What is it about?

Metastasis, in Greek, means removal or migration, dislocation, but also departing from life. Plato and Aristotle used the term metastasis to discuss the change, by revolution or transition, of a political constitution. In a medical context, metastasis means the transference of the seat of disease. In the texts of the Hippocratic corpus (c. 5th–4th century BC), there are at least nine entries for metastasis (μετάστασις), some in well-known treatises. These entries, however, appear in a context, unrelated to cancer, a disease, nevertheless, amply, repeatedly and clearly described in the corpus. The ancients were aware that cancer could spread to regional lymph nodes but for this development they used the term "sympathy" not metastasis. As late as the 19th century, the Boston Medical and Surgical Journal (the precursor of the NEJM) proposes "gout" as a remarkable instance of metastasis! As far as cancer is concerned, "metastasis" achieves its current meaning of "disseminated neoplasia", in the early 20th century.

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Why is it important?

It would appear that the current meaning of metastasis in cancer, is the result of the discovery of circulating malignant cells in the peripheral blood and better understanding of the biology of the disease.

Perspectives

Today we are perplexed with the propensity of uveal melanoma to metastasize to the liver in 95% of cases, occasionally as many as 20 years or longer after enucleation of the eye harbouring the primary lesion, whereas this same tumour hardly ever metastasizes to the brain. Is this a haematogenous metastasis or is it an as yet unidentified "sympathy" between the choroid of the eye and the liver?

Dr Spyros Retsas

Read the Original

This page is a summary of: Cancer and the arts: metastasis—as perceived through the ages, ESMO Open, July 2017, BMJ,
DOI: 10.1136/esmoopen-2017-000226.
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