Bone Marrow in Perspectives to Cure Breast Cancer

 

There are perspectives to cure breast cancer, and the main strategy in that way is the exact estimation of tumor dissemination at diagnosis. It is well proved that disseminated tumor cells in the bone marrow are the most important prognostic factor in operable breast cancer [1]. Its prognostic role become visible at late periods after surgery (sometimes, 25 years). Taking in mind that women with breast cancer are around 60-year-old, one may see that the relapses arises usually after 80. It appears in brain, lung and other distant organs as hematologic metastases, and unfortunately, nothing is possible to do in the most of those cases, so the main reasons of deaths in breast cancer are distant metastases.

Hematological dissemination of breast cancer takes place at very early stages of the diseases, sometimes even at carcinoma in situ [2]. The main reservoir of tumor cells in the organism is bone marrow [3,4]. Those cells survive for a long time and then wake up and come to some distant organs via blood stream. When the primary tumor was not completely resected or there is a tumor in lymph nodes these sites are preferential for re-seeding by tumor cells [5]. Not only primary tumor metastasizes but the metastases as well can metastasize into the primary tumor. It is their “home”, and malignant cells should not adapt to breast tumor tissue and can survive there. Those cells not only survive but as well receive many new features, the most important of which is the possibility to multi-organ metastasizing. Kim et al. very carefully proved it in their fundamental article in Cell [5]. From clinical oncologist point of view, one of the main tasks is the complete elimination of primary tumor and regional metastases to prevent re-seeding.

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