Where do thedead cancer cells go?

I would think that they go like any other dead cell in the body - eaten by the macrophages and then the residues carried by the blood in the intestines and excreted from there.

Here's a link:

http://www.wisegeek.com/how-does-the-human-body-eliminate-dead-cells.htm 

And another one in more scientific terminology:

http://en.wikipedia.org/wiki/Efferocytosis 

Trust me:  those dead cells are not going to cancer-cell-heaven.  No way.

The wisegeek explanation is only partly correct.  The part that's okay is this:  "A macrophage cell can literally detect dead cells through smell, much like a scavenger bird detects dead animals. Whenever dead cells reach the part of the bloodstream patrolled by a macrophage, the macrophages surround them and convert them into easily removed components."

But, alas -- the rest of the wisegeek explanation is not-so-wise and not the least bit geeky.  I tried to find a more accurate explanation on line, but failed.  So I had to resort to looking up "dead cells" in the pathology textbooks I have on my bookshelves.  Let's give it another try...

First, remember that we are talking about human (mammalian) cells here -- not bacteria or other microbial cells. Things work differently for those types of cells. 

Second, recall some basic cell biology.  All living (human) cells have a "cell membrane" around their outside that separates them from each other and from all the other stuff in our tissues.  Also, cells have "organelles" inside them (a nucleus, mitochondria, ribosomes, lysosomes, endoplasmic reticulum, etc.), and some of those structures are also surrounded by membranes.  The membranes are critical, because they keep everything in its place -- kind of like zip-lock bags keep stuff separated in your picnic cooler.  The membranes around the lysosomes are especially important, because lysosomes contain the enzymes that cells use to digest the things they eat.  Ever have a bottle of bleach or nail polish-remover spring a leak in your cupboard?  It makes a mess, and starts dissolving things.

Okay, so what happens after a cell dies?  (There are two main ways a cell can die -- necrosis, or apoptosis -- but that's a book in itself.)  Regardless of what causes a cell to die -- whether it's a lack of oxygen, physical damage, chemical poisoning, energy starvation, etc. -- the outcome will be pretty much the same.

All the biochemical pathways that allowed the cell to perform its normal functions and held it together physically will stop when the cell dies.  Those membranes around the outside of the cell and on the inside (keeping all those innards separated) will become leaky.  That leakiness will allow enzymes and chemicals that are inside the cell to leak out; and other chemicals and fluids that are supposed to stay outside the cell will pass in. The zip-lock baggies full of enzymes (the lysosomes) will ooze, and their nasty contents will begin to digest the insides of the cell.

Then things get really bad.  The chromosomes that were arranged so nicely in the nucleus of the cell will break into small pieces.  Proteins in the cell (and there are lots proteins) will "denature".  Basically, the chemical bonds in the proteins will fall apart, causing the proteins to lose their normal shape and get all wadded up.  (Think of what happens when you fry an egg.  All that protein is being denatured.)  The lipid membranes will continue to degrade.

While all this is going on inside the cell, the stuff that's leaking out of it will attract scavengers.  (The wisegeek site is right, in that regard.)  In this case, the scavengers are white blood cells whose job is to eat (literally) and digest dead things -- dead cells and cell debris.  There are two main types of cells that do that:  neutrophils and macrophages, both of which are called "phagocytes". 

The neutrophils almost always come from the blood, and they get to the dead cells first.  Neutrophils squeeze through the blood vessel walls and move to where the dead cells are.  Macrophages take a little longer to arrive and also come from the blood; but there are also lots of macrophage-type cells already in the tissues of the body (in addition to those in the blood).  They're sort of like resident garbage collectors.  Neutrophils and macrophages are attracted by chemical signals released by the dying/dead cells.

Once the neutrophils and macrophages (the phagocytes) get to where the dead cells are, they start eating them.  By that time, there won't be much left of the dead cells except random chunks and hollowed-out (digested) bags filled with molecular slush.  So it's usually not difficult for the phagocytes to eat that debris and digest it completely. Everything gets recycled -- all the proteins and sugars, the nucleic acids, the energy-containing components, all of it gets re-used by other cells.  Nothing goes to waste.  Dead cancer cells are as tasty to a phagocyte as any other type of dead cell.  (Vultures aren't very picky, either.)

That's where the wisegeek explanation gets weird.  The dead cells cannot "re-enter the bloodstream" once they've been digested by macrophages, because the digestion process breaks down the chunks into individual chemical components (amino acids, lipids, sugars, minerals).  And, dead cells will not pass into the intestinal tract to be disposed of.  That's backwards.  All that stuff in the lower intestinal tract is stuff we've eaten but have not digested and absorbed, like plant fibers (cellulose, lignin) and intestinal bacteria.  The cells in the wall of the intestine will add a little mucus and some water to slide things along more easily.  And, as those intestinal cells grow old and die, they will be sloughed off into the intestinal contents.  That's about it, though -- dead breast cancer cells will not end up being flushed down your toilet (even though I truly like that image).

I hope that makes sense.

otter

One 'place' a lot of the cells that die during Chemo wind up in the gall bladder. It can/will form into 'gall bladder sludge' - yes that is a medical term. Sometimes it will pass on away and sometimes it will form gall stone. I developed the sludge during Taxol - it showed up on the CT the day of last Taxol. Did go on to become stones (showed up about a yr later on a scan done for another reason) but have never had any issue with then but at least I know they are there and to get to a Dr if any issues show up.

kicks what if you don't have a gall bladder? Lost mine about 5 1/2 years ago

Nancy

Otter (or anyone else), what if the cells are dying naturally (reduced tumor size) and not from chemo? Might it take a long time for the tumor to completely disappear? A radiologist told me that if any tumor shows up it means it's still malignant, but I've read about masses being found to be dead after surgical removal. I don't know whether to wait for continued progress, or have the surgery on the basis that any mass still showing up must be malignant. So much contradictory information, and I have to decide. Thanks.