Why would esophageal cancer spread to the brain a few years after the patient got the “all clear” following treatment?

Just how reassuring is that “no evidence of disease” result in a patient who’s been treated for esophageal cancer — when it’s possible that a few years later, a head scan will show metastases in the brain?

“One of the frustrating aspects of caring for and/or operating on cancer patients is that staging scans for metastases will not detect a small metastatic deposit — a so-called micrometastasis,” says Alex Little, MD, a thoracic surgeon with a special interest in esophageal and lung cancer.

“Time goes by, and the originally small number of [non-detected] cells eventually grow, spread and do their damage.”

The esophageal cancer – or any cancer in this scenario – has not “come back,” as is often termed the case.

This is why the proclamation of “We got it all” needs to be taken with a grain of salt; not too literally.

Dr. Little continues, “This is particularly true if the micrometastasis is in the brain, as chemotherapeutic drugs may not penetrate the blood-brain barrier — so that chemotherapy is not able to kill them.

“So it’s more likely the malignant cells were in the brain all the time, just undetected until they grew enough to be symptomatic, and did not spread later.”

Alex Little, MD, trained in general and thoracic surgery at the Johns Hopkins University School of Medicine; has been active in national thoracic surgical societies as a speaker and participant, and served as president of the American College of Chest Physicians. He’s the author of “Cracking Chests: How Thoracic Surgery Got from Rocks to Sticks,” available on Amazon.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.


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