What was the progression of your mets?
 

I've been a lurker but this is my first post.

I was dx'ed with a recurrence in my brain only at the beginning of the year. I read that brain as the first/only site of mets was becoming more common due to the targeted therapies killing the cancer in the body but the escaped cells squeezing through the BBB. Well my body scans were clear for months but the last one showed something in my liver. My onc isn't jumping to the conclusion that's it's mets but agrees it's suspicious because it's new.

If it is mets, is it more likely a) the cancer squeezed its way back through the BBB or b) there was cancer there all along but since I was on systemic treatment for 7 months, it wasn't big enough to show up until I took a break from systemic treatment? Brain as the first/site of mets is still unusual enough that I haven't found anyone else in the same situation.

Re: What was the progression of your mets?
 

My first confirmed mets were in my liver. But I was metsastatic at diagnosis, so no conclusions about the effects of earlier treatment can be drawn, since there was none.

My liver mets cleared up on first treatment protocol. Then I got a bone met. Then, over the course of several years, gradually worsening lung mets. I had one brain MRI as part of initial staging--no symptoms and no further scans.

I should say that it's not at all clear how metastasis works. The theory that systemic treatment controls them in the body, but can't do the brain because the drugs don't cross the blood brain barrier, makes sense and is pretty widely held, but it's still just a theory. I haven't ever heard before that cancer stem cells or whatever they are in the brain might cross the BBB to go take up residence in a liver. But I suppose it's possible.

One thing I've heard recently (don't recall the source) is that mets and the original tumor are actually different enough that they may need different treatment approaches. I don't know. But it's worth considering.

The main point is, if we actually understood how metastasis works we could cure it, or prevent it. That'll be the day.

Re: What was the progression of your mets?
 

My first (and at this time) mets were skeletal. I had just an 18 month reprieve from early stage treatment before being Dx'd. At the inception of early stage treatment (surgery,chemo and radiation), I had a PET/CT that was clear of mets.

I have had two clear brain MRIs in the last two years and there is no evidence of mets there (thank you, GOD). So where did my mets come from? Likely stem cells not actively dividing when I was doing treatment.

Currently, there is no way to address stem cells in cancer treatment. This is where the cure will come from.