The spread of the disease from one organ or part to another non-adjacent organ or part is called metastasis or metastatic disease. Previously it was that only malignant tumor cells had the capacity to metastasize which is now in reconsideration due to research. The word metastasis in Greek means “removal from one place to another” and the plural form of metastasis is given as metastases.
Metastases are given as the process through which the cancer spreads from the place it started as a primary tumor to other parts of the body distant from the affected area. For example, a person with melanoma may have metastases in their brain and another person with colon cancer may not show symptoms of metastases.
Cancerous cells have two abilities such as increased motility and invasiveness on which metastases depends. Cells that metastasize are basically of same kind and have acquired increased motility and capacity to invade other organs. If cancer arises in lungs and metastasizes to liver, the cancer cells present in the liver are lung cancer cells.
A clinical research was conducted on metastases. A 65 year old man was admitted with dysphagia and no pulmonary symptoms were noted in him. A barium swallow test marked constriction of the middle esophagus and also an esophageal stricture with apparently normal mucosa 35cm from the incisors. A 2staged operation was planned for the patient due to his past history of cerebral thrombosis with right hemiplegia. Then thoracotomy cervical esophagostomy was carried out in which a tumor mass measuring 3.0 X 3.0 cm was found at the base of the middle lobe of right lung.
Two months later, esophageal reconstruction with a gastric tube placed in subcutaneous space was performed. In lower lung field, a tumor shadow was found during the post operative period. The epithelial surface of the esophagus appeared smooth and was stained with Lugol’s solution. It was to provide evidence that mucosa was normal. But after histological examination, it was found that the tumor was in the muscle layer and infiltrating the submucosal and other deeper layers. The tumor was poorly differentiated adenocarcinoma as it was a metastatic lesion from a lung cancer, but no specimen of pulmonary tumor was obtained and the patient died 231 days after the surgery.
On the basis of research and findings in patients, an aggressive surgical approach is needed for metastatic esophageal carcinoma when the primary tumor growth is suspected to be slow. But the decision to resect these lesions should be made after evaluation which ensures clinical benefit to patients.
Oxaliplatin is one kind of drug belonging to 3rd generation of platinum and it plays an important role in treatment of cancer and tumors. Capecitabine has slighter side effect and can be taken orally in the gastro-intestinal tract. The investigators believed that Oxaliplatin combined with Capecitabine treatment provides a safe, well tolerated and effective treatment for patients with metastatic disease.
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