Patients with brain metastasis will present with neurologic symptoms like seizures, headache, cranial nerve deficiency, and positional vertigo. Thoracic metastasis may presentwith hemoptysis, dry cough, and dyspnea. Jaundice, hepatomegaly and nausea are usually observed in hepatic metastasis. Bone metastasis will present with the most excruciating metastasis especially those with spinal cord involvement. Regional lymph node adenopathy are typically seen in regional metastasis [8].

• Cervical Lymphadenopathy

  A practical treatise on diseases of the skin, for the use of students and practitioners (1897) (14784221795).jpg 1.820 × 1.444; 530 KB Cancer Metastasis in Vertebra.jpg 1.303 × 746; 41 KB Cannon ball mets in ca breast.jpg 1.277 × 633; 96 KB Cervical lymphadenopathy [commons.wikimedia.org]

• Weight Loss

  In case 2, a 61-year-old man with worsening dysmetria in the setting of unintentional weight loss presented with multiple masses in the pelvis, abdomen, lung, and brain. [ncbi.nlm.nih.gov]

  Symptoms of Liver Metastases When symptoms occur, they may include: Anorexia Fevers Jaundice Nausea Pain, usually in the upper right part of the abdomen Sweats Weight loss Tests to Diagnose Liver Metastases include: Bilirubin blood test CT scan or MRI [surgery.ucsf.edu]

  Liver metastases may cause jaundice (a yellow discoloration of the skin,) bloating, abdominal pain, and weight loss. Metastases to the adrenal gland are often asymptomatic but important with regard to treatment. [verywellhealth.com]

  nausea, and vomiting Metastasis to the lungs may cause: Chronic cough or inability to get a full breath Abnormal chest X-ray Chest pain Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite [nationalbreastcancer.org]

• Fatigue

  However, the treatment was discontinued because of gastrointestinal side effects and fatigue. [ncbi.nlm.nih.gov]

  Liver Metastasis to the liver may cause: jaundice, or yellowing of the skin and the whites of the eyes itchiness abdominal pain loss of appetite nausea vomiting Lungs Metastasis to the lungs may cause: chronic cough chest pain fatigue shortness of breath [healthline.com]

  Common side effects are fatigue, fever, nausea, vomiting, diarrhea, anemia, weakness, arthralgia, myalgia, and bone/joint pain. [physio-pedia.com]

  […] liver Abdominal pain, appetite loss, nausea, and vomiting Metastasis to the lungs may cause: Chronic cough or inability to get a full breath Abnormal chest X-ray Chest pain Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue [nationalbreastcancer.org]

  Palbociclib Some possible side effects include low white blood cell counts, low red blood cell counts (anemia), fatigue, nausea, mouth sores, hair thinning, diarrhea and in rare cases, blood clots. [ww5.komen.org]

• Fever

  Symptoms of Liver Metastases When symptoms occur, they may include: Anorexia Fevers Jaundice Nausea Pain, usually in the upper right part of the abdomen Sweats Weight loss Tests to Diagnose Liver Metastases include: Bilirubin blood test CT scan or MRI [surgery.ucsf.edu]

  If the hepatic metastatic burden is large then the presentation or symptoms related to the liver disease may include: localized pain and tenderness due to capsular stretching disordered liver metabolic function ascites low-grade fever 2 The most common [radiopaedia.org]

  […] vomiting slurred speech changes in personality or behavior seizures weakness numbness paralysis trouble with balance or walking Nonspecific symptoms that may accompany any form of metastatic breast cancer include: fatigue loss of appetite weight loss fever [healthline.com]

  Weight loss, loss of appetite, fever, and gastrointestinal disorders may indicate liver metastases. Liver blood tests may first detect cancer in the liver. [imaginis.com]

  Common side effects are fatigue, fever, nausea, vomiting, diarrhea, anemia, weakness, arthralgia, myalgia, and bone/joint pain. [physio-pedia.com]

• Respiratory Distress

  However, he died of acute respiratory distress syndrome. CONCLUSIONS: Awareness of the possibility of abdominal metastasis by salivary carcinosarcoma may help in managing patients with a history of abdominal surgery. [ncbi.nlm.nih.gov]

  After primary tumor removal, mice were sacrificed at the first signs of respiratory distress (typically 8–10 weeks after surgery) to collect metastases. [doi.org]

• Abdominal Pain

  A 74-year-old man was admitted to the emergency room with abdominal pain and vomiting, and abdominal computed tomography (CT) indicated obstruction of the ascending colon due to a huge mass. [ncbi.nlm.nih.gov]

  […] or nausea Behavioral changes or personality changes Metastasis to the liver may cause: Jaundice Itchy skin or rash Abnormally high enzymes in the liver Abdominal pain, appetite loss, nausea, and vomiting Metastasis to the lungs may cause: Chronic cough [nationalbreastcancer.org]

• Loss of Appetite

  […] of appetite weight loss fever Some symptoms may not be caused by the cancer itself, but by the treatment that you may be undergoing. [healthline.com]

  Some side effects of chemotherapy are: loss of hair, loss of appetite, nausea and vomiting, mouth sores, diarrhea, increased chance of infection, problems with bruising and bleeding, and feeling weak or fatigue. [physio-pedia.com]

  Liver metastasis can cause pain, weight loss, nausea, loss of appetite, abdominal fluid (ascites) or jaundice (yellowing of the skin and the whites of eyes, dark urine, light colored stools). Diagnosis There is no one test to check for metastasis. [my.clevelandclinic.org]

  Broken bones, as a result of weakening from the metastasis Loss of appetite, nausea, extreme thirst, and other symptoms from excess calcium in the blood; as bone becomes destroyed by the metastatic tumor, the bone releases calcium into the bloodstream [webmd.com]

• Jaundice

  jaundice Shortness of breath Lung Brain Bone Headaches, seizures, unsteadiness Bone pain or fracture Prostate Bone Bone pain or fracture Symptoms Sometimes symptoms of metastatic disease may be the only signal of cancer. [patientresource.com]

  Jaundice, hepatomegaly and nausea are usually observed in hepatic metastasis. Bone metastasis will present with the most excruciating metastasis especially those with spinal cord involvement. [symptoma.com]

  […] fractured or broken Metastasis to the brain may cause: Persistent, progressively worsening headache or pressure to the head Vision disturbances Seizures Vomiting or nausea Behavioral changes or personality changes Metastasis to the liver may cause: Jaundice [nationalbreastcancer.org]

  When this happens, the following symptoms may occur: loss of appetite weight loss dark-colored urine abdominal swelling or bloating jaundice, a yellowing of the skin or the whites of the eyes pain in the right shoulder pain in the upper right abdomen [healthline.com]

  Liver metastasis can cause pain, weight loss, nausea, loss of appetite, abdominal fluid (ascites) or jaundice (yellowing of the skin and the whites of eyes, dark urine, light colored stools). Diagnosis There is no one test to check for metastasis. [my.clevelandclinic.org]

• Back Pain

  Univariate analysis showed that back pain (P = .028), preoperative CA19-9 level (P [ncbi.nlm.nih.gov]

  MRIs of the spine of a 54-year-old man with a history of glioblastoma multiforme, who presented with new urinary frequency and urgency, thoracic-to-lumbar back pain and inability to walk. [cmaj.ca]

  When to See a Doctor Anyone with a cancer or a history of cancer should call the physician if back pain occurs suddenly and/or if existing back pain suddenly becomes much worse. [spine-health.com]

  It is these nerves that cause back pain when pressed upon by a growing tumor. Therefore, this is where an alcohol is injected during an alcohol nerve block to stop the sensation of pain. [pathology.jhu.edu]

• Hip Pain

  The main complaint was hip pain with limited activity for about 3 months. Expansive bone destruction and periprosthetic osteolysis at the right femoral trochanter were identified through X-ray and Tc bone scan. [ncbi.nlm.nih.gov]

  […] arthroplasties presents with left hip pain and dysuria. [orthobullets.com]

• Numb Chin Syndrome

  The diagnosis was numb chin syndrome secondary to mandibular metastasis. Apart from supportive treatment, she was started on palliative chemotherapy and radiotherapy. [ncbi.nlm.nih.gov]

The following tests and work up modalities are implored in the diagnosis of metastasis:

• Tissue biopsy: Tissues taken from metastatic lesions are examined under the microscope to determine the point of origin of the tumor [9].
• Cranial CT scan: This imaging technique will demonstrate the presence and the extent of the cranial metastatic tumor.
• Chest X-ray: This imaging modality can be used to screen patients with possible chest or intrathoracic metastasis.
• Magnetic resonance imaging (MRI): This imaging scan will elucidate and define tumors intraabdominally and in the thoracic cavity.

The management of metastasis greatly depends on the patient’s age, general health, and history of previous treatments. The treatment options for metastasis include radiosurgery, radiation therapy, debulking surgery, chemotherapy, and hormone therapy [10]. A combination therapy from among these may be implored to treat some cancer metastasis. A great majority of the cancers are hard to treat but testicular and thyroid metastasis are usually treatable.

The prognosis of metastastatic cancers depend on the time the disease condition is diagnosed and how aggressive the management is. The site of the metastasis also affects the relative morbidity and mortality of the patient. Brain metastasis and thoracic metastasis carries the most morbid prognosis among the other possible sites. Pain symptoms are more pronounced and debilitating in bone metastasis compared to thoracic metastasis that may sometimes remain asymptomatic. Metastasis where the tumor of origin is not identified may be difficult to treat and control which occurs in 3% of all the cases [7].

Almost all types of cancer can metastasize including cancers of the blood and the lymphatic system. Primary tumor may metastasize to distant organs by way of the lymphatic system or the blood stream. The formation of the metastatic tumor in the recipient organ will form a clinically detectable cancer which may invade the vascular or lymphatic structures of the new site and metastasize to another site. Primary cancers can spread contiguously to another coelom or compartment which is also known as transcoelomic metastasis. Cancers can also spread to regional lymph nodes and show signs of cancer spread within a solitary or group of lymph nodes. The lymphatic spread of the cancer cells to a nearby lymph node is called transplantation and implantation metastasis [1].

The actual incidence and prevalence of metastasis a disease is a reflection of the aggressiveness of a given primary cancer. Metastatic tumors to the brain are the most common type of brain tumor in adults [2]. In the case of hepatocellular carcinoma (HCC), intrathoracic metastasis is the most common site of metastasis, followed by abdominal spread, and bone metastasis accordingly [3]. As in the case of pulmonary metastasis, the incidence of its metastasis increased with increasing age. An approximate total of 6 to 10% of invasive breast cancers are initially diagnosed as metastatic or stage IV in classification.

The pathogenesis of metastasis starts with the breaking away of the cancer cells from the primary tumor that attaches to it, or degrades to the extracellular matrix (ECM) which separates the tumor from the normal apposing tissues. Recent researches on cancer have postulated that one of the most critical event involved in the development of metastasis is the development of the new blood vessel network or tumor angiogenesis [4].

In the same way, angiogenesis inhibitors has been successfully determined to prevent the progression of some metastatic processes. The endothelial progenitor cells are critical for the development of metastasis and its angiogenesis [5]. Epigenetic regulations like H3K4 methylation and H3K9 methylation in the histones allows for the proliferation of the disseminated tumor cells in distant organs [6].

Metastasis can actively be prevented by the early diagnosis and treatment of the primary tumors. A routine annual bone scan, chest X-ray and ultrasound of the pelvic organs can prevent the progression of some primary tumors to disseminate to distant organs. Regular Pap smear and self-examination of the breast can effectively detect cancers in its very early stages. Slight neurological disturbances merit an early cranial CT scan to detect brain metastasis.

Metastasis is a medical condition where a cancer cell from a tumor of origin disseminates to another organ not directly related to it. The tumor that is formed by a metastatic cancer cell is known as a metastatic tumor or secondary tumor. The majority of metastatic tumors could not be healed by standard treatment modalities. The primary goal in the treatment of metastatic cancer is to control the neoplasm growth and control the symptoms brought about by its occurrence.

Definition

Metastasis is a clinical process by which cancer spreads from a primary site where it arose to distant locations of the body.

Cause

Metastasis can spread by contiguous spread, lymphatic circulation, lymph node transplantation, and hematogenous spread.

Symptoms

Symptoms largely depend on the site where metastasis has thrived. Lung metastasis presents with hemoptysis and dyspnea, brain metastasis with neurologic signs, bone metastasis with bone pain, and regional lymph node swelling.

Diagnosis

Imaging techniques for the diagnosis of metastasis include X-ray, CT scan, and MRI. Tissue biopsy of the metastasis can determine the origin and the mode of treatment.

Treatment and follow-up

Metastasis are treated with a combination of radiation therapy, chemotherapy, hormone therapy, radiosurgery and debulking surgery.

1. Kumar, Vinay; Abbas, Abul K; Fausto, Nelson; Robbins, Stanley L; Cotran, Ramzi S (2005). Robbins and Cotran pathologic basis of disease (7th Ed.). Philadelphia: Elsevier Saunders. 
2. Fox BD, Cheung VJ, Patel AJ, Suki D. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. 2011 Jan; 22(1):1-6, v. 
3. Si MS, Amersi F, Golish SR, Ortiz JA, Zaky J, Finklestein D. Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival. Am Surg. 2003 Oct; 69(10):879-85.
4. Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis—correlation in invasive breast carcinoma. N Engl J Med. 1991 324 (1): 1–8. Doi: 10.1056.
5. Gao D, Nolan DJ, Mellick AS, Bambino K, McDonnell K, Mittal V. Endothelial Progenitor Cells Control the Angiogenic Switch in Mouse Lung Metastasis. Science 2008 319 (5860): 195–198.
6. Lujambio A, Esteller M. How epigenetics can explain human metastasis: a new role for microRNAs. Cell cycle 2009 (Georgetown, Tex.) 8 (3): 377–82.
7. Briasoulis E, Pavlidis N. Cancer of Unknown Primary Origin. Oncologist 1997 2 (3): 142–152.
8. Coghlin C, Murray GI. Current and emerging concepts in tumour metastasis. Journal of Pathology 2010; 222(1):1–15.
9. Ramaswamy S, Ross KN, Lander ES, Golub TR. A molecular signature of metastasis in primary solid tumors. Nature Genetics 2003 33 (1): 49–54.
10. Nguyen DX, Bos PD, Massagué J. Metastasis: from dissemination to organ-specific colonization.Nature Reviews Cancer 2009; 9(4):274–284.