Once again, about METASTASIS

The deadliest aspect of cancer is its ability to spread to other organs of the body, otherwise known as metastasis.

Cancer cells are initially a cluster which then forms the primary tumor. Once a tumor is formed, one by one - or in groups - of cells begin to break away from this tumor and travel to other parts of the body's tissues. This process is called metastasis. These cancer cells travel through the circulatory or lymphatic system [1] and soon form new tumors in locations far from their original location (the place where the primary tumor was first discovered).

Metastasis is a very complicated process that is still not fully understood. In order to metastasize, a cancer cell must break away from the primary tumor, penetrate the circulatory or lymph systems which will transport it to a new location where it will then develop itself.

Basically our bodies have many protection systems to prevent 'unknown' cells from doing things like this, and cancer cells themselves don't actually have much ability to overcome these security systems. But in fact they can metastasize. Therefore, recent studies and research on cancer are trying to focus more on understanding how cancer cells mutate to evade the body's defense system, so they are free to move and can spread to other organs.

When cancer is diagnosed, it may be found in a location that is not actually the site of the primary tumor. Through various methods of testing, usually the doctor will find the location of the primary tumor and determine how far it has spread from its initial location. Localized tumors that have not had time to metastasize have the best prognosis for healing. Cancer that has metastasized usually shows signs of advanced disease and of course treatment becomes more difficult with poorer outcomes. In the end, breast cancer patients, for example, may succumb to lung, liver, or brain cancer, which is actually not the original cancer they are suffering from.

Metastases generally occur via the bloodstream or lymphatic system. Just like other normal cells, cancer cells also need a blood supply to function. They also have access to the bloodstream as healthy cells do. It is this access that allows cancer cells to escape from their primary tumor and then carry out an 'invasion' to any part of the body. Once in the bloodstream, cancer cells by themselves have the opportunity to move throughout the body. Meanwhile, the lymphatic system also has its own channels throughout the body, just like the circulatory system, through which cancer cells can also spread freely.

HOW DO METASTASIS OCCUR?
When surgeons remove a tumor, they usually also remove nearby parts of the lymph system - including lymph nodes - which are the most common sites where cancer cells first metastasize. If metastases have occurred in the lymphatic system, then efforts (prognosis) for healing will be very difficult.

To initiate the process of metastasis, a tumor cell must first break away from the primary tumor. In normal tissue, cells support and anchor themselves to one another in the protein connective tissue that fills the spaces between them. This protein connective tissue is known as the extracellular matrix [2] The layer between the cells and the extracellular matrix is ​​called the epithelium, [3]the tissue cells that make up the lining of the skin and the tissues of the mouth, stomach, lungs, and other organs. To separate themselves, cancer cells must first break away not only from the cells around them, but also from the extracellular matrix. Cells are held together by cell adhesion molecules [4].This adhesion also allows interactions between various proteins on the cell surface. In cancer cells, these adhesion molecules appear to be absent or disrupted. Cadherins, a family of intercellular adhesion protein molecules, play a large role in keeping cells together. One of the subtypes in this family, E-cadherin, is an adhesion molecule found in mammalian cells. This molecule appears to be an important factor in the cell–cell adhesion process. In cancer cells, some or all of E-cadherin is absent. This allows cancer cells to escape from one another, including from the matrix that holds everything in place. Clinical studies involving manipulation of E-cadherin have proven that this molecule is important for stopping metastases. This study also showed that blocking E-cadherin on cancer cells changed them from non-invasive to invasive. This demonstrates the importance of cell adhesion, particularly its ability to inhibit the capacity of cancer cells to 'invade' by remaining attached to other cells. If cell adhesion is disrupted, cancer cells have the opportunity to metastasize and invade other areas of the body. When it comes to oral cancer, research shows that saliva provides a good environment for metastases. Saliva is naturally rich in hyaluronic acid (HA), a molecule that binds to cell surfaces, making it easier for cells to move. This helps cancer cells escape cell adhesions and allows them to move more freely. especially its ability to inhibit the capacity of cancer cells to 'invade' by continuing to bind them to other cells. If cell adhesion is disrupted, cancer cells have the opportunity to metastasize and invade other areas of the body. When it comes to oral cancer, research shows that saliva provides a good environment for metastases. Saliva is naturally rich in hyaluronic acid (HA), a molecule that binds to cell surfaces, making it easier for cells to move. This helps cancer cells escape cell adhesions and allows them to move more freely. especially its ability to inhibit the capacity of cancer cells to 'invade' by continuing to bind them to other cells. If cell adhesion is disrupted, cancer cells have the opportunity to metastasize and invade other areas of the body. When it comes to oral cancer, research shows that saliva provides a good environment for metastases. Saliva is naturally rich in hyaluronic acid (HA), a molecule that binds to cell surfaces, making it easier for cells to move. This helps cancer cells escape cell adhesions and allows them to move more freely. When it comes to oral cancer, research shows that saliva provides a good environment for metastases. Saliva is naturally rich in hyaluronic acid (HA), a molecule that binds to cell surfaces, making it easier for cells to move. This helps cancer cells escape cell adhesions and allows them to move more freely. When it comes to oral cancer, research shows that saliva provides a good environment for metastases. Saliva is naturally rich in hyaluronic acid (HA), a molecule that binds to cell surfaces, making it easier for cells to move. This helps cancer cells escape cell adhesions and allows them to move more freely.

Apart from binding to each other, cells are also bound to the extracellular matrix, which is a matrix consisting of connective tissue proteins such as collagen [5].and elastin interact to form a highly insoluble material. The extracellular matrix not only holds cells together, it also allows cells to survive and reproduce. Research has shown that a cell is dependent on the place where it settles. This means that cells cannot reproduce unless they attach to a tissue surface. This is made possible through cell surface molecules called integrins, which are bound to the extracellular matrix. Only after the cell attaches to a tissue surface can the reproductive cycle begin. Cells that stand alone will not reproduce, or grow. A nuclear protein called E-CDK2 regulates cell growth and division. If the cell is not attached to anything, then the inhibitory substance in the cell nucleus will turn off E-CDK2, so the cell stops growing.apoptosis , or commit programmed suicide.

The ability to stop the growth of unbound cells is one of the body's security systems to maintain tissue integrity. Normal cells have a certain place where they must settle in order to survive. However, cancer cells can exist without settling down. Their E-CDK2 protein remains active and allows cancer cells to grow and multiply. What causes their E-CDK2 protein to remain active is unknown, but researchers suspect that this has something to do with oncogene processes [6] . Oncogenes are mutated versions of proto-oncogenes [7]found in healthy cells, and capable of turning normal cells into malignant cells. It is possible that within cancer cells, proteins made by oncogenes convey the false message that the cell is bound, when in fact it is not. This allows cancer cells to continue to grow and reproduce when they should enter the process of apoptosis, or programmed cell death.

Once the cancer cell has broken away from the extracellular matrix and other cells, it will make its way into the blood circulation or lymphatic system in order to reach other organs. The most common route is via the bloodstream, as blood vessels are often nearby. Tumors themselves are able to create new blood vessels (angiogenesis) because of their need for nutrition, and these blood vessels certainly provide a great opportunity for cancer cells to move to other organs.

Entry into the blood vessels requires penetration of the basement membrane which is a thin layer of special extracellular matrix. Basement membranes surround blood vessels but they are also fused with epithelial cells. Epithelial cells, which are cells that are the most common area for cancer growth, have a basement membrane that separates them from the surface of the body's organ tissues. Cancerous tumors that develop in epithelial cells must penetrate two basement membranes, namely the epithelium and the blood vessels for transport. For this cancer cells will release enzymes called metalloproteinases (MMPs). This enzyme will dissolve the basement membrane and other extracellular matrix, thus allowing penetration of the basement membrane and blood vessels which will provide access for it to penetrate other parts of the body. Once in the bloodstream, Cancer cells must fight against the body's defense system before they can (or cannot) attach themselves to a new location. Fewer than 1 in 10,000 cancer cells survive attempts to form new tumors. Blood circulation plays an important role in determining where cancer cells can travel. Cancer cells are usually trapped in the first cluster of capillaries they encounter at the point of entry. Often these capillaries are in the lungs. Because after going through various organs, venous blood will be returned to the lungs for reoxygenation, and because from the intestine, blood is first transported to the liver, then cancer cells that leave the intestine will also be carried there. This is why the lungs and liver are the two most common places for metastases to occur in the human body.

Once in a new location, these cells again have to penetrate the basement membrane and blood vessels and begin building new tissue on their own. In the primary tumor itself, only certain cancer cells can metastasize. Not all cancer cells have the ability to survive their journey to other areas of the body. Many cancer cells that make this journey die because they don't have the ability to metastasize. While the properties of the primary tumor itself, such as deformability, aggregation, and expression of adhesive molecules, prevent cancer cells from breaking away from their parent. Meanwhile, the body also has weapons, such as blood turbulence, platelets, T-cells, natural killer cells, and macrophages, which are constantly circulating to kill harmful cells, including cancer cells.

NOT ALL CANCER CELLS ARE ABLE TO METASTASIS 
A study conducted on mice showed that less than 1% of B16 melanomas (malignant tumor cells) injected into mice survived their attempts to metastasize. This low survival rate supports the notion that certain growing unique subpopulations (tumor cells that develop distant from the primary tumor) have special traits. These cells have the tools they need to successfully complete their metastatic process. Whereas most other tumor cells will die at some point in their journey. From this research, cancer cells could be identified and isolated, thereby proving that not all cancer cells have the ability to metastasize.

There are also studies that conclude that certain tumors only produce metastases to certain organs. Research has shown that although cancer cells can reach all organs of the body, they are attracted only to certain organs. Only when the cells reach these organs do they stop and reproduce. Ivan Stamenkovic of Harvard Medical School supports this theory when he successfully directs the metastatic spread of tumor cells by inserting certain adhesion molecules into the livers of mice. It turned out that tumor cells then concentrated there. Adhesion molecules inserted into the livers of these mice showed true markers that tumor cells were indeed looking for certain places to proliferate. This, and many other experiments,

Source: oralcancerfoundation.org | Adapted freely from the original article: Metastasize 

FOOTNOTE 
[1] See the video below this footnote. 
[2]The extracellular matrix is ​​the largest component of normal skin and gives skin its unique properties of elasticity, flexibility and compaction. The extracellular matrix is ​​the largest component of the dermis. The extracellular matrix can affect cell shape, cell survival, cell proliferation, polarity and cell behavior. Most cells need to attach to the extracellular matrix in order to grow and reproduce. The two main classes of macromolecules that make up the extracellular matrix are polysaccharide chains in a class called glycosaminoglycans (GAGs), which are normally found covalently linked to proteins in the form of proteoglycans and fibrous proteins, which include collagen, elastin, fibronectin, and laminin, which have structural and adhesive functions. Glycosaminoglycans (GAGs) are unbranched polysaccharide chains composed of repeating disaccharide units and are a heterogeneous group of negatively charged polysaccharide chains that are covalently linked to proteins to form proteoglycan molecules. GAGs are called because one of the 2 sugars in a repeating disaccharide is always an amino sugar (N-acetylglucosamine/N-acetylgalactosamine). The second sugar is usually uronic acid (glucuronic or iduronic). GAGs are highly negatively charged because there are sulfate or carboxyl groups in most of their sugars. GAGs are called because one of the 2 sugars in a repeating disaccharide is always an amino sugar (N-acetylglucosamine/N-acetylgalactosamine). The second sugar is usually uronic acid (glucuronic or iduronic). GAGs are highly negatively charged because there are sulfate or carboxyl groups in most of their sugars. GAGs are called because one of the 2 sugars in a repeating disaccharide is always an amino sugar (N-acetylglucosamine/N-acetylgalactosamine). The second sugar is usually uronic acid (glucuronic or iduronic). GAGs are highly negatively charged because there are sulfate or carboxyl groups in most of their sugars.

Four main groups of GAGs are distinguished by their sugars, the type of relationships between sugars, and the number and location of sulfate groups: (1) hyaluronan, (2) chondroitin sulfate and dermatan sulfate, (3) heparan sulfate, and (4) keratin sulfate. Examples of GAGs: hyaluronan and proteoglycans. Hyaluronan is the simplest GAGs. Hyaluronan does not contain sulfated sugars, has all the disaccharide units the same, has very large chain lengths (thousands of sugar monomers), and is generally not covalently linked to any core protein. Proteoglycans are composed of GAG chains that are covalently connected to the core protein. Proteoglycans are thought to have a major role in chemical signaling between cells.

[3]Epithelial tissue is one of the four basic tissues (others: connective tissue, muscle tissue, nervous tissue). In the past, the term epithelium was used to refer to the clear membrane that is above the surface of the connective webbing protrusions on the red lips (Epitel: Epi above; Thele lip). This term is now used for all the tissues that line a structure or channel.

[4]Cell adhesion is a biological process by which a single cell forms a network of cells in the body such as in the veins and blood vessels (vasculature). Cell adhesion is important for determining cell morphology, mitosis, cell movement, cell aggregation in the body. The process of cell adhesion has many roles in different diseases including, cancer, autoimmune diseases (type 1 diabetes mellitus, arthritis, multiple sclerosis), and thrombosis. For example (see illustration), normal cells are anchored (adhesion) to the extracellular matrix by means of receptors (proteins) located on the cell surface. These receptors attach to extracellular matrix proteins, such as Fibronectin (Fn), Vitronectin (Vn), Fibrinogen (Fg), Laminin (Lm), and Collagen (Cg). The receptors on the cell surface come from a family of proteins called Integrins. In contrast, cancer cells that do metastasize do not have adhesion properties to the extracellular matrix, and cancer cells can move freely to other parts of the body because they are not attached to the extracellular matrix proteins (see illustration). Cell adhesion also plays a role in the process of clotting (aggregation) of platelets in the blood (thrombosis). This process begins with the activation of platelets which causes the gpIIb/III receptors (Integrin family) to change structure and interact with fibrinogen in the plasma. Because fibrinogen consists of three chains (alpha, beta, gamma) each of which has a sequence recognized (Arg-Gly-Asp or RGD) by the gpIIb/IIIa receptor, several platelet cells can attach to a single fibrinogen molecule.

Types of cell adhesion Cell adhesion
is mediated by receptor proteins on the cell surface belonging to the integrin, immunoglobulin, and cadherin families. There are two categories of cell adhesion:
  • cell adhesion to extracellular matrix proteins such as Fibronectin, Vitronectin, etc. (as mentioned above); and
  • cell adhesion to other cells.

Cell adhesion can be with similar cells (homotypic) and different types of cells (heterotypic). Examples of conspecific cell adhesion (homotypic cell adhesion) can be found in the cell nets of the blood vessels (vascular endothelial) and the epithelial cell lining of the intestine. Heterotypical cell adhesion can be found in the interaction of T cells with antigen-presenting cells or in the adhesion of T cells to the vascular endothelial.

[5]Collagen is the main protein in the extracellular matrix and is a family of fibrous proteins found in all multicellular animals. The main types of collagen found in connective tissue are types I, II, III, V, and XI. Collagen polypeptide chains are synthesized on membrane-bound ribosomes and inserted into the lumen of the endoplasmic reticulum as large precursors, called pro-α chains. Each pro-α chain then joins with the other two to form a hydrogen-bonded, triple-stranded helix molecule known as procollagen. After secretion, fibrillar procollagen molecules are cut into collagen molecules, which assemble into fibrils. In its utilization, collagen is used for cosmetic ingredients so that the skin becomes firm because of its flexibility.

[6]Oncogenes (English: oncogene) are modified genes that increase the malignancy of tumor cells. Oncogenes generally play a role in the early stages of tumor formation. Oncogenes increase the likelihood of normal cells becoming tumor cells, which can eventually lead to cancer. Recent research has shown that short RNAs (small RNAs) as long as 21-25 nucleotides known as microRNAs (miRNAs) can control oncogenes. Oncogenes were first discovered by Francis Peyton Rous in 1910[1] while observing tumors in birds that could be transmitted to other creatures because they had sarcoma cells containing a retrovirus, later called RSV (English: Rous sarcoma virus). 1976Dr. John Michael Bishop and Dr. Harold E. Varmus from the University of California San Francisco proved that oncogenes originate from damaged proto-oncogenes. Proto-oncogenes have been found in many organisms, including humans. For this important discovery, Dr. Bishop and Dr. Varmus received the Nobel Prize in 1989.

[7] Proto-oncogenes are normal genes that can become oncogenes when they are mutated, or when their expression is increased. Proto-oncogenes encode proteins that are necessary for cells to regulate proliferation and differentiation. Proto-oncogenes are often found to play a role in signal transduction and execution of mitogen signals, which are generally carried out by the protein products they produce. Once activated, proto-oncogenes or their products become tumor inducers called oncogenes.

Proto-oncogenes can become oncogenes with minor modifications to their original function. There are two types of activation, a mutation occurs in an oncogene resulting in a change in protein structure, which is caused by:
  • increased activity of proteins (enzymes)
  • loss of regulation
  • the occurrence of hybrid between proteins through chromosomal damage in cell division. It is known that chromosomal damage

Occurs when cell division in the spinal cord can cause leukemia, increased protein concentration, which is caused by:
  • increased protein expression due to misregulation
  • increased protein stability, which makes its presence and activity in cells longer
  • gene duplication, which results in an increase in the amount of protein in the cell.

Type: v-erbA is an oncogene protein derived from the proto-oncogene c-erbA type alpha which is a core absorber of T3/T4 hormones, and retinoic acid,[4] which is activated by avian erythroblastosis virus (AEV), which causes leukemia in chickens by inhibiting erythrocyte progenitor cell differentiation and triggering sarcomatous transformation.

bcl-2, a proto-oncogene activated by chromosomal translocation in lymphoma, transforms into an oncogene that inhibits lymphoid cell apoptosis. In normal mode, the bcl-2 gene stores protein data from the inner mitochondrial membrane, endoplasmic reticulum and cell nucleus membrane, and functions as part of the antioxidant substances that inhibit lipid peroxidation in cell membranes.

Cell division factors (Growth factors)
Cell division factors, or mitogens, are generally produced by some specialized cells to induce cell division. If a cell that normally does not produce growth factors suddenly starts producing them (because they turn into oncogenes), the cell will experience uncontrolled division. It can also spread to adjacent cells.


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