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PH-SD09

Invasion, recurrence and cancer cachexia

How cancer cells detach, digest and migrate through tissue, the routes they take and why some tumours spread more than others, why cancer can recur after removal, and how cancer cachexia wastes muscle in ways that feeding cannot fully reverse.

By the end, you can

  • Describe the steps of invasion and the molecules involved: E-cadherin, integrins and matrix metalloproteinases.
  • Compare the routes of spread and explain what determines metastatic potential.
  • Explain local, regional and distant recurrence, including dormancy and late recurrence.
  • Explain the mechanisms of cancer cachexia and how it differs from starvation.

What it is

Invasion is the active movement of cancer cells through the basement membrane and surrounding tissue; metastatic potential is a tumour’s capacity to establish growths at distant sites. Recurrence is the return of a cancer, locally, in regional nodes or at distant sites, after a period in which it could not be detected. Cancer cachexia is a syndrome of continuing loss of skeletal muscle, with or without fat, that ordinary nutritional support cannot fully reverse.

2 types to tell apart
Local, regional and distant recurrence
Local recurrence returns at the original site, regional in the draining nodes, distant as metastases in other organs.
Cachexia and starvation
Cachexia is driven by inflammation and tumour signals and wastes muscle early; starvation is driven by lack of food, spares muscle at first and is reversed by feeding.

US spelling: tumour → tumor.

Normal function

Cells that stay in place

Epithelial cells are held to one another by junctions built on E-cadherin and by desmosomes, and anchored to the by integrins, receptors that bind its laminin and type IV collagen. The epithelium has no vessels of its own: lie in the beneath, and epithelial cells are fed by diffusion across the basement membrane.

Normal cells respect these boundaries. A cell that detaches from its matrix normally dies by a form of apoptosis called anoikis, contact with neighbours slows division, and the matrix is remodelled only under tight control, as when a wound heals.

Skeletal muscle and fat are the body’s great stores of protein and energy. Muscle protein is turned over continuously, and in health synthesis balances breakdown, adjusted by food, activity, insulin and other hormones.

Point to it on the model