffer from pain anymore. In cancer patients in particular, freedom from pain is sought, even if high doses of opiates have to be administered for this.

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