Adrenal gland as a "spreader" site for metastasis - 1255197

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Adrenal gland as a "spreader" site for metastasis - 1255197

I just read a brief article which discusses "sponge" sites versus "spreader" sites for metastasis. It suggests that bone tends to act like a sponge and prevent mets from spreading, whereas the kidneys and adrenal glands foster proliferation of metastases. This is very worrisome, as I have many new bone mets but also a new met on my adrenal gland, and I recall Blue Skies developed one there in the spring...

Here's the article:

Should I consider having the adrenal lesion radiated? Or is that a silly idea?


Reply To: Adrenal gland as a "spreader" site for metastasis

Hi Jazz,

Of course it's not a silly idea, but I'm sure you're familiar with the "whack-a-mole" problem of radiating mets, and not only does the article present a new, untested theory but it's also pretty light on details as to why they have come to this model of how tumors metastasize. That process is poorly understood, and at present no one knows why some cancers (even the same type of cancer in different patients) produce mets in some parts of the body, while others go elsewhere. It seems that once the cancer cells enter the bloodstream there are factors we don't understand which cause them to "stick" in certain places.

For what it's worth, at diagnosis my wife's cancer had spread to the pleural (and possibly pericardial) fluid, later spreading to brain, liver and bones throughout her body without ever being detected in her kidney or adrenal gland.

For those unfamiliar with Dr. Pinder's whack-a-mole analogy, Dr. Weiss provides a link and discussion here:

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<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

certain spring
Reply To: Adrenal gland as a "spreader" site for metastasis

First, these people are mathematicians.
Second, they are relying on autopsy reports from between 1914 and 1943.
Third, it's worth quoting the journal abstract for the article that resulted from this research:
"The model shows that the combined characteristics of the primary and the first metastatic site to which it spreads largely determine the future pathways and timescales of systemic disease." [my italics]

Dr West
Reply To: Adrenal gland as a "spreader" site for metastasis

I think certain spring has provided a critical review of the paper. I think it should lead to absolutely no changes in clinical decisions based on this work.

-Dr. West

Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

Reply To: Adrenal gland as a "spreader" site for metastasis

Thanks, Jim, CS, and Dr. West. The premise did seem a bit thin, but I try to keep an open mind. There are so many new and intriguing ideas... perhaps I've been watching too many "Through the wormhole" shows (listening to all those theoretical physicists and mathematicians). I'm probably searching for control in an out-of-control situation. I imagine my oncologist wouldn't radiate my adrenal gland anyway, not even for the sake of palliation. Not only am I familiar with whack-a-mole (or whack-a-gopher, right now), I've participated in the radiate-oligo-mets game. And that very one (T8) is back, dadgummit!

I worry about those adrenal glands...but I also have a zillion bone mets - many of which are new. I was not on a bisphosphonate for 8 of the months I was on afatinib-cetuximab. Perhaps the bone disease wasn't as well-controlled as the areas under surveillance (target lymph node and measurable soft tissue tumors), or there was very rapid, aggressive progression as soon as resistance set in.

As an update, 2 cycles of Carbo-Gemzar-Tarceva are done. 3/25 CT scan "stable" as compared to January; bone scan shows mets to skull, ribs, spine... next appointment April 1. Probably will stay the course. Heading to UCLA to consult, get on wait list for CO-1686, around 4/10. One trial participant (at Stanford) had 25% shrinkage at first 6-week scan and is due for 2nd scan soon. He has no side effects. Another participant, on study since December, had dose increase - 900mg to 1200mg and experienced pericarditis; is unsure if related. She's stable and had some muscle aches. I'm really starting to wonder how long it's going to take to find MTD!

Thanks again to the GRACE brain trust. Thank goodness for all the critical thinking going on here! It appears my skills in that arena were left at the last bus stop...

Love to all,

Jazz :)