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What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? 2024 meta analysis of seeding I didn't see ultrasound in there: https

What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? 2024 meta analysis of seeding I didn't see ultrasound in there: https://pubmed.ncbi.nlm.nih.gov/39605885/ https://pubmed.ncbi.nlm.nih.gov/39605885/ Here is a study on AEs specifically from this type of ultrasound: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0026110 https://journals.plos.org/plosone/article?id=10.1371/journal... Quote: "Cavitation detaches cancer cells/emboli from the primary site and thereby releases them into the circulation, leading to metastasis"

agumonkey 10mo ago
It would not be the first therapy that may promote spread while curing the primary site. Hopefully there are measures to assess the cost / benefits.
- CGMthrowaway 10mo ago
  For sure. Goes without saying in any cancer treatment that cost/benefit is a prime consideration. Still, that will not stop me from asking the question. You can't do that analysis without the answers after all.
  - agumonkey 10mo ago
    Stopping you wasn't my intent. I'm just a visitor sharing some stuff. If any medical professional could give answers that would be neat.
jjtheblunt 10mo ago
> What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? that's discussed in the article
- j16sdiz 10mo ago
  I read it three time and can't see anything related.
  - jjtheblunt 10mo ago
    they mention at the end that the destruction of tissue exposes proteins normal and abnormal to the immune system, with the abnormal ones no longer hidden by tumor structures. if you then search (kagi, google, etc) for this there are results where this worked fantastically.
candiddevmike 10mo ago
> The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood Seems a little too speculatively worded, IMO.
- flir 10mo ago
  If it was true, couldn't you get the same effect by taking a biopsy, fragmenting the cells, and injecting them back in? Like a vaccination, in fact. Somebody must have studied that approach already.
  - cowsandmilk 10mo ago
    Major damage tends to cause a much larger immune response than a vaccination. That said, they do have therapeutic cancer vaccines that present proteins from cancer (sometimes patient-specific) with adjuvants to help stimulate the immune response.
  - londons_explore 10mo ago
    I assume the immune system probably already reacts to this in a specific way. For example, a major bruise has a lot of broken up cells, but doesn't warrant a big immune response.
  - klipt 10mo ago
    Cancer immunotherapy is a whole field of research and treatment, yes.
  - rincebrain 10mo ago
    There were reports that if you inject the goo from melting the tumor into another mouse, that mouse became much more resistant to that class of tumor[1], so... [1] - https://news.engin.umich.edu/2023/10/these-bubbles-kill-cancer/ https://news.engin.umich.edu/2023/10/these-bubbles-kill-canc...
  - f6v 10mo ago
    First issue is that tumors don't necessarily have to be highly immunogenic, e.g. there're tumors that don't present many neoantigens on the surface. This means immune cells can't easily recognize them. Second issue is that tumor microenvironment evolves to be immunosuppressive. There're many different signals that regulate immune cells activation and simply having antigen-specific cells isn't enough. But as someone said in a sister thread, what you're describing is a basis for multiple clinical trials that combine antigen release with immune activation.
pedalpete 10mo ago
It seems they are initially focused on pancreatic cancer, which has a very low survival rate ~14% [1]. In theory, this may mean that metastisizing this tumour could destroy it in the pancreas, but allow the cells to spread to more treatable locations? 1 - https://www.canceraustralia.gov.au/cancer-types/pancreatic-cancer/pancreatic-cancer-australia-statistics https://www.canceraustralia.gov.au/cancer-types/pancreatic-c...
- cowsandmilk 10mo ago
  ?? HistoSonics first target was the liver, second was kidney. Pancreas is the third organ they’ve targeted.
adamredwoods 10mo ago
Chemo post-histrophy would remove any lingering cancer cells effectively. Cancer cells need lots of fuel or they stop replicating, and this is what traditional chemo is great at stopping.
- makestuff 10mo ago
  Is the idea that you would need less chemo after the tumor is broken up to remove any remaining cancer cells versus just starting out with chemo to remove the tumor?
  - adamredwoods 10mo ago
    Chemotherapy isn't always successful, and depends on the tumor's characteristics, but the idea is yes, less chemo. Histrophy is similar to resection, physically removing a tumor. I've seen chemo options for both scenarios with resectable cancers. For example, hormonal therapy is usually prescribed after resectable breast cancer, regardless of outcome. Or, chemo first to shrink the tumor, and have better surgical margins.
- gamblor956 10mo ago
  The keto diet is also very good for this because many (but not all) cancer cells can't metabolize ketones. However recent research from Columbia Medical School suggests that it can promote metastasis.
  - bythreads 10mo ago
    Edited for politeness: Cancer metabolism isn’t a 2-bit meme. Tumors adapt. If they couldn’t, they wouldn’t metastasize.
    - gamblor956 10mo ago
      It's a good thing you edited for politeness because you seemed to be basing your understanding of what I said based on stuff you read on Reddit. A number of studies show that, in humans, the keto diet (the medical keto diet[1] and not the meat heavy Internet version) causes metabolic stress in breast cancer cells and in several other types of cancer, due to their significantly increased metabolic needs. It's like the difference between a normal human and Michael Phelps during Olympic competition. The cancer cells can process ketones, but not efficiently enough to fuel their activity so they starve. In humans this eventually results in the death or deactivation of the cancerous cells (deactivation being the primary way that tumors "adapt" to a starvation diet). There have been few, if any, reported cases of metastasis in the types of cancers studied in humans. This outcome is statistically significant enough that multiple cancer treatment centers recommend the medical keto diet to human patients as part of a treatment regime. As mentioned, the recent study from 2024 shows that this type of metabolic stress can, in mice cause the cancerous cells to metastasize in a last-ditch attempt to survive. However, very little of the cancer research conducted on mice has applications to human cancers. For example, chemotherapy has also been shown to cause metastasis in mice, and a number of earlier studies attempting to replicate the keto research in humans shows that the keto diet in mice increases tumor growth, which is the opposite effect it has in humans. [1] The medical keto diet is basically just fat and vitamins. No carbs, and minimal to no protein because protein can get converted into glucose by gluconeogenesis. It is not a diet anyone would want to be on longer than strictly necessary. One of my friends had stage 4 metastatic lung cancer, which she discovered during a company-sponsored mud run. Surgery was not an option and chemotherapy was not working. With less than 4 months to live, she went on the medical keto diet and the two-punch combo of keto and chemo put the cancer into remission for almost three years. (Note: She only maintained the diet for a few months after ending chemo treatment. Unfortunately not all of the cancer cells had died, some had merely deactivated. Four years after remission the cancer cells reactivated with a vengeance and she died the day after she started showing symptoms.)
TaupeRanger 10mo ago
We simply won’t know until they do the inevitable phase2/3 RCTs. They will need to show that this method helps people survive longer or with better quality of life than the current standard of care.
- cowsandmilk 10mo ago
  HistoSonics has studies published with 50 patients. Their upcoming study with 5000 liver patients obviously will give more information, but we already have some. And with that said, these studies are more relevant than the top of thread linking to a review from 2011 looking at papers from 2005-2006 for ultrasound cavitation causing metastases.
  - observationist 10mo ago
    >>> ... the study found that removing the parachute prior to jumping led to a shocking increase in mortality among skydivers. When there's a clear causal mechanism, additional research that doesn't propose a clear resolution to the underlying problem doesn't negate the clear causal mechanism. Releasing a bunch of loose cancer into the body is a clear causal mechanism, so unless you're filtering it or killing the loose cancer somehow, I'm not sure what those studies could tell you that overcomes the underlying problem. And until they address that problem, it's going to be limited to a quality of life type application - stopping the tumor from killing you now with the certainty of metastasis killing you later.
    - nradov 10mo ago
      So what's the problem? The vast majority of cancer treatments seek only to put the condition into remission for a while. Realistically that's often all that can be done.
      - thaumasiotes 10mo ago
        Putting it into remission is basically the opposite of causing it to metastasize.
amypetrik8 10mo ago
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer. If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"
- deleted 10mo ago
  [deleted]
- jessriedel 10mo ago
  Cancers aren't perfectly optimized to metastasize, and metasteses (rather than, e.g., bulk pressure from the original tumor) are usually what kills you. It's perfectly possible that the procedure kills 90% or 99% of the cells in the original tumor but increases migration of the remaining cells such that the net effect reduces patient survival.
  - elcritch 10mo ago
    Don't cancer metastases have more to do with cancer mutations allowing the cancer cells to form new tumors? Some cancer types tend do not develop the ability to colonize new tumors while others do regularly.
    - jessriedel 10mo ago
      It's quite a bit about that, but it doesn't detract from my point. Mechanical disturbance alone can spread cancer and increase mortality. "The risk of tumor seeding after liver biopsy is 2.7%" https://easl.eu/wp-content/uploads/2018/10/Hepatocellular-Carcinoma-English-Report.pdf https://easl.eu/wp-content/uploads/2018/10/Hepatocellular-Ca... Tissue containment systems for uterine morcellation https://www.fda.gov/medical-devices/safety-communications/update-perform-only-contained-morcellation-when-laparoscopic-power-morcellation-appropriate-fda https://www.fda.gov/medical-devices/safety-communications/up...
yread 10mo ago
Metastasis is not just random tumor cell going for a hike, they are seeded with extracellular vesicles carrying particular mix of microRNAs, growth factors, vimentin and other stuff.

agumonkey 10mo ago

It would not be the first therapy that may promote spread while curing the primary site. Hopefully there are measures to assess the cost / benefits.

CGMthrowaway 10mo ago
For sure. Goes without saying in any cancer treatment that cost/benefit is a prime consideration. Still, that will not stop me from asking the question. You can't do that analysis without the answers after all.
- agumonkey 10mo ago
  Stopping you wasn't my intent. I'm just a visitor sharing some stuff. If any medical professional could give answers that would be neat.

jjtheblunt 10mo ago

> What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? that's discussed in the article

j16sdiz 10mo ago
I read it three time and can't see anything related.
- jjtheblunt 10mo ago
  they mention at the end that the destruction of tissue exposes proteins normal and abnormal to the immune system, with the abnormal ones no longer hidden by tumor structures. if you then search (kagi, google, etc) for this there are results where this worked fantastically.

candiddevmike 10mo ago

> The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood Seems a little too speculatively worded, IMO.

flir 10mo ago
If it was true, couldn't you get the same effect by taking a biopsy, fragmenting the cells, and injecting them back in? Like a vaccination, in fact. Somebody must have studied that approach already.
- cowsandmilk 10mo ago
  Major damage tends to cause a much larger immune response than a vaccination. That said, they do have therapeutic cancer vaccines that present proteins from cancer (sometimes patient-specific) with adjuvants to help stimulate the immune response.
- londons_explore 10mo ago
  I assume the immune system probably already reacts to this in a specific way. For example, a major bruise has a lot of broken up cells, but doesn't warrant a big immune response.
- klipt 10mo ago
  Cancer immunotherapy is a whole field of research and treatment, yes.
- rincebrain 10mo ago
  There were reports that if you inject the goo from melting the tumor into another mouse, that mouse became much more resistant to that class of tumor[1], so... [1] - https://news.engin.umich.edu/2023/10/these-bubbles-kill-cancer/ https://news.engin.umich.edu/2023/10/these-bubbles-kill-canc...
- f6v 10mo ago
  First issue is that tumors don't necessarily have to be highly immunogenic, e.g. there're tumors that don't present many neoantigens on the surface. This means immune cells can't easily recognize them. Second issue is that tumor microenvironment evolves to be immunosuppressive. There're many different signals that regulate immune cells activation and simply having antigen-specific cells isn't enough. But as someone said in a sister thread, what you're describing is a basis for multiple clinical trials that combine antigen release with immune activation.

pedalpete 10mo ago

It seems they are initially focused on pancreatic cancer, which has a very low survival rate ~14% [1]. In theory, this may mean that metastisizing this tumour could destroy it in the pancreas, but allow the cells to spread to more treatable locations? 1 - https://www.canceraustralia.gov.au/cancer-types/pancreatic-cancer/pancreatic-cancer-australia-statistics https://www.canceraustralia.gov.au/cancer-types/pancreatic-c...

cowsandmilk 10mo ago
?? HistoSonics first target was the liver, second was kidney. Pancreas is the third organ they’ve targeted.

adamredwoods 10mo ago

Chemo post-histrophy would remove any lingering cancer cells effectively. Cancer cells need lots of fuel or they stop replicating, and this is what traditional chemo is great at stopping.

makestuff 10mo ago
Is the idea that you would need less chemo after the tumor is broken up to remove any remaining cancer cells versus just starting out with chemo to remove the tumor?
- adamredwoods 10mo ago
  Chemotherapy isn't always successful, and depends on the tumor's characteristics, but the idea is yes, less chemo. Histrophy is similar to resection, physically removing a tumor. I've seen chemo options for both scenarios with resectable cancers. For example, hormonal therapy is usually prescribed after resectable breast cancer, regardless of outcome. Or, chemo first to shrink the tumor, and have better surgical margins.
gamblor956 10mo ago
The keto diet is also very good for this because many (but not all) cancer cells can't metabolize ketones. However recent research from Columbia Medical School suggests that it can promote metastasis.
- bythreads 10mo ago
  Edited for politeness: Cancer metabolism isn’t a 2-bit meme. Tumors adapt. If they couldn’t, they wouldn’t metastasize.
  - gamblor956 10mo ago
    It's a good thing you edited for politeness because you seemed to be basing your understanding of what I said based on stuff you read on Reddit. A number of studies show that, in humans, the keto diet (the medical keto diet[1] and not the meat heavy Internet version) causes metabolic stress in breast cancer cells and in several other types of cancer, due to their significantly increased metabolic needs. It's like the difference between a normal human and Michael Phelps during Olympic competition. The cancer cells can process ketones, but not efficiently enough to fuel their activity so they starve. In humans this eventually results in the death or deactivation of the cancerous cells (deactivation being the primary way that tumors "adapt" to a starvation diet). There have been few, if any, reported cases of metastasis in the types of cancers studied in humans. This outcome is statistically significant enough that multiple cancer treatment centers recommend the medical keto diet to human patients as part of a treatment regime. As mentioned, the recent study from 2024 shows that this type of metabolic stress can, in mice cause the cancerous cells to metastasize in a last-ditch attempt to survive. However, very little of the cancer research conducted on mice has applications to human cancers. For example, chemotherapy has also been shown to cause metastasis in mice, and a number of earlier studies attempting to replicate the keto research in humans shows that the keto diet in mice increases tumor growth, which is the opposite effect it has in humans. [1] The medical keto diet is basically just fat and vitamins. No carbs, and minimal to no protein because protein can get converted into glucose by gluconeogenesis. It is not a diet anyone would want to be on longer than strictly necessary. One of my friends had stage 4 metastatic lung cancer, which she discovered during a company-sponsored mud run. Surgery was not an option and chemotherapy was not working. With less than 4 months to live, she went on the medical keto diet and the two-punch combo of keto and chemo put the cancer into remission for almost three years. (Note: She only maintained the diet for a few months after ending chemo treatment. Unfortunately not all of the cancer cells had died, some had merely deactivated. Four years after remission the cancer cells reactivated with a vengeance and she died the day after she started showing symptoms.)

TaupeRanger 10mo ago

We simply won’t know until they do the inevitable phase2/3 RCTs. They will need to show that this method helps people survive longer or with better quality of life than the current standard of care.

cowsandmilk 10mo ago
HistoSonics has studies published with 50 patients. Their upcoming study with 5000 liver patients obviously will give more information, but we already have some. And with that said, these studies are more relevant than the top of thread linking to a review from 2011 looking at papers from 2005-2006 for ultrasound cavitation causing metastases.
- observationist 10mo ago
  >>> ... the study found that removing the parachute prior to jumping led to a shocking increase in mortality among skydivers. When there's a clear causal mechanism, additional research that doesn't propose a clear resolution to the underlying problem doesn't negate the clear causal mechanism. Releasing a bunch of loose cancer into the body is a clear causal mechanism, so unless you're filtering it or killing the loose cancer somehow, I'm not sure what those studies could tell you that overcomes the underlying problem. And until they address that problem, it's going to be limited to a quality of life type application - stopping the tumor from killing you now with the certainty of metastasis killing you later.
  - nradov 10mo ago
    So what's the problem? The vast majority of cancer treatments seek only to put the condition into remission for a while. Realistically that's often all that can be done.
    - thaumasiotes 10mo ago
      Putting it into remission is basically the opposite of causing it to metastasize.

amypetrik8 10mo ago

What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer. If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"

deleted 10mo ago
[deleted]
jessriedel 10mo ago
Cancers aren't perfectly optimized to metastasize, and metasteses (rather than, e.g., bulk pressure from the original tumor) are usually what kills you. It's perfectly possible that the procedure kills 90% or 99% of the cells in the original tumor but increases migration of the remaining cells such that the net effect reduces patient survival.
- elcritch 10mo ago
  Don't cancer metastases have more to do with cancer mutations allowing the cancer cells to form new tumors? Some cancer types tend do not develop the ability to colonize new tumors while others do regularly.
  - jessriedel 10mo ago
    It's quite a bit about that, but it doesn't detract from my point. Mechanical disturbance alone can spread cancer and increase mortality. "The risk of tumor seeding after liver biopsy is 2.7%" https://easl.eu/wp-content/uploads/2018/10/Hepatocellular-Carcinoma-English-Report.pdf https://easl.eu/wp-content/uploads/2018/10/Hepatocellular-Ca... Tissue containment systems for uterine morcellation https://www.fda.gov/medical-devices/safety-communications/update-perform-only-contained-morcellation-when-laparoscopic-power-morcellation-appropriate-fda https://www.fda.gov/medical-devices/safety-communications/up...

yread 10mo ago

Metastasis is not just random tumor cell going for a hike, they are seeded with extracellular vesicles carrying particular mix of microRNAs, growth factors, vimentin and other stuff.