All About Metastatic Cancer

What is metastatic cancer?

Metastatic cancer is not a single type of cancer, but a term used to describe any cancer that has spread from the area it started to other areas of the body. This can include spread to lymph nodes or more distant organs and bones.

• The area the cancer starts is called the "primary site."
• The area the cancer spreads to is the "site of metastasis."

For example, colon cancer that has spread to the liver is metastatic, with the colon being the primary site and the liver being the site of metastasis. Cancer can spread from the original location by traveling through the lymph system or the bloodstream.

A person may have a single metastatic tumor, which would be called a metastasis. If there is more than one metastatic tumor, it is called metastases (the plural of metastasis). Some other terms you may hear used to describe metastatic cancer include stage IV (4) disease and advanced cancer.

When cancer spreads to another part of the body, it still looks and acts like the original (primary) tumor. If you have lung cancer that has spread to the brain, you do not have lung and brain cancer. It is lung cancer that has spread to the brain. When a sample of the tumor in the brain is looked at under a microscope, it looks like lung cancer. This helps guide treatment – in this example, the brain tumor is treated with therapies that work for lung cancer, not those used to treat brain tumors.

How can I prevent metastatic cancer?

Early detection and successful treatment of the primary cancer are the best ways to prevent metastatic cancer. It is helpful to follow the guidelines for early detection and screening for some cancers, including breast, colon, and cervical to prevent the diagnosis of metastatic cancer. However, in most cases, we cannot prevent metastatic cancer.

Where does cancer spread?

All cancerous (malignant) tumors can spread to other parts of the body. Some spread locally (close to the original tumor) and some spread to distant (further away from the original tumor) parts of the body.

Some cancers tend to spread "locally," or just in the area where they started. Some examples of tumors that spread locally are head and neck cancers, brain tumors, and esophageal cancer. "Blood cancers" (leukemia, multiple myeloma) may be considered metastatic when they are diagnosed because the cancerous cells can be found throughout the bloodstream and in the bone marrow. Lymphomas tend to spread through the lymph nodes, spleen, and bone marrow. In some cases, blood cancers and lymphomas can spread to the brain or spinal cord.

Certain cancers tend to spread to certain parts of the body. Remember that these areas are often not close to the primary tumor, also called distant metastasis.

The following table shows the most common sites of metastasis, excluding lymph nodes, for some of the common solid tumors:

Source: National Cancer Institute; Cancer.gov

How is metastatic cancer treated?

Your metastatic cancer may be treated differently than someone else’s. In some cases, a single site of metastasis can be treated with surgery or radiation. Some metastatic cancers are treated with chemotherapy, immunotherapy, or radiation, while for others the goal of treatment shifts toward quality of life. You and your oncology providers will talk about your goals for treatment.

Your treatment options will be specific to your cancer. You should weigh the potential risks and benefits of all your options. Think about your treatment goals and ask how the treatments will affect your quality of life. You may want to get a second or multiple opinions. A second opinion is an educational session – it can present new treatment options or clarify those you have already heard about. Get the most out of a second opinion by coming prepared with questions, understanding the options that were already presented, and asking why this oncology provider does or doesn't recommend the same. This is a time to call on your support people to help you take notes at your appointments and remember what was talked about after the appointments.

A diagnosis of metastasis can mean different things to different people- each situation is unique. You may want to start aggressive treatment right away. Maybe this isn't your first experience with cancer. Perhaps you just aren't sure you want to go through more chemotherapy or surgery. Whatever you decide, talk with your care team about the role of palliative care in your plan. Palliative care can help relieve side effects and symptoms of illness. There is no "right" way to respond. While surgery, chemotherapy, or a clinical trial of a new medication may be the best option for some, others may feel that they don't want to have aggressive treatments. And that is okay. It may not be a decision family and friends will understand, but it is your own decision to make.

Finding Support

A diagnosis of metastatic cancer can make finding support harder. Friends and family may not know what to say or do for you and support groups with patients who are dealing with early-stage cancer just don't seem to "fit." Reach out to trusted friends and family and tell them what you need. People who are unsure of how to help will appreciate being given a task – pick up records from my provider to take for a second opinion, take my kids to soccer practice, etc. Make a list of tasks that people can help with. Think about the skills of your support people, assigning tasks to people who are good for the job. For example, don't ask your friend who hates to cook to make a meal for your family. Have them run an errand or provide transportation to an appointment.

Talk to your healthcare providers about finding support. Ask to see a social worker who can provide support and help you find resources for psychosocial and financial support. They can help you find a local support group or pair you with a "buddy" who has been through treatment. You are not in this alone!

Resources for More Information

The American Cancer Society – Advanced Cancer

CancerCare – Online support groups and counseling

Cancer Support Community – Local and online support and education

Metastatic Breast Cancer Network