All cancers begin in a single organ or tissue, such as the lungs or skin. When these cancers are confined in their original organ or tissue, they are generally more treatable.

But a cancer that spreads is much more dangerous, as the organs it spreads to may be vital organs. A skin cancer, for example, might spread to the brain.

This new growth makes the cancer much more challenging to treat, as it can be difficult to find all the new tumours. If a cancer can invade different organs or tissues, it can quickly become lethal.

When cancer spreads in this way, it’s called metastasis. Metastasis is responsible for the majority (67%) of cancer deaths.

Cells are supposed to stick to surrounding tissue

Our bodies are made up of trillions of tiny cells. To keep us healthy, our bodies are constantly replacing old or damaged cells.

Each cell has a specific job and a set of instructions (DNA) that tells it what to do. However, sometimes DNA can get damaged.

This damage might change the instructions. A cell might now multiply uncontrollably, or lose a property known as adherence. This refers to how sticky a cell is, and how well it can cling to other surrounding cells and stay where it’s supposed to be.

If a cancer cell loses its adherence, it can break off from the original tumour and travel through the bloodstream or lymphatic system to almost anywhere. This is how metastasis happens.

Many of these travelling cancer cells will die, but some will settle in a new location and begin to form new cancers.

Particular cancers are more likely to metastasise to particular organs that help support their growth. Breast cancers commonly metastasise to the bones, liver, and lungs, while skin cancers like melanomas are more likely to end up in the brain and heart.

Unlike cancers which form in solid organs or tissues, blood cancers like leukaemia already move freely through the bloodstream, but can escape to settle in other organs like the liver or brain.

When do cancers metastasise?

The longer a cancer grows, the more likely it is to metastasise. If not caught early, a patient’s cancer may have metastasised even before it’s initially diagnosed.

Metastasis can also occur after cancer treatment. This happens when cancer cells are dormant during treatment – drugs may not “see” those cells. These invisible cells can remain hidden in the body, only to wake up and begin growing into a new cancer months or even years later.

For patients who already have cancer metastases at diagnosis, identifying the location of the original tumour – called the “primary site” – is important. A cancer that began in the breast but has spread to the liver will probably still behave like a breast cancer, and so will respond best to an anti-breast cancer therapy, and not anti-liver cancer therapy.

As metastases can sometimes grow faster than the original tumour, it’s not always easy to tell which tumour came first. These cancers are called “cancers of unknown primary” and are the 11th most commonly diagnosed cancers in Australia.

One way to improve the treatment of metastatic cancer is to improve our ways of detecting and identifying cancers, to ensure patients receive the most effective drugs for their cancer type.

What increases the chances of metastasis and how can it be prevented?

If left untreated, most cancers will eventually acquire the ability to metastasise.

While there are currently no interventions that specifically prevent metastasis, cancer patients who have their tumours surgically removed may also be given chemotherapy (or other drugs) to try and weed out any hidden cancer cells still floating around.

The best way to prevent metastasis is to diagnose and treat cancers early. Cancer screening initiatives such as Australia’s cervical, bowel, and breast cancer screening programs are excellent ways to detect cancers early and reduce the chances of metastasis.

New screening programs to detect cancers early are being researched for many types of cancer. Some of these are simple: CT scans of the body to look for any potential tumours, such as in England’s new lung cancer screening program.

Using artificial intelligence (AI) to help examine patient scans is also possible, which might identify new patterns that suggest a cancer is present, and improve cancer detection from these programs.

More advanced screening methods are also in development. The United States government’s Cancer Moonshot program is currently funding research into blood tests that could detect many types of cancer at early stages.

One day there might even be a RAT-type test for cancer, like there is for COVID.

Will we be able to prevent metastasis in the future?

Understanding how metastasis occurs allows us to figure out new ways to prevent it. One idea is to target dormant cancer cells and prevent them from waking up.

Directly preventing metastasis with drugs is not yet possible. But there is hope that as research efforts continue to improve cancer therapies, they will also be more effective at treating metastatic cancers.

For now, early detection is the best way to ensure a patient can beat their cancer.

Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute and John (Eddie) La Marca, Senior Resarch Officer, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will have it this year.

Chronic pain, of which back pain is the most common, is the world’s most disabling health problem. Its economic impact dwarfs other health conditions.

If you get back pain, how long will it take to go away? We scoured the scientific literature to find out. We found data on almost 20,000 people, from 95 different studies and split them into three groups:

• acute – those with back pain that started less than six weeks ago
• subacute – where it started between six and 12 weeks ago
• chronic – where it started between three months and one year ago.

We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.

Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.

More pain doesn’t mean a more serious injury

Most acute back pain episodes are not caused by serious injury or disease.

There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.

Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.

The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.

The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.

Reduce your chance of lasting pain

Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:

• understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain
• reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.

How to reduce your pain sensitivity and learn about pain

Learning about “how pain works” provides the most sustainable improvements in chronic back pain. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.

These programs have been in development for years, but high-quality clinical trials are now emerging and it’s good news: they show most people with chronic back pain improve and many completely recover.

But most clinicians aren’t equipped to deliver these effective programs – good pain education is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.

When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just been told it’s all in their head.

Community-driven not-for-profit organisations such as Pain Revolution are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than 80 local pain educators and supported them to bring greater understanding and improved care to their colleagues and community.

But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.

Sarah Wallwork, Post-doctoral Researcher, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Many of us try to eat more fruits and vegetables and less ultra-processed food. But why is sticking to your goals so hard?

High-fat, sugar-rich and salty foods are simply so enjoyable to eat. And it’s not just you – we’ve evolved that way. These foods activate the brain’s reward system because in the past they were rare.

Now, they’re all around us. In wealthy modern societies we are bombarded by advertising which intentionally reminds us about the sight, smell and taste of calorie-dense foods. And in response to these powerful cues, our brains respond just as they’re designed to, triggering an intense urge to eat them.

Here’s how food cravings work and what you can do if you find yourself hunting for sweet or salty foods.

What causes cravings?

A food craving is an intense desire or urge to eat something, often focused on a particular food.

We are programmed to learn how good a food tastes and smells and where we can find it again, especially if it’s high in fat, sugar or salt.

Something that reminds us of enjoying a certain food, such as an eye-catching ad or delicious smell, can cause us to crave it.

The cue triggers a physical response, increasing saliva production and gastric activity. These responses are relatively automatic and difficult to control.

What else influences our choices?

While the effect of cues on our physical response is relatively automatic, what we do next is influenced by complex factors.
Whether or not you eat the food might depend on things like cost, whether it’s easily available, and if eating it would align with your health goals.

But it’s usually hard to keep healthy eating in mind. This is because we tend to prioritise a more immediate reward, like the pleasure of eating, over one that’s delayed or abstract – including health goals that will make us feel good in the long term.

Stress can also make us eat more. When hungry, we choose larger portions, underestimate calories and find eating more rewarding.

Looking for something salty or sweet

So what if a cue prompts us to look for a certain food, but it’s not available?

Previous research suggested you would then look for anything that makes you feel good. So if you saw someone eating a doughnut but there were none around, you might eat chips or even drink alcohol.

But our new research has confirmed something you probably knew: it’s more specific than that.

If an ad for chips makes you look for food, it’s likely a slice of cake won’t cut it – you’ll be looking for something salty. Cues in our environment don’t just make us crave food generally, they prompt us to look for certain food “categories”, such as salty, sweet or creamy.

Food cues and mindless eating

Your eating history and genetics can also make it harder to suppress food cravings. But don’t beat yourself up – relying on willpower alone is hard for almost everyone.

Food cues are so powerful they can prompt us to seek out a certain food, even if we’re not overcome by a particularly strong urge to eat it. The effect is more intense if the food is easily available.

This helps explain why we can eat an entire large bag of chips that’s in front of us, even though our pleasure decreases as we eat. Sometimes we use finishing the packet as the signal to stop eating rather than hunger or desire.

Is there anything I can do to resist cravings?

We largely don’t have control over cues in our environment and the cravings they trigger. But there are some ways you can try and control the situations you make food choices in.

• Acknowledge your craving and think about a healthier way to satisfy it. For example, if you’re craving chips, could you have lightly-salted nuts instead? If you want something sweet, you could try fruit.
• Avoid shopping when you’re hungry, and make a list beforehand. Making the most of supermarket “click and collect” or delivery options can also help avoid ads and impulse buys in the aisle.
• At home, have fruit and vegetables easily available – and easy to see. Also have other nutrient dense, fibre-rich and unprocessed foods on hand such as nuts or plain yoghurt. If you can, remove high-fat, sugar-rich and salty foods from your environment.
• Make sure your goals for eating are SMART. This means they are specific, measurable, achievable, relevant and time-bound.
• Be kind to yourself. Don’t beat yourself up if you eat something that doesn’t meet your health goals. Just keep on trying.

Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University and Justin Mahlberg, Research Fellow, Pyschology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.