METASTATIC TUMORS

METASTATIC TUMORS IN INDIA

Metastatic brain tumors occur more frequently than primary brain tumors and occur in approximately 25% of patients who die of cancer each year. The main treatment goals for patients with brain metastases are the relief of neurological symptoms and long-term control of the tumors. Glucocorticoids and external beam whole brain radiation therapy (WBRT) comprise the current standard of care and increase median survival from one month to three to six months. Patients with three or less tumors (greater than 70% of patients) also commonly undergo surgery or stereotactic radiosurgery (SRS) with the goal of lengthening survival.

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Two prospective randomized trials have shown a significant survival benefit for patients undergoing surgical resection of single tumors in combination with WBRT compared to patients receiving WBRT alone.

Although there have been no prospective randomized studies comparing SRS and WBRT to WBRT alone, there have been numerous large retrospective series reporting a significant survival benefit from SRS. To date, a prospective randomized trial comparing surgery to SRS has not been reported. Despite the lack of rigorous data, there are proponents for each of these treatment modalities. Those in favor of surgery cite the ability to achieve a complete resection in most cases, the almost immediate relief of symptoms, and the low rate of local recurrence. Those in favor of SRS cite an equivalent degree of local tumor control compared to surgery, the relative ease of the one day outpatient procedure, and the ability to treat lesions in deeper brain structures .

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Metastatic disease can be viewed as two simultaneously occurring diseases. Brain cancer and systemic cancer (elsewhere in the body). Each disease has quite different mortality rates. Untreated brain metastases are rapidly fatal, while systemic cancer may not be. Metastatic brain disease is a focal disease and focal control of the tumor is paramount to patient survival. The approach in the past has been to treat metastatic brain disease as a whole brain disease, with whole brain radiation (WBR). Because of poor local control of tumor growth when treated solely by WBR, brain metastases in the past were rapidly lethal. Therefore patients with brain metastases did not benefit from many advances in cancer therapy (immuno therapy, chemo therapy, conformal radiotherapy etc.) because these therapies do no effectively reach brain metastases and individuals died quickly from neurological progression.

Metastatic liver cancer most commonly originates in the lungs, breasts, large intestine, pancreas, or stomach. Leukemia (a cancer of white blood cells) and lymphoma (a cancer of the lymph system), especially Hodgkin’s disease, may involve the liver. Cancers spread to the liver because the liver filters most of the blood from the rest of the body, and when cancer cells break away from a primary cancer, they often enter and travel through the bloodstream. Sometimes the discovery of metastatic liver cancer is the first indication that a person has cancer.

metastatic breast cancer is considered to be incurable, and the goals of treatment are the prolongation of life and the palliation or prevention of symptoms. Within this context, it is not surprising that local therapy is not routinely recommended for patients presenting with stage IV disease and intact primary tumors. Surgery is reserved for patients who develop complications such as bleeding, ulceration, and infection at the primary tumor site, a type of surgery that historically has been described as “toilette” mastectomy. In this issue of the Journal of Clinical Oncology, Rapiti et al1 present the results of a retrospective, population-based study of the impact of surgical therapy of the primary tumor on survival outcomes in 300 women with metastatic disease at the time of the initial diagnosis of breast cancer. The authors observed that women having surgery of the primary tumor had a 50% reduction in breast cancer mortality compared with women who did not undergo surgery, the survival benefit was limited to women with tumor-free margins of resection, and a significant survival benefit for axillary surgery was not observed.

Symptoms of Metastatic Brain Tumors Headache in India

Headache is caused by stretching of sensitive structures such as blood vessels or nerves due to edema, spinal fluid obstruction or tumor growth, or by injury to the brain caused by the tumor. Initially, the headache comes and goes, and is usually more common in the morning, just after awakening. It gradually increases in duration and frequency.

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