Metastasis and Local Invasion: When Cancer Spreads

Metastasis and Local Invasion: Two Different Ways for Cancer to Spread

Cancer spreads in two ways: metastasis and local invasion. Let’s look at metastasis first.

Metastasis: When Cancer Spreads to Distant Body Parts

Metastasis is when cells from an already established tumor break free and move, typically via the bloodstream or lymphatic system, to another part of the body, where they grow and divide, creating additional tumors.¹

Metastasis is often referred to as the “spread” of cancer. Metastasis usually means the cancer is more aggressive.¹

Some of the most common sites of metastasis in dogs are the bone, lymph nodes, spleen, and lung tissues.²

Doesn’t the Immune System Stop Metastasis?

The immune system is your dog’s main defense against metastasis, and for the most part, it does just that.³

• Cancerous cells will inevitably break away from their tumor and enter your dog’s bloodstream or lymph nodes.³
• The immune system is typically well-equipped to catch these stragglers and eliminate them.³
• For those cells that do manage to by-pass the immune system, most of them will die due environmental factors in the part of the body they find themselves.³
• On average, only about 0.2% of cancer cells break away and successfully establish tumors in other parts of the body.³

Those new tumors in other parts of the body are cancer metastasis.

Metastasis Involves Multiple Processes

Researchers once thought that metastasis happened step-wise, proceeding one process at a time. However, scientists are now learning that metastasis is more complex with multiple overlapping processes.¹

Three steps can overlap in metastasis:

Invasion

Invasion is when changes in the ability of the tumor cell to adhere to other cells allow it to either “ratchet” forward or rapidly move along a path of least resistance.⁴ This may be triggered by environmental factors such as pH, low levels of oxygen, or other chemical signals in the body.^4,5

Bloodstream Survival

Survival in the bloodstream is the next hurdle a cancer cell must face. The bloodstream is an unfriendly place for cancer cells. It’s full of immune cells, moves rapidly, and has few places where cancer cells can attach.

Regardless, it only takes one cell to be successful. Research suggests that some cancer cells contain signal receptors that make them more likely to survive in the bloodstream.⁴

Metastasis is less common than you might think: only about 0.2% of cancer cells break away and successfully establish tumors in other parts of the body.

Establishing a Tumor

The final step is metastatic colonization, which doesn’t happen as often as you might presume. Just because a cell has survived the bloodstream and established itself doesn’t mean it will become a tumor.

In a study on melanoma, only one in 100 cancer cells were able to persist longer than ten days.⁴

This is because of the role that environmental conditions and “assistant” proteins play. If the conditions aren’t right, or if certain proteins aren’t available, colonization won’t happen.

For example, a cancer cell needs to establish new blood vessels, a process called angiogenesis. This provides the tumor oxygen and nutrients it needs for growth.⁴ However, angiogenesis is dependent on several key players, such as a protein called VEGF.⁴

Tricky Dormant Cancer Cells: a Cause for Concern?

Some cells attach to tissue and survive but do not proliferate (multiply). These are called “dormant” cells.⁴

They remain viable but are quiet and inactive. Not only do scientists not understand what reactivates dormant cells, but they also don’t know much about how to kill them before they reactivate.⁴

Only one in 100 cancer cells were able to persist longer than ten days.

Local Invasion: When Cancer Spreads to Tissues Right Next to the Tumor

In addition to metastasis, cancerous tumors can infiltrate via “local spread” or “local invasion.”

In this case, tumors grow in place, spreading out. Some grow so big they impact other tissues, structures, or organs.⁶ For example, a tumor in the nasal cavity might invade the eye socket or the skull.

Local Invasion and Metastasis Can Happen at the Same Time

A single type of cancer can grow through local invasion, metastasis, or both. For instance, an ovarian tumor can grow so large that it invades and spreads to the pelvic wall, kidneys, and abdominal organs while it also releases cells into the bloodstream that metastasize to the brain.

Once metastasis occurs, the prognosis worsens. A single tumor might be removed, but many in a single location are more difficult to address. More tumors in more locations is even worse, means a more aggressive cancer and more expensive and challenging treatments.

Using the example above, the ovaries, pelvic wall, and brain, would all have ovarian tumor cells present, but it would still be the ovarian cancer cells. That’s why treatment would likely focus on the original type of cancer diagnosed while also attempting to alleviate symptoms in the brain.^7,8

How Veterinarians Find Metastasis and Local Invasion

Most of the tests and images that veterinarians run when they stage cancer are looking for evidence of metastasis and local invasion.

Staging your dog’s tumor helps you and your veterinarian understand what you are up against and helps your veterinarian or oncologist make treatment plans.

The tests needed will vary depending upon the tumor type and location, but some of these tests could include:

• Blood work can reveal a great deal about your dog’s general health, including white and red blood cell count and kidney and liver function.
• Imaging techniques such as ultrasound, x-ray, MRI, or CT scan could reveal where the tumors are and how big they are.
• A biopsy is a small surgery to get a tumor sample to send out to a pathologist.
• If they weren’t already, local lymph nodes may be sampled to look for metastasis.

Why So Many Tests, Doc?

One of the reasons veterinarians want to run so many staging tests is because they are looking for both metastasis and local invasion, and each blood test, imaging test, or biopsy test might reveal more clues.

For example, when a mammary gland tumor grows, that is a local invasion. By comparing measurements from previous appointments, your veterinarian can determine whether the tumor is spreading.

But mammary cancer can also spread to other locations in the body. So, your veterinarian may want to run other tests that look for tumors elsewhere in the body to detect whether the breast tumor has metastasized (spread to distant non-breast locations). For example, breast cancer can metastasize to the liver, so your veterinarian might look for a liver mass. If one is found, you now know mammary cancer cells migrated from the primary tumor and are now creating a mammry gland tumor in the liver.

Choose staging tests based on whether you need that information.

You don’t have to do every staging test, of course. The value of the information gained has to be balanced against the cost.

• If you know you will not do chemotherapy, which treats metastasis in many cancer types, you might not need to look for metastasis.
• If you know surgery is out of the question, you might not need to get detailed images.

“Metastasis of Unknown Origin”

Occasionally, veterinarians cannot determine where the original tumor is for the cancer cells tested. This is called “metastasis of unknown origin” (MUO) or “metastatic cancer of unknown primary” (MCUP).^2,9

Unfortunately, either of these designations generally entails a poor prognosis.^2,9

Is My Dog Dying If They Have Metastasis and Local Invasion?

Many dog lovers worry when their veterinarians find evidence of local invasion and/or metastasis. They worry that their dog is very close to death.

Cancers that have grown and spread are indeed harder to treat. It’s also true that they have a generally worse prognosis.

It’s not true, however, that cancer is likely to kill your dog immediately, right away, or even soon. In most cases, especially when you catch it early, there is time to think about your options, read and learn, and make good decisions.

You have time to read, think, and make good decisions.

Every case is different, and different cancers have different treatments and protocols, but in every case, there are ways to increase your dog’s quality of life for however much time they have left with you.

If your veterinarian thinks your dog is very close to natural death, especially if they think she is suffering and can’t relieve the pain or discomfort, they will tell you. Hospice, and perhaps eventually euthanasia, may be appropriate.