Growth and Expansion of the Tumor at the Secondary Site

Expansion of the tumor at its secondary site represents perhaps the most clinically significant of the metastatic steps, for it is this growth and colonization at the target organ that causes the physical disruption and physiologic derangement of that organ, ultimately giving rise to the morbidity and mortality characterizing metastatic disease.

Factors influencing expansion of the metastatic mass are similar to those modulating growth at the primary tumor site. These factors include properties inherent to the metastatic cell itself such as accelerated and uninhibited growth, as well as the ability to co-opt the resources of the secondary target site for the cell's own metabolic requirements.

In addition to its inherent characteristics, the metastasizing cell also relies on a receptive microenvironmental soil to achieve optimal growth at the secondary site. As the site of the primary tumor location, the immunologic, angiogenesis-promoting and growth-stimulatory milieu of the secondary site modulates the extent of metastatic tumor expansion.202-206 Further understanding of those variables that promote successful completion of this last metastatic step may afford new insights into strategies directed at preventing and vanquishing metastatic disease.

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