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Local spread
The cancer grows directly into nearby body tissues. There is more about this in the page on how a cancer grows.
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When it is in the bloodstream, it is swept along by the circulating blood until it gets stuck somewhere, usually in a very small blood vessel called a capillary. Then it must move back through the wall of the capillary and into the tissue of the organ close by. There it must start to multiply to grow a new tumour. As you can see, this is a complicated journey. Most cancer cells do not survive it. Probably, out of many thousands of cancer cells that reach the blood circulation only one will survive to form a secondary cancer or metastasis. Some cancer cells are probably killed off by the white blood cells in our immune system. Others cancer cells may die because they are battered around by the fast flowing blood. Cancer cells in the circulation may try to stick to platelets to form clumps to give themselves some protection. This may also help them to be filtered out in the next capillary network they come across so they can then move into the tissues to start a secondary tumour.
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Micrometastases
Micrometastases are areas of cancer spread (metastases) that are too small to see. If there are individual cells, or even small areas of growing cells elsewhere in the body, no scan is detailed enough to show them. For a few types of cancer, blood tests can detect certain proteins released by the cancer cells. These may give a sign that there are metastases too small to show up on a scan. But for most cancers, there is no blood test that can say whether a cancer has spread or not. For most cancers the doctor can only say whether it is likely or not that a patient has micrometastases. This 'best guess' may be based on the following factors. Previous experience of many other patients treated in the same way. Doctors naturally collect and publish this information to help each other.
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Whether cancer cells are found in the blood vessels in the tumour removed during surgery (for example in testicular cancer). If they are found then cancer cells are more likely to have reached the bloodstream and spread to somewhere else in the body. The grade of the cancer - the higher the grade, the more aggressive the cancer and the more likely that cells have spread. Whether lymph nodes removed during an operation contained cancer cells (for example in breast cancer or bowel cancer). If the lymph nodes contained cancer cells this shows that cancer cells have broken away from the original cancer. But there is no way of knowing whether they have spread to any other areas of the body. This information is important. If the doctor thinks it is likely that there are micrometastases, they may offer further treatment such as chemotherapy, radiotherapy, biological therapy or hormone therapy. Treatment after surgery is called 'adjuvant treatment'. The aim is to kill the areas of cancer cells before they grow big enough to be seen on a scan. Some doctors call this 'belt and braces' treatment. In other words, the treatment is to try to make sure the cancer does not come back. But no one can know for sure if all the cancer cells have been destroyed when someone has finished treatment. It is this uncertainty that can make cancer difficult to cope with for many people, even if they seem to have been successfully treated.
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