
 <b>METASTASIS</b>

a. Metastasis is progression of the disease, and is Stage IV. Metastases indicate systemic illness. Metastases will either be few or many.

b. If there are very few metastases, and they are operable, usually the solution is surgical resection or ablation. This may or may not be followed by chemotherapy. 

c. If there are many metastases, then you are dealing with systemic disease, and systemic treatment is the treatment of choice, in order to try to get some control over the disease.  Usually this is chemotherapy, but it could be targeted molecular therapy, antiangiogenesis cocktails, vaccine, or immuno- or viro- therapy.  Currently, chemotherapy is the most effective method available for LMS, but those with more chemoresistant tumors should investigate other treatments.  
 
d. LMS is a chemotherapy and radiation resistant cancer. Surgical or ablative methods are the treatments of choice. Therefore be very thoughtful if offered chemotherapy or radiation for treatment of an operable tumor.

e. Definition: Ablative methods include 'frying' tumors out of functioning existence with heat [e.g. Radio Frequency Ablation], or freezing them solid with liquid nitrogen or similarly cold substances--so that the cells burst when they defrost [Cryosurgery].

f. Consider RFA or VATS [thoracoscopic, or keyhole chest surgery] for lung metastases. If you want to know more about these techniques, ask on the LMS List, and check &&url.

g. Consider surgery, or laparoscopic surgery, or RFA, or cryosurgery for LMS recurrences in all other locations. [LMS is a chemo and radiation resistant cancer. Surgical or ablative methods are the treatments of choice.  &&url] 

h. Definition: Neoadjuvant Treatment. If the tumor is inoperable, then judicious use of chemotherapy or radiation sometimes actually downgrades the situation and makes it operable. The attempt to downgrade an inoperable situation into an operable one by means of radiation and/or chemotherapy is called neoadjuvant treatment.

i. Chemotherapy &/or radiation can be VERY useful, but there are good reasons to use it/them sparingly. Chemotherapy or radiation is toxic, has risks of permanent & troublesome damage, and might only control the LMS for a short period of time because resistance develops. It might be a good idea to use surgical options wherever possible, and to save your chemotherapy & radiotherapy options for controlling cascading metastases, or neoadjuvant or inoperable situations.

j. Often there is a surgical window of opportunity, which can close, sometimes within a month or two, if an LMS tumor encroaches upon, surrounds, or destroys necessary structures or vital organs. It is important not to lose this window of opportunity. For aggressive, fast-growing, high-grade tumors it is necessary to act quickly and decisively. 

k. As time goes on, cancers 'dedifferentiate'. This means that they become more primitive and can act less well controlled, and more aggressive. It occurs because they are continually accumulating more and more mutations. So a previously slowly growing cancer can suddenly become aggressive and fast growing, and surprise everyone by becoming inoperable quickly.  Be aware.  Suddenly you don't have the time to arrange things that you thought you had from past experience, and the tumor has grown inoperable very quickly.