Colorectal Cancer Spread to Lungs: Prognosis & Care
Colorectal Cancer Spread to Lungs: Prognosis & Care Colorectal cancer is a serious disease that affects thousands of individuals each year. In some cases, the cancer may spread beyond the colon and rectum to other parts of the body, including the lungs. When colorectal cancer spreads to the lungs, it can complicate prognosis and treatment options.
At Acıbadem Healthcare Group, we understand the challenges faced by patients with colorectal cancer that has spread to the lungs. Our team of experts is dedicated to providing comprehensive care and personalized treatment plans for each individual.
We will discuss the various treatment options available, the importance of early detection, and effective management of metastatic disease. Whether it’s targeted therapy, surgical interventions, or multidisciplinary care, we strive to offer the most advanced and effective treatments.
Early detection of lung metastases is crucial in improving patient outcomes. We will explore screening methods, signs and symptoms to watch out for, and the significance of regular follow-ups for patients at risk. Additionally, we will discuss strategies for managing metastatic colorectal cancer and preventing the further spread of the disease to the lungs.
At Acıbadem Healthcare Group, we believe in personalized approaches to treatment. We take into account each patient’s individual needs and genetic profile to develop tailored treatment plans. Our team also understands the importance of supportive care and lifestyle changes in maintaining physical and emotional well-being during treatment.
Join us as we explore the latest advancements in research related to colorectal cancer that has spread to the lungs. We will discuss ongoing studies, emerging treatment options, and future perspectives in the field. Together, we strive to improve the prognosis and quality of life for patients with colorectal cancer and lung metastases.
Trust Acıbadem Healthcare Group for expert care and innovative treatments for colorectal cancer spread to the lungs. Your health is our priority.
Understanding Colorectal Cancer Metastasis
In this section, we will delve into how colorectal cancer spreads to the lungs through the process of metastasis. Metastasis is the spread of cancer cells from the primary tumor to other parts of the body, and the lungs are a common site for metastases in colorectal cancer patients.
Colorectal cancer metastasis occurs when cancer cells break away from the primary tumor in the colon or rectum and travel through the bloodstream or lymphatic system to establish new tumors in the lungs. The process of metastasis involves several steps, including invasion of surrounding tissues, intravasation into blood or lymph vessels, transportation through the circulatory or lymphatic system, extravasation into distant tissues, and colonization to form new tumors.
There are several risk factors that increase the likelihood of colorectal cancer spreading to the lungs. These risk factors include advanced stage of the primary tumor, lymph node involvement, aggressive tumor characteristics, and inadequate treatment response. Understanding these risk factors can help healthcare providers identify patients who are at a higher risk of developing lung metastases.
The lungs are particularly susceptible to metastases because they receive a significant amount of blood supply and have a rich network of blood vessels. Furthermore, the anatomy of the lungs provides numerous sites for cancer cells to establish new tumors.
Early detection of lung metastases is crucial for improving patient outcomes. Regular monitoring and imaging tests, such as chest X-rays, CT scans, and PET scans, play a crucial role in identifying the presence of lung metastases at an early stage. Early detection allows for prompt intervention and the implementation of appropriate treatment strategies.
Now, let’s take a closer look at the mechanisms behind colorectal cancer metastasis to the lungs and explore the risk factors associated with lung metastases.
Treatment Options for Lung Metastases
When colorectal cancer spreads to the lungs, it is essential to explore effective treatment options to improve patient outcomes. To address this, there are various non-surgical and surgical interventions available that target lung metastases. These treatment options include targeted therapy and surgical removal of the metastases.
Targeted Therapy for Lung Metastases
Targeted therapy is a specialized treatment approach that focuses on specific molecular targets within cancer cells. In the case of lung metastases from colorectal cancer, targeted therapies are designed to inhibit the growth and spread of cancer cells that have reached the lungs.
One example of targeted therapy for lung metastases is cetuximab, a monoclonal antibody that targets the epidermal growth factor receptor (EGFR). By blocking EGFR, cetuximab can help slow down or stop the progression of lung metastases from colorectal cancer.
Another targeted therapy option is bevacizumab, a monoclonal antibody that targets vascular endothelial growth factor (VEGF). By inhibiting VEGF, bevacizumab can help reduce the blood supply to tumors in the lungs, effectively impeding their growth and spread.
Surgical Options for Lung Metastases
Surgical removal of lung metastases can also be considered as a treatment option for patients with colorectal cancer. The goal of surgery is to remove the metastases from the lungs, potentially offering a chance for long-term disease control and improved survival.
The suitability of surgical intervention depends on various factors, including the number and location of the metastases, the overall health of the patient, and the extent of disease in other parts of the body. Typically, patients with limited and resectable lung metastases are considered for surgical removal.
Some surgical options for lung metastases include:
- Wedge resection: This procedure involves removing a small portion of the lung tissue that contains the metastasis.
- Lobectomy: In a lobectomy, an entire lobe of the lung is removed.
- Pneumonectomy: Pneumonectomy is a surgical procedure in which the entire lung is removed.
The choice of surgical option depends on the size, number, and location of the lung metastases, as well as the patient’s overall health and individual circumstances.
It’s important for patients with colorectal cancer and lung metastases to consult with a multidisciplinary team of healthcare professionals to determine the most appropriate treatment approach. The team may include medical oncologists, surgical oncologists, radiation oncologists, and other specialists who will work together to develop a personalized treatment plan.
Prognosis of Colorectal Cancer Spread to Lungs
In this section, we will examine the prognosis of colorectal cancer that has spread to the lungs. Understanding the prognosis is critical in guiding treatment decisions and providing patients and their families with valuable information regarding their disease.
The prognosis of colorectal cancer spread to the lungs can vary depending on several factors. These factors include the stage of the cancer, the extent of lung metastases, the overall health of the patient, and the effectiveness of the chosen treatment plan.
Factors Influencing Prognosis
Various factors can influence the prognosis of colorectal cancer spread to the lungs. These factors include:
- Tumor stage: The stage of the colorectal cancer at the time of diagnosis plays a crucial role in prognosis. Early-stage cancers that have not yet metastasized to the lungs generally have a better prognosis compared to advanced-stage cancers.
- Extent of lung metastases: The number and size of lung metastases can impact the prognosis. Smaller and fewer metastases may respond better to treatment and offer a more favorable prognosis.
- Response to treatment: The efficacy of the chosen treatment plan, including chemotherapy, targeted therapy, and surgery, can significantly influence prognosis. A positive response to treatment may improve prognosis and extend survival.
- Overall health: The overall health and well-being of the patient also play a role in prognosis. Patients who are in good health and have a strong immune system may have a better prognosis compared to those with underlying health conditions.
Survival Rates
Survival rates for colorectal cancer spread to the lungs vary depending on the individual case and treatment approach. It is important to note that survival rates are statistics and cannot predict the outcome for an individual patient. However, they can provide a general understanding of the disease’s prognosis.
The following table provides an overview of survival rates based on various factors:
| Factor | 5-Year Survival Rate |
|---|---|
| Early-stage diagnosis | Approximately 80-95% |
| Advanced-stage diagnosis | Approximately 14-20% |
| Successful treatment response | Varies depending on individual case and treatment |
Note: The survival rates provided above are general estimates and may not reflect the individual prognosis of each patient. It is crucial to consult with a healthcare professional for the most accurate and personalized prognosis.
Importance of Early Detection
Early detection plays a vital role in improving the prognosis for colorectal cancer that has spread to the lungs. When lung metastases are detected at an early stage, treatment interventions can be initiated promptly, leading to better outcomes for patients.
Regular screenings, such as colonoscopies and imaging tests, can help detect colorectal cancer early, allowing for timely treatment and potentially preventing the spread of the disease to the lungs. Additionally, awareness of the signs and symptoms of lung metastases, such as persistent cough, shortness of breath, and chest pain, can prompt individuals to seek medical attention as soon as possible.
By prioritizing early detection efforts, healthcare providers can improve the prognosis of colorectal cancer spread to the lungs and ultimately enhance patient outcomes.
Early Detection of Lung Metastases
In the management of colorectal cancer that has spread to the lungs, early detection plays a critical role in improving patient outcomes. By detecting lung metastases at an early stage, healthcare providers can intervene promptly and implement appropriate treatment strategies. Regular screenings and close monitoring of patients at risk are essential for early detection.
Screening methods for the early detection of lung metastases include:
- Chest X-rays: This non-invasive imaging technique can detect abnormalities in the lungs, such as the presence of tumors or nodules.
- Computed Tomography (CT) Scans: A CT scan provides detailed cross-sectional images of the lungs, allowing healthcare providers to identify any signs of metastatic disease.
It is crucial for patients to be aware of potential signs and symptoms that may indicate lung metastases. These may include:
- Persistent cough or chest pain
- Shortness of breath
- Coughing up blood
- Unexplained weight loss
Patients who experience any of these symptoms should promptly report them to their healthcare provider for further evaluation. Regular follow-ups with healthcare providers are recommended for patients who have been diagnosed with colorectal cancer, especially those at a higher risk of developing lung metastases.
The Importance of Regular Follow-ups
Ongoing monitoring and follow-up visits enable healthcare providers to closely monitor the patient’s condition and detect any signs of lung metastases in a timely manner. During these follow-up visits, healthcare providers may perform imaging tests, such as chest X-rays or CT scans, to assess the patient’s lung health.
Regular follow-ups also provide an opportunity for healthcare providers to assess the effectiveness of treatment interventions and make any necessary adjustments to the treatment plan. They offer a supportive environment where patients can discuss any concerns or changes in their symptoms with their healthcare team.
Managing Metastatic Colorectal Cancer
In the management of metastatic colorectal cancer, a multidisciplinary approach is key. Treatment options vary based on individual factors, and may include chemotherapy, radiation therapy, surgery, and other supportive treatments.
Chemotherapy: Chemotherapy is often used as a first-line treatment for metastatic colorectal cancer. It involves the use of drugs to kill cancer cells or stop them from growing. Different chemotherapy regimens may be used, depending on the patient’s specific needs.
Radiation therapy: Radiation therapy uses high-energy beams to target and destroy cancer cells. It may be used to relieve symptoms and shrink tumors in patients with metastatic colorectal cancer. This treatment is often combined with other therapies for optimal results.
Surgery: In some cases, surgical intervention may be an option for patients with metastatic colorectal cancer. Surgical removal of the primary tumor and metastases can help improve prognosis and relieve symptoms. However, not all patients are eligible for surgery, and the decision depends on various factors.
Other supportive treatments: Alongside primary treatments, supportive care plays a crucial role in managing metastatic colorectal cancer. Palliative care, pain management, and psychological support are essential to improve quality of life for patients and their families.
To prevent the spread of colorectal cancer to the lungs, early detection and effective treatment of primary colorectal tumors are crucial. Regular screenings, such as colonoscopies, can help identify precancerous polyps and early-stage cancers, reducing the risk of metastasis. Lifestyle modifications, such as maintaining a healthy weight, following a balanced diet, and avoiding smoking, may also contribute to preventing the spread of colorectal cancer.
The following table summarizes the treatment options for managing metastatic colorectal cancer:
| Treatment Option | Description |
|---|---|
| Chemotherapy | Administering drugs to kill or hinder the growth of cancer cells. |
| Radiation Therapy | Using high-energy beams to target and destroy cancer cells. |
| Surgery | Removing primary tumor and metastases through surgical intervention. |
| Supportive Treatments | Palliative care, pain management, and psychological support. |
Targeted Therapy for Lung Metastases
In the treatment of lung metastases from colorectal cancer, targeted therapies have emerged as a promising approach. Unlike traditional chemotherapy, targeted therapies are designed to specifically attack cancer cells while minimizing damage to healthy tissues. These therapies work by targeting specific molecular alterations that drive the growth and spread of cancer.
Targeted therapy for lung metastases focuses on inhibiting the signaling pathways that promote tumor growth and survival. By disrupting these pathways, targeted therapies can slow down or even shrink the metastatic tumors, improving patient outcomes.
There are various types of targeted therapies that have shown efficacy in treating lung metastases from colorectal cancer:
- Monoclonal Antibodies: These are laboratory-produced antibodies that can recognize and bind to specific proteins on cancer cells, inhibiting their growth and spread. Monoclonal antibodies commonly used in the treatment of lung metastases include cetuximab (Erbitux) and panitumumab (Vectibix).
- Tyrosine Kinase Inhibitors (TKIs): TKIs are small molecules that block the activity of specific enzymes called tyrosine kinases, which are essential for the growth and survival of cancer cells. Examples of TKIs used in targeted therapy for lung metastases include regorafenib (Stivarga) and vandetanib (Caprelsa).
- Angiogenesis Inhibitors: These drugs target the formation of new blood vessels that supply nutrients to the tumor, effectively cutting off its blood supply and preventing further growth. Bevacizumab (Avastin) is an angiogenesis inhibitor that has shown efficacy in treating lung metastases.
In addition to these targeted therapies, other molecularly targeted agents, such as immune checkpoint inhibitors, may also play a role in the treatment of lung metastases from colorectal cancer. These agents work by unleashing the immune system against cancer cells, leading to tumor regression and improved survival.
It is important to note that targeted therapies are often used in combination with other treatment modalities, such as chemotherapy or surgery, to maximize their effectiveness. The choice of targeted therapy depends on several factors, including the specific genetic alterations present in the tumor and the patient’s overall health.
Targeted therapy for lung metastases represents a significant advancement in the management of colorectal cancer. By specifically targeting the molecular changes driving tumor growth, these therapies have the potential to improve outcomes and provide hope for patients with this challenging condition.
| Types of Targeted Therapy | Examples |
|---|---|
| Monoclonal Antibodies | Cetuximab (Erbitux) Panitumumab (Vectibix) |
| Tyrosine Kinase Inhibitors (TKIs) | Regorafenib (Stivarga) Vandetanib (Caprelsa) |
| Angiogenesis Inhibitors | Bevacizumab (Avastin) |
Surgical Options for Lung Metastases
When it comes to treating colorectal cancer that has spread to the lungs, surgical intervention is one of the key options available. Surgical procedures can help remove lung metastases and alleviate symptoms, improving the overall prognosis for patients.
There are several different surgical options that may be considered for lung metastases from colorectal cancer. The choice of procedure depends on various factors, including the size and location of the metastases, the overall health of the patient, and the extent of the disease.
Surgery Types for Lung Metastases
The following are some of the surgical options commonly used to remove lung metastases:
- Wedge Resection: This procedure involves removing a small, wedge-shaped portion of the lung that contains the metastasis.
- Lobectomy: A lobectomy involves removing an entire lobe of the lung that contains the metastasis. It is considered the standard surgery for larger or centrally located metastases.
- Bilobectomy: In some cases, when metastases are present in two adjacent lobes of the lung, both lobes may need to be removed.
- Pneumonectomy: This surgery involves removing an entire lung when metastases are extensive or located in a specific area of the lung.
It’s important to note that surgical options may not be suitable for all patients. The decision to undergo surgery is made based on careful evaluation by a multidisciplinary team of healthcare professionals, including surgeons, oncologists, and pulmonologists.
Risks and Benefits of Surgery
Like any surgical procedure, there are potential risks associated with lung metastasis removal. Common risks include infection, bleeding, and complications related to anesthesia. It’s essential for patients to have a thorough discussion with their healthcare team to understand the potential benefits and risks specific to their situation.
| Surgical Options | Potential Benefits | Potential Risks |
|---|---|---|
| Wedge Resection | – Minimally invasive procedure – Preserves lung function – Shorter hospital stay |
– Risk of recurrence – Potential for incomplete removal of metastasis – Potential for air leakage from the lung |
| Lobectomy | – Provides definitive treatment – Higher chance of complete metastasis removal – Long-term survival benefits |
– Longer hospital stay – Higher risk of complications – Longer recovery time |
| Bilobectomy | – Removes metastases in two lobes – Potential for complete removal |
– Higher risk of complications – Longer recovery time |
| Pneumonectomy | – Removes extensive metastases – Potential for complete removal in specific cases |
– Loss of one lung – Higher risk of complications – Longer recovery time |
It’s important for patients to have a comprehensive understanding of the potential benefits and risks of surgical interventions. This knowledge can help them make informed decisions about their treatment plan in consultation with their healthcare team.
In conclusion, surgical options for removing lung metastases from colorectal cancer play a significant role in the management and prognosis of patients. However, the decision to undergo surgery should be made based on individual factors and in close collaboration with a multidisciplinary team of healthcare professionals.
Personalized Approaches to Treatment
When it comes to treating colorectal cancer that has spread to the lungs, personalized approaches play a crucial role. Recognizing that each patient is unique, healthcare providers are increasingly tailoring treatment plans to address individual needs and characteristics. This personalized approach allows for more targeted and effective interventions, ultimately improving patient outcomes.
Genetic testing plays a significant role in guiding personalized treatment decisions. By analyzing an individual’s genetic profile, healthcare professionals can gain valuable insights into the specific mutations and genetic alterations that drive the growth and spread of cancer. Armed with this information, they can then develop customized treatment strategies that specifically target these genetic abnormalities.
Take a look at the table below to understand the key aspects of personalized approaches to treatment for colorectal cancer that has spread to the lungs:
| Treatment Approach | Description |
|---|---|
| Targeted Therapy | This type of treatment directly targets the specific genes or proteins implicated in the growth and spread of cancer. By blocking the signaling pathways that promote tumor growth, targeted therapies can inhibit cancer progression and shrink tumors. |
| Immunotherapy | Immunotherapy harnesses the power of the body’s immune system to fight cancer. By enhancing the immune response against cancer cells, immunotherapeutic agents help the body recognize and destroy cancer cells more effectively. |
| Chemotherapy | Chemotherapy involves the use of drugs to kill cancer cells. While it may not be as precisely targeted as other treatment approaches, chemotherapy can still be individualized by selecting specific drugs and dosages based on genetic factors. |
| Surgical Intervention | For some patients, surgical removal of lung metastases may be an option. The decision for surgery is individualized, taking into consideration factors such as tumor size, location, and overall health of the patient. |
| Combination Therapies | Often, a combination of different treatment modalities is used to maximize effectiveness. Treatment plans may include a combination of targeted therapy, immunotherapy, chemotherapy, and surgery, tailored to the specific needs of each patient. |
By adopting personalized approaches to treatment, healthcare providers can optimize outcomes for patients with colorectal cancer that has spread to the lungs. Through genetic testing and individualized treatment planning, patients receive the most effective interventions for their unique circumstances, helping to improve survival rates and quality of life.
Supportive Care and Lifestyle Changes
For patients with colorectal cancer that has spread to the lungs, supportive care and lifestyle changes play a crucial role in improving overall well-being and managing treatment side effects. Implementing strategies that address physical and emotional needs can greatly enhance the quality of life during this challenging time.
Managing Treatment Side Effects
As patients undergo treatment for colorectal cancer metastasized to the lungs, they may experience various side effects. Supportive care measures aim to alleviate these symptoms and enhance comfort. Some common side effects and their management strategies include:
- Nausea and vomiting: Antiemetic medications may be prescribed to control these symptoms. Altering the diet by consuming smaller, more frequent meals can also help.
- Loss of appetite: Nutrition plays a vital role in supporting overall health. Small, nutrient-dense meals and snacks can help maintain energy levels. Consulting a registered dietitian for personalized recommendations is highly recommended.
- Fatigue: Frequent rest breaks, gentle exercise routines, and prioritizing activities can help manage fatigue. Adequate sleep and maintaining a balanced sleep-wake cycle are also essential.
- Pain: Pain management may involve medications prescribed by healthcare professionals. Targeted therapies or other interventions may be recommended based on an individual’s situation.
- Changes in bowel habits: Specialized diets, medications, and lifestyle modifications may be recommended to manage changes in bowel habits associated with treatment.
- Emotional well-being: The emotional impact of a cancer diagnosis and treatment cannot be overlooked. Support groups, counseling services, and engaging in relaxing activities can help reduce anxiety and improve emotional well-being.
Maintaining Physical and Emotional Well-being
Alongside managing treatment side effects, patients can focus on maintaining their physical and emotional well-being through lifestyle changes. These include:
- Regular exercise: Engaging in physical activity, based on individual capabilities, can improve overall fitness, boost mood, and reduce fatigue. Consultation with healthcare professionals before initiating an exercise routine is important.
- Healthy diet: A nutrient-rich diet consisting of fruits, vegetables, whole grains, and lean proteins can support the body’s healing process. Limiting processed foods and sugar intake is also recommended.
- Stress management: Practicing relaxation techniques such as meditation, deep breathing exercises, and mindfulness can help reduce stress levels. Engaging in hobbies, spending time with loved ones, and seeking emotional support are also beneficial.
- Sleep hygiene: Establishing a regular sleep schedule and creating a soothing bedtime routine can promote better sleep quality. Minimizing screen time before bed and ensuring a comfortable sleep environment are additional important factors.
- Preventive healthcare: Regular check-ups, screenings, and vaccinations are essential for maintaining overall health and preventing complications. Consult with healthcare professionals to determine the appropriate preventive measures.
Incorporating these supportive care strategies and lifestyle changes can have a positive impact on the well-being of patients with colorectal cancer that has spread to the lungs. It is important to work closely with healthcare professionals to tailor these interventions to individual needs and circumstances.
Advances in Research and Future Perspectives
In recent years, remarkable advances in research have been made in understanding and treating colorectal cancer that has spread to the lungs. Ongoing studies have focused on identifying new targets for therapy, developing innovative treatment approaches, and improving patient outcomes. These advances offer hope for patients and pave the way for future perspectives in the field.
One area of research that shows promise is immunotherapy, which harnesses the power of the immune system to fight cancer cells. Clinical trials exploring the use of immune checkpoint inhibitors have demonstrated encouraging results in patients with metastatic colorectal cancer, including those with lung metastases. Further research in this area could lead to more effective and targeted immunotherapeutic strategies.
In addition to immunotherapy, targeted therapies tailored to specific genetic mutations have shown efficacy in treating colorectal cancer. Precision medicine approaches that use comprehensive genomic profiling can identify actionable mutations and guide targeted treatment decisions. Future perspectives in this field involve the development of novel targeted agents and the refinement of personalized treatment strategies.Colorectal Cancer Spread to Lungs: Pro
Furthermore, advancements in diagnostic techniques and imaging modalities have improved early detection and accurate staging of lung metastases. This is especially significant for patients with colorectal cancer, as early detection allows for timely intervention and better outcomes. Ongoing research aims to enhance these diagnostic tools and identify new biomarkers that can aid in the early detection of lung metastases.
FAQ
What is colorectal cancer metastasis?
Colorectal cancer metastasis refers to the spread of cancer cells from the colon or rectum to other parts of the body, including the lungs. When colorectal cancer spreads to the lungs, it is called lung metastases from colorectal cancer.
What are the treatment options for lung metastases?
The treatment options for lung metastases from colorectal cancer depend on various factors, including the extent of metastasis and the patient's overall health. Non-surgical treatment options may include chemotherapy, targeted therapy, and radiation therapy. Surgical options may involve the removal of lung metastases through a procedure called metastasectomy.
What is the prognosis of colorectal cancer spread to the lungs?
The prognosis of colorectal cancer spread to the lungs can vary depending on several factors, such as the stage of the primary cancer, the extent of lung metastases, and the response to treatment. Early detection and effective management play a crucial role in improving outcomes and prolonging survival.
How can lung metastases from colorectal cancer be detected early?
Early detection of lung metastases can be achieved through regular follow-ups and monitoring for signs and symptoms. Imaging tests, such as chest X-rays, CT scans, and PET scans, may help in detecting the presence of lung metastases. Increased awareness of potential symptoms and close collaboration with healthcare professionals are essential for early detection.
How is metastatic colorectal cancer managed?
The management of metastatic colorectal cancer involves a multidisciplinary approach, including chemotherapy, radiation therapy, targeted therapy, and supportive care. Individualized treatment plans are tailored to each patient's specific needs and may depend on factors such as the location and extent of metastases, overall health, and genetic makeup.
Are there targeted therapy options for lung metastases?
Yes, targeted therapy options are available for lung metastases from colorectal cancer. These therapies specifically target cancer cells with certain genetic mutations or abnormalities, aiming to inhibit their growth and spread. Targeted therapies may be used alone or in combination with other treatment modalities.
What are the surgical options for lung metastases?
Surgical options for lung metastases may include the removal of tumors through a procedure called metastasectomy. The eligibility for surgery depends on various factors, including the number, size, and location of lung metastases, as well as the patient's overall health and fitness for surgery. The decision for surgical intervention is made on an individual basis, considering the potential benefits and risks.
How can the spread of colorectal cancer to the lungs be prevented?
Preventing the spread of colorectal cancer to the lungs involves effective management of the primary cancer, including early diagnosis, proper staging, and appropriate treatment. Regular follow-ups and surveillance after treatment are crucial to monitor for any signs of recurrence or metastasis. Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding risk factors such as smoking, may also help reduce the risk of metastasis.
