Cancer Gone Wild - Learn All About Metastasis

Like the seeds of a dandelion drift on the wind and land other places, cancer can spread under the right conditions. How does cancer spread and why does it happen? We tackle these questions in this episode in our series “Everything you always wanted to know about cancer, but didn’t have anyone to ask.” https://bit.ly/440dQKo

In This Episode:

• 3:44 - Road Trip: Missouri and Recipe for Gooey Butter Cake
• 5:22 - What is Your Life's Resume? A Short Guide to a Happy Life
• 8:10 - What Makes Cancer Spread? (Metastasize)
• 11:33 - Why Does Metastasis Happen?
• 13:58 - Where Does Cancer Tend to Spread To?
• 16:02 - Discussion About Metastatic Cancer
• 17:42 - Discussion - How Do You Find Cancer?
• 23:26 - What's Left of Me: Poems of a Dead Soul
• 24:12 - Outro

Simply put, metastasis is when the cancer moves from the original organ to another part of the body. The goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well-controlled. The treatment depends on the type of primary cancer, where it has spread, previous cancer treatments, and general health.

Cancer researchers, at the most basic level, focus their energy on what makes cancer cells start in the first place and what makes it metastasize. We’ve been talking the last few weeks about the basic aspects of cancer and this week we are going to talk about cancer cells going rogue and moving through the body. This is called metastasis, or stage 4 cancer. 

#cancer #metastaticcancer #metastasis #stage4 #stageIV #stupidcancer #cancersucks #healtheducation #publichealth #everyonedies #everydayisagift #palliativecare #cancerresources #cancereducation 

Chapters

• 0:00 Intro
• 3:44 Road Trip: Missouri and Recipe for Gooey Butter Cake
• 5:22 What is Your Life’s Resume? A Short Guide to a Happy Life
• 8:10 What Makes Cancer Spread? (Metastasize)
• 11:33 Why Does Metastasis Happen?
• 13:58 Where Does Cancer Tend to Spread To?
• 16:02 Discussion About Metastatic Cancer
• 17:42 Discussion – How Do You Find Cancer?
• 23:26 What’s Left of Me: Poems of a Dead Soul
• 24:12 Outro

Transcript

Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement. I'm Marianne Matzo, I'm a nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every-person viewpoint to our podcast.

We are both here because we believe that the more you know, the better prepared you are to make difficult decisions. Also, this podcast does not provide medical nor legal advice, so please listen to the complete disclosure at the end of the recording. Welcome to this week's show.

Please relax, get yourself a milkshake or a cuppa, and thank you for spending the next hour with Charlie and me as we continue with our series titled, Everything You Always Wanted to Know About Cancer, But Didn't Have Anyone to Ask. With a conversation about how cancer can spread in the body. Like the BBC, we see our show as offering entertainment, enlightenment, and education, and divide it into three halves to address each of these goals.

Our main topic is in the second half, so feel free to fast forward to that loose lip free zone. In the first half, Charlie has our recipe of the week and an excerpt from Anna Quinlan's A Short Guide to a Happy Life. In the second half, I'm going to continue our cancer series with a discussion about how and where cancer spreads in the body.

And in the third half, Charlie has a poem from Tychus Poetry. How are you doing, Charlie? Fine. This is crazy, Marianne.

This is now the end of our fifth year. I know. So you know what that means.

Cake? Yes, and Edith too, or Edith too, you know, whichever one comes up. Whatever your proclivity is. Yes, exactly.

What's going on over there? Well, I had a traumatic morning. Oh? I let the dogs out. Woof, woof, woof, woof.

And... Okay, yes. They, the little one came in, the two big ones didn't come in. So then I saw them running by the window, so I opened the door.

And the big one that stays with us, that lives down the road, is like looking back over her shoulder at Luna. And Luna's squeaking. Now, Luna doesn't have a toy and they've eaten all the squeakers out of their toys.

I'm like, what the heck? And she comes up and she drops in front of me a baby bunny that's just squeaking in distress. Oh. It has no fur on it.

But it sounds like a squeak toy. Oh. Exactly, like a squeak toy.

And I'm like, ah! And so I say, Luna, leave it, get in the house. And before I can rescue the bunny, which is still alive, because they don't do it to kill them, they think it's a squeak toy. Right.

Apparently, or two different, no difference. I do the same thing. So go ahead.

So Snowball, the neighbor's dog, picks it up and runs like a bat out of hell up the hill. I'm like, well, there's one bunny who's not going to live to its first birthday. It was very traumatic.

And they're proud of themselves. Look what I got, Mom. Well, the name of the show is Everyone Dies, so.

I knew you were going to say that. But little baby bunnies. Am I so predictable? I don't know, Marianne, we'll skewer over an open fire.

In our first half, the Everyone Dies road trip finds us in the state where Sandy, our producer, lives, Missouri, which is also home to Budweiser, the King of Beers. Coincidence? I think not. Missouri is known as the Show Me State.

Of the time, Missouri Congressman Willard Duncan Van Diver, in an 1899 speech in Philadelphia, said, For thy eloquence neither convinces nor satisfies me. I am from Missouri. You have got to show me.

The familiar American folk song, Shenandoah, was originally sung in the early 19th century about a trader on the Missouri River who fell in love with the daughter of the Algonquin chief, Shenandoah. They are known for the St. Paul's Sandwich, which was invented in a St. Louis Chinese restaurant. It is an egg-fu young patty between two pieces of white bread with pickle, onion, mayo, lettuce, and tomato.

We thought we would spare you that recipe this week and instead have another Missouri favorite, gooey butter cake. That is not only buttery, but also gooey. Go figure.

According to legend, the first gooey butter cake came from a German baker in the 1930s who had a bit of a mix-up with how much of each ingredient to use. Dusted with powdered sugar, it is an irresistible addition to any funeral lunch. Bon appétit! And now for something completely different.

I have an excerpt from the book, A Short Guide to a Happy Life by Anna Quindlen, the best-selling novelist and columnist. In it, she reflects on what it takes to get a life, to live deeply every day and from your own unique self, rather than merely exist through your days. People don't talk about the soul very much anymore.

It's so much easier to write a resume than to craft a spirit. But a resume is cold comfort on a winter night, or when you're sad, or broke, or lonely, or when you've gotten back the chest x-ray and it doesn't look so good, or when the doctor writes prognosis. Poor.

Here's my resume. It's not what my professional bio says, proud as I am of all that. I am a good mother to three good children.

I have tried never to let my profession stand in the way of being a good parent. I no longer consider myself the center of the universe. I show up, I listen, I try to laugh.

I am a good friend to my husband. I have tried to make my marriage vows mean what they say. I show up, I listen, I try to laugh.

I am a good friend to my friends and they to me. You know, without them, I would have nothing of interest to say to anyone because I would be a cardboard cutout. But I call them on the phone and I meet them for lunch.

I show up, I listen, I try to laugh. I would be rotten or at best mediocre at my job if those other things were not true. You cannot be really first rate at your work if your work is all you are.

Please go to our webpage for this week's recipe for dewy butter cake and additional resources for this program. Everyone Dies is offered at no cost but is not free to produce. Can we count on you to contribute? Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone.

You can also donate at www.everyonedies.org. That's every, the number one, dies. Or at our site on Patreon, www.patreon.com and search for Everyone Dies. Marianne? Thanks, Charlie.

Cancer researchers at the most basic level focus their energy on what makes cancer cells start in the first place and what makes it metastasize. We've been talking the last few weeks about the basic aspects of cancer and this week we're going to talk about cancer cells going rogue and moving through the body. This is called metastasis or stage 4 cancer.

Simply put, metastasis is when the cancer moves from the original organ to another part of the body. Remember when you were a kid and you would pick up a dandelion after it had gone white and fuzzy? If you blew on it, the fuzzy seeds would float on the wind. Most of those seeds are going to land in the region where you are, but some, if the conditions are just right, can float away pretty far.

Cancer's like that. Most often the cancer cells, if they're going to move, are going to move to an area close to where they started, but some will go much further away. So, for example, if someone has ovarian cancer and the cancer metastasizes, no matter where it lands, let's say it goes to the lung, it's still ovarian cancer.

That's because if you look at the cells under a microscope, they are ovary cells, not lung cells. It'll be called metastatic ovarian cancer and not lung cancer. And it's treated as stage 4 ovarian cancer, not as lung cancer.

The NCI details the steps cancer cells take as they spread through the body. And these are first, they grow into or invade nearby normal tissue. Then second, they move through the walls of nearby lymph nodes or blood vessels.

And remember lymph nodes from our talk last week are those kind of grape-like structures that the blood filters through. They filter part of your body. Third, they'll then travel through the lymphatic system, which is made up of the lymph nodes and the bloodstream, to other parts of the body.

Number four is they stop in small blood vessels at a distant location, invading the blood vessel walls and moving into the surrounding tissue. Five, they grow into this tissue until a tiny tumor forms. And lastly, they cause new blood vessels to grow, which creates a blood supply that allows the metastatic tumor to continue to grow.

Now cancer does not have to metastasize. The cancer cells can die at any stage of the process. Or they can even make those tiny tumors and those tumors can just sit there and not grow.

In fact, they can sit around for years and never grow. Or they can start to grow for no reason that we really know. Also, if we continue our ovarian cancer example, women years after hysterectomy can't believe that they have ovarian cancer.

But even if the ovaries are gone, you still have ovarian cells in your body and they can start to grow and develop ovarian cancer. So what is this metastasis and why does it happen? The why is something that's really still clear and under debate. Scientists who study cancer metastasis are trying to clarify what is a complex process that involves at least hundreds, if not thousands of molecules.

The factors that seem to influence metastasis are genetic or environmental factors, or maybe both. Genetic factors include whether metastasis is an inherited or learned trait of the cancer. Meaning, if cancer starts because of a genetic mutation or an error, as we talked about in the beginning of this series, then the metastasis is a trait of cancer.

In other words, it's part of the cancer's genetics. Or, and, it could be environmental factors that focus on the tumor microenvironment, which appears to play an essential role in metastasis. Tumor cells communicate with their environment through what are called polypeptide growth factors.

And high levels of these growth factors, not enough oxygen, and acidic conditions within the tumor microenvironment help the cancer cells adapt to and invade other organs. Now, the environmental factors can include chronic inflammation caused by environmental triggers such as infections, smoking, or obesity can further boost metastasis by helping processes like developing new blood vessels and immune evasion. Immune evasion is a self-defense mechanism that involves changes in the immune response triggered by cancer cells that guarantees their survival and unlimited growth and spread.

Second is exposure to cancer-causing agents like ultraviolet radiation and industrial chemicals can increase the likelihood of mutations that result in metastasis. These are all theories that are still being studied. And this research is really vital because metastasis is the primary cause of 90% of cancer deaths.

Cancer can spread to almost any part of the body, but different types of cancer are more likely to spread to certain areas than others. Most common sites where cancer spreads are bones, liver, and lung. Now, there's a list in the show notes that shows the most common sites of metastasis, not including lymph node cancers, that are common for different types of cancers.

So, for example, breast cancer tends to metastasize to the bone, the brain, the liver, or the lung. Now, does that mean it can't go to the kidney? No, it doesn't mean that. But when you look at it statistically, if you have a diagnosis of breast cancer and if it metastasizes, it's going to most likely go to the brain, the bone, the liver, or lung.

Prostate cancer tends toward the adrenal glands, the bone, the liver, or the lung. While metastatic cancer does not always cause symptoms, when they do, the symptoms will depend on the size and the location of the metastasis. So, if cancer were to spread to the bone, what you would see is pain and fractures.

If it spreads to the brain, what you would see most commonly are headache, seizures, or dizziness. If it spreads to the lung, shortness of breath. If it spreads to the liver, you'll see like a yellow tinge to skin, which is called jaundice, or swelling in the belly.

The goal of treating metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. The treatment depends on the type of primary cancer, where it is spread, previous cancer treatments, and general health.

Charlie, what questions can I answer for you? Okay, first, so, I'm sorry, 90% of cancer metastasizes. So, as far as you know, I mean, has this always been the case? Or, I mean, just- No, that's not, that's not what I said. So, 90% of cancer deaths are the result of metastasis.

So, whatever percentage, and because there's so many variables, you have some cancers that are wild, you know, like small cell lung cancer, for example, is kind of a wild child, and it tends to grow and get out of control. Other cancers don't do that. So, I'm glad that you asked that question so we can clarify it.

Those cancers may metastasize. Some cancers are not found until they've metastasized, like we did a show on ovarian cancer. And a lot of those cancers are found at stage four because the symptoms aren't recognized as ovarian cancer.

So, what I'm saying is that when you look at the cause of death for people with cancer, 90% of those are because of cancer metastasis. Jeepers. Well, my question then is, if someone doesn't, I mean, how do you find out if you have some cancer growing in you? I mean, if someone doesn't feel anything, and then suddenly, oh yes, you have cancer, and it's, you know, it has grown, but you haven't felt anything.

I mean, is there a way to check? Well, that's a good question. So, there's two answers to that. One is that when somebody's diagnosed with cancer, they, and we'll go through this later in the series, they'll go through what's called cancer surveillance.

And so, we use NCCN guidelines that tell us, based on the research, how frequently we need to scan people and, you know, what we're looking for. So, for some cancers, many of them are one-year surveillance where they get a CAT scan with contrast and follow up with their oncologist with blood work and that kind of thing to see if there's any changes they can see in the CT and if their blood work is, you know, looking at white counts, red counts, all those things. Also, some cancers have what are called tumor markers.

So, for ovarian cancer, for example, there's a tumor marker called CA-125. So, when you go in for surveillance or even if you're scanned once a year, you might get twice a year CA-125 to see if that number is staying stable. Or prostate cancer, PSA test looks at the tumor marker.

And, you know, and even if it goes up, like for CA-125, it can go up for a variety of different reasons, but the primary reason is because of growth. But, if the CA-125 does go up, then it just tells the oncologist, okay, we need to look closer, see what's going on. So, but say, for example, an annual checkup.

Just by, I mean, at an annual checkup, I mean, I don't, I mean, I've been screened for, you know, for cancer and fortunately nothing is there, but is that, you know, once we start to get older, is that part of an annual checkup just to screen people for cancer or do you have to ask for it or what? Well, there's not a standard screening for cancer. So, plus, you know, a CAT scan is radiation and the contrast in it can be pretty hard on your body. So, they're not going to do those things unless there's an indication.

So, if you come in and you say, I have this pain here all the time, they'll work up that pain. It could be anything. You know, they'll, they used to routinely check PSAs, but I know that that's, there's some controversy about some people will have high PSAs and then it sets off this whole rollercoaster of do you really want to be on? They don't routinely, you know, check for a CA-125 unless a woman's reporting any kind of symptoms, but like we've said, those symptoms tend to be vague.

But the takeaway is that you need to know your own body and if you're washing your armpits or washing your groin and you feel those are places where your lymph nodes are or in your neck and you feel a lump that's never been there before, don't say, hmm, wonder what that is. I'm gonna, you know, I'll wait a while and find out. No, call your doctor and say, I felt this.

Can I come in and have you examine me? So, don't wait on things that you find that are different because it might be your body telling you something's going on. Okay. No, it's just, well, you know, as we get older, there's just more to, yeah, your body changes, you know, our body deteriorate.

Yeah, just something always to keep at the forefront now, not in the, you know, not in the back of your mind. Well, I don't think, I mean, I don't, I wouldn't obsess over it. I would just be aware that something's different.

No, no, no, to be aware of it, not to obsess over it. Yeah. Yeah.

Yeah. Okie dokie. But that's true at any age.

You don't have to be older to say, oh, I should pay attention to what my body's telling me. That's not, I don't consider that an age-related thing because plenty of young people get cancer. That's true.

I've just been lucky and, you know, healthy for pretty much my entire life, but yeah, my body seems to have other ideas now. What? You're on the right side of the grave, so. That's true.

And at least it's not like one foot in the grave and another on a banana peel. So, you know, I have that going for me. Well, you don't even eat bananas.

Yes, I do. Banana daiquiris. So, that's banana.

That sounds awful. Yeah. In our third half, today's poem is written by Titus Poetry from his book, What's Left of Me, Homes of a Dead Soul.

And when death finds me, I hope it whispers, come now, the fight is done, and takes my hand gently like an old friend who understands why I'm so tired. I hope it says, you've carried enough. Let me hold this weight for you.

I hope it promises, here, there is quiet. Here, you can rest. And that is it for the end of season five of Everyone Dies.

Thank you for listening and please stay tuned. This is Charlie Navarette, and once again from Titus. If I was dead, at least I wouldn't be ignored.

But living in this darkness feels like screaming into a void. And I'm Marianne Matzo. We'll see you next week.

Remember, every day is a gift. This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.