Therapy of metastases

If tumor cells spread through the lymphatic pathways or with the bloodstream to other organs and multiply there, daughter tumors, the so-called metastases, are formed. Breast cancer cells can settle in almost any organ of the body, most often breast cancer metastasizes to the bones, to the lungs, and less often to the brain. Metastasized breast cancer is usually treated systemically because systemic therapy acts throughout the body and thus should reach all cancer cells. Whether endocrine, chemotherapy, or targeted therapy, such as a bisphosphonate or a RANK ligatde inhibitor (denosumab) for bone metastases, is decided by tumor biology. If possible, before choosing a therapy, the properties of metastases should be checked again, since they partially differ from the cells of the original tumor.

Some metastases can be targeted locally:

• Local chemotherapy by applying a cream can be used in the treatment of skin metastases.
• A special form of local chemotherapy is intraperitoneal chemotherapy. In this case, a solution of a cytostatic drug is injected into the abdominal cavity in order to destroy peritoneal metastases (peritoneal carcinomatosis) right on the spot.
• Surgical treatment can be applied in specific situations with metastases to the skin, bones, liver, lungs and brain, as well as the accumulation of fluid in the chest cavity (pleural effusion). With metastases in the skin, in bones, in soft tissues (muscles), radiation is possible.
• A bisphosphonate or RANK ligatd inhibitor (denosumab) is prescribed for bone metastases.
• Puncture (fluid removal) does not directly destroy metastases, but relieves the associated condition: fluid in the abdominal cavity (ascites) as a result of damage to the peritoneum (peritoneal carcinomatosis) or accumulation of fluid in the chest (pleural effusion) as a result of damage to the lungs or pleura (pleural carcinomatosis)