Cancer and Metastasis Reviews

, Volume 29, Issue 4, pp 737–750 | Cite as

Distant metastases do not metastasize

  • Dieter Hölzel
  • Renate Eckel
  • Rebecca T. Emeny
  • Jutta Engel


Distant metastases (MET) are for most solid cancers decisive life-threatening events. Data about MET-free survival and survival after MET show a strong dependency on the kind of cancer and the prognostic features. Nonetheless, within biological subgroups, the MET process is very homogenous. Therefore, the growth rate can be estimated from initiation of MET to MET diagnosis and to time of death. Based on the known volume doubling time of breast cancer, the time of the first possible dissemination can also be estimated. Important consequences of these MET-initiation estimates are the hypotheses that almost all MET are initiated before removal of the primary tumor and that MET do not metastasize in a clinically relevant magnitude. Although breast cancer data were primarily used to form these hypotheses, the discussed MET process can be generalized to all solid cancers. The impact of these hypotheses on diagnostic, curative and palliative treatment, aftercare, and especially on clinical research would be important.


Breast cancer Metastasis Tumor growth Dissemination Survival 



Breast cancer


(Distant) metastasization


(Positive) lymph node


Primary tumor


Tumor cell (dissemination)


Volume doubling (time)



We thank the many doctors and clinicians who cooperate within the complex network of the Munich Cancer Registry despite the back-breaking medical bureaucracy for the daily health care. It is our duty to provide an adequate evaluation of the submitted data for outcomes, quality management and innovative treatments.

Conflict of interest

We declare that we have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Dieter Hölzel
    • 1
  • Renate Eckel
    • 1
  • Rebecca T. Emeny
    • 1
  • Jutta Engel
    • 1
  1. 1.Munich Cancer Registry (MCR) of Munich Comprehensive Cancer CentreLudwigs-Maximilians-UniversityMunichGermany

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