Tumors are malignant only if they can invade other parts of the body. Malignant tumors extend into neighboring tissue or travel to distant sites, forming secondary growths known as metastases. To metastasize, tumor cells break through a nearby blood vessel to enter the circulatory system or through a lymphatic vessel wall to enter the lymphatic system.
Lung cancer begins when epithelial cells lining the respiratory tract start to reproduce in an uncontrolled fashion. These cells invade surrounding tissue, forming a mass called a tumor and, when hardened, a carcinoma. Cancerous cells may penetrate blood and lymph vessels, to be carried through the body until they reach a juncture through which they cannot pass. At this point, they lodge and new tumors form. Metastasis, the spreading of cancer from its original location to other parts of the body, is the diseaseís most destructive characteristic.
Most metastases occur in organs that are the next site downstream in the circulatory system or the lymphatic system and contain a network of capillaries, or small blood vessels. For example, cancer of the large intestine often travels through the bloodstream to the liver, the organ immediately downstream from the intestines. In the lymphatic system, tumor cells can spread to surrounding lymph nodes, or lymph glands. Normally, lymph nodes filter out and destroy infectious materials circulating in the lymphatic system. The unique receptors on the surface of a cell may also play a role in where tumors metastasize. Specialized molecules on a cellís surface identify where in the body the cell belongs. Similar cells adhere to one another when their surface receptors are compatible. Most often cells from different tissues and organs have incompatible surface receptors. However, some tissue types share similar surface receptors, enabling cancerous cells to move between them and proliferate. Prostate cells and bone cells, for example, have similar surface receptors. This gives prostate cancer cells a natural affinity for bone tissue, where they can settle to form a new tumor. Many cancers shed cells into the bloodstream early in their growth. Most of these cells die in the bloodstream, but some lodge against the surface of the blood vessel walls, eventually breaking through them and into adjacent tissue. In some cases, these cells survive and grow into a tumor. Others may divide only a few times, forming a small nest of cells that remain dormant as a micrometastasis. They may remain dormant for many years, only to grow again for reasons not yet known.