THERE’S A TUMOR AND THINGS ARE NOT GOING WELL

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If things are not going well, it means that the tumor has gone beyond the localized phase and has entered the advanced phase. Unfortunately, in the majority of cases, the advanced stage of the tumor is no longer a curable condition. But there are exceptions, and we must always look for them. 

In this phase, the aim of treatment is generally to halt the growth of a tumor that would otherwise progress quickly to a size that is no longer compatible with life. Halting the growth of a tumor means stabilizing its size and, if possible, reducing it, in the hope that the benefits yielded by the treatment will be long-lasting.  

An “advanced stage” of disease means one of the two following situations.

  • New sites of disease have been found in organs such as bones, liver, lung etc. These are distant metastases that have spread from the primary tumor (WHAT ARE METASTASES?)
  • A tumor or a local recurrence of the primary tumor has been found at the original site, without distant metastases. Although there are no metastases, the tumor has invaded the nearby vital structures and cannot be removed.

These two conditions may already be present at the time of the first diagnosis. Alternatively, they may occur some time (even years) after the primary tumor has been removed.

In both of these situations – distant metastases or local recurrence of the tumor – it is very unlikely that the patient can be cured. A patient who has a local recurrence of a tumor (i.e. the tumor has re-formed only at the original site), if there are no distant metastases, has a better chance of being cured than one who has metastases. Indeed, metastases are very unlikely to be single or isolated, FIGURE 14.

Fig 14. On relapse, metastases may appear at different times and grow at different speeds
Fig 14. Sometimes the relapse occurs a few months after surgery; other times, even several years after surgery. This is due to the different growth rate of the metastases. No one knows why certain metastases grow very fast and others are very slow.

For example, if imaging tests detect 3-4 metastases, there is a 95% probability that there will be another 30-40 that are still too small to be seen (less than 5 mm), in the same organ or in other organs. This means that further surgery will generally be useless. The illusion that “everything has been removed” will not last long; after a few months, new visible metastases will be found in the various organs. 

In short, when there is a local recurrence, the first option to consider is “rescue surgery”, if this is feasible. By contrast, when there are scattered metastases, the usual approaches to administer medical therapies: chemotherapy, hormone therapy, immunotherapy and other biological therapies. (HOW MANY WAYS CAN TUMORS BE TREATED?)

 

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