Metastatic cancer: 4 treatment options that patients can consider

By Dr Tejinder Kataria

Actress Sonali Bendre has been recently diagnosed with metastatic cancer, and is undergoing treatment in New York.

Metastatic cancer is an advanced type of cancer, caused by uncontrolled cells which further breach the basement membrane of the affected organ and spread to other organs such as the lung, bone, liver or brain through the lymph nodes or the blood vessels. Out of the various types of cancers, high-grade cancer is considered as the most aggressive because it spreads rapidly.


ALSO READ: Metastatic cancer - everything you need to know about the disease Sonali Bendre is fighting

According to National Cancer Institute, in this deadly disease, cancer cells break away from its primary location (where the cancer originated) and travel through the lymph nodes and blood stream to form new tumours (metastatic tumours) in other parts of the body.

Signs And Symptoms
Metastatic cancer cannot be easily self-diagnosed. However, there are certain signs and symptoms that can help recognise the disease.The symptoms depend on the size and location of the metastatic tumour.

One can identify cancer reaching the bone when the patient has difficulty in walking, and experiences excessive pain or sudden fractures. When cancer reaches the brain, one starts experiencing headaches, dizziness, seizures or even visual problems. One can know the lung is affected when the patient experiences shortness of breath. In case of liver,random swelling in the belly or diseases like jaundice are common symptoms.


Treatments
The treatment for metastatic cancer is often different from the ones used for a normal tumour. Metastatic cancer is difficult to control once it spreads and treatment depends on the original site of cancer based on how much it has spread, the patient's age and his/her medical history. In certain metastatic cancers, with radiation and immunotherapy, long term survival is possible.

Four types of treatment can be offered to metastatic cancer patients:

Radiation
Radiation can shrink and help control specific spots where the cancer has spread. This helps in decreasing pain, lowering the risk of broken bones in areas that may be weakened from cancer, decrease bleeding, improving breathing by opening up blocked airways, and taking pressure off a pinched nerve that might be causing pain or weakness. The radiation dose and schedule for metastases depends on a number of factors - urgency of the situation, frequency of radiation and schedule off other ongoing treatments (if any). Radiation is an important modality to control and sometimes cure brain metastases as it can disrupt the blood-brain barrier to facilitate drugs to penetrate the brain tumours.

Surgery
Surgery is generally conducted among patients suffering from spinal cord compression caused by metastatic cancer. Patients with metastatic epidural spinal cord compression can be treated with direct decompressive surgery alongside post-operative radiotherapy. This procedure will help retain and regain the patient's ability to walk longer as compared to patients treated with radiotherapy alone.


Chemotherapy
The primary benefit of chemotherapy is response time and works very well for metastatic breast cancer. Chemotherapy shrinkstumours faster than hormone therapy. With hormone therapies, if the first chemotherapy drug stops working and the cancer begins to grow again, a second or third drug can be used.
In chemotherapy, the use of each type of drug for metastatic breast cancer is called a 'line' of treatment. For example, the first chemotherapy used is called the 'first-line' treatment and the second is called the 'second-line' treatment.

Immunotherapy
After decades of research on solid tumour immunology, immunotherapy has shown effectiveness in patients with metastatic solid cancers. The most effective form of immunotherapy, capable of eradicating large tumour burdens in melanoma patients, is the adoptive cell transfer (ACT) of Tumor-Infiltrating Lymphocytes (TIL) given to patients after lymphodepletion.
With this approach, tumour regression is now being reported for cancers other than melanoma. However, success remains constrained by the identification of antigens expressed with high specificity by cancer cells and not by normal tissues.

(The author is Chairperson, Radiation Oncology, Cancer Institute, Medanta, Gurgaon)

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