Metastasis (Metastatic Cancer)

What is metastasis?

Metastasis is when cancer spreads beyond the place where it started to other areas of your body. Nearly all cancers have the potential to metastasize. But whether they do depends on several factors — like the type, size and location of the primary tumor (where the cancer originated).

Metastases can occur in three ways. Cancer cells can:

1. Grow directly into the tissue surrounding the primary tumor.
2. Travel through your bloodstream to distant locations like other organs or your bones.
3. Move through your lymphatic system to nearby or distant lymph nodes.

Other names for metastasis include:

• Metastatic cancer.
• Stage IV (4) cancer.
• Secondary cancer.
• Cancer with mets (or mets cancer).

Which cancers metastasize?

Nearly all cancers can metastasize (spread). Some of the most common types include metastatic:

• Breast cancer.
• Colorectal cancer.
• Esophageal cancer.
• Lung cancer.
• Ovarian cancer.
• Pancreatic cancer.
• Prostate cancer.
• Skin cancers.
• Stomach cancer.
• Uterine cancer.

Where does cancer metastasize first?

Where cancer spreads during metastasis depends on the location of the primary (original) tumor. Some of the most common sites of metastases are the:

• Adrenal glands.
• Bones.
• Brain.
• Liver.
• Lungs.
• Lymph nodes.
• Peritoneum.

What are the symptoms of metastatic cancer?

Metastasis doesn’t always cause symptoms. Cancer cells can grow and spread gradually over many months or years. In some instances, it’s possible to have Stage IV (4) cancer and not know it.

General symptoms of metastasis may include:

• Extreme fatigue.
• Night sweats.
• Unexplained weight loss.

Some signs of metastatic cancer depend on the location of the primary tumor and where the cancer cells spread. Depending on the type of metastasis you have, symptoms might include:

• Bloating, swollen belly, decreased appetite, getting full quickly or jaundice (common in liver metastases).
• Bone pain or fractures (common in bone metastases).
• Dizziness, headaches and seizures (common in brain metastases).
• Shortness of breath (common in lung metastases).

What causes metastasis?

Metastasis happens when cancer cells break off from the original tumor and spread to other parts of your body. These cancer cells can travel through your bloodstream or lymph vessels.

Many factors can trigger metastasis, like:

• A weakened immune system.
• Hypoxia (a lack of oxygen in your tissues).
• Lactic acidosis (a buildup of lactic acid in your blood).
• Autophagy (a type of cell death).

How is metastatic cancer diagnosed?

Some people already have metastatic cancer at the time of their diagnosis. In these cases, a healthcare provider usually detects metastases during initial testing.

Other people develop metastases after completing treatment for non-metastatic cancer. During routine follow-ups, a healthcare provider checks for signs of recurrence (cancer that comes back after treatment).

What tests will be done to diagnose metastasis?

Your healthcare provider may use one or more of the following to diagnose metastatic cancer:

• Biopsy.
• Blood tests.
• Bone scans.
• CT (computed tomography) scans.
• MRI (magnetic resonance imaging) scans.
• PET (positron emission tomography) scans.
• Tumor marker-based tests.
• Ultrasound.
• X-rays.

How is metastatic cancer treated?

Healthcare providers can treat metastasis based on where the cancer started. For example, if a person has breast cancer and the cancer spreads to their liver, their provider will still treat it the same way as breast cancer. This is because the cancer cells haven’t changed — they’re just living in a new place.

Metastatic cancer treatments may include:

• Chemotherapy.
• Hormone therapy.
• Immunotherapy.
• Radiation therapy.
• Targeted therapy.

Some metastases may require local targeted therapy to manage symptoms. For instance, if you have breast cancer that spreads to the bone and causes pain or fractures, your provider can treat and ease those symptoms with surgery or radiation to the bone.

Can metastasis be prevented?

You can’t always prevent cancer from spreading. But when providers can detect cancer earlier, a combination of surgery and adjuvant therapy might lower your risk for developing metastasis. Common adjuvant therapies include chemotherapy, targeted therapy and immunotherapy.

Experts continue to research ways to slow, stop or prevent the spread of cancer cells. But sometimes, metastasis happens, despite doing all the right things. According to research, there aren’t any diets that make people more prone to cancer or prevent metastasis from happening.

If you have metastatic cancer, it’s important to know that it’s not your fault and that you haven’t done anything wrong.

What can I expect if I have metastatic cancer?

Your healthcare provider will work closely with you during cancer treatment and beyond. You’ll likely have many medical visits and will need to make important decisions regarding your overall health. Be sure to lean on friends, family and your healthcare team for support.

Metastatic cancer life expectancy

In most cases, metastatic cancer isn’t curable. But treatment can slow tumor growth and ease many of your symptoms. It’s possible to live for several years with some types of cancer, even after metastasis. Some metastases are potentially curable, including melanoma and colon cancer.

Metastatic cancer survival rates

The five-year survival rate depends on the type of metastases you have. For example, the five-year survival rate for metastatic lung cancer is 9%. This means that 9% of people diagnosed with metastatic lung cancer are still alive five years later. Meanwhile, the five-year survival rate of metastatic breast cancer is 30% for women and people assigned female at birth (AFAB) and 19% for men and people assigned male at birth (AMAB).

It’s important to understand that survival rates are only estimates. They can’t tell you how you’ll respond to treatment or how long you’ll live. Ask your healthcare provider about survival rates for your specific condition.

How do I take care of myself?

A metastatic cancer diagnosis comes with many challenges. These challenges vary from person to person, but you might:

• Feel sad, angry or hopeless.
• Worry that treatment won’t work and that your cancer will get worse quickly.
• Get tired of going to so many appointments and making so many important decisions.
• Need help with daily routines.
• Feel frustrated about the cost of your treatment.

Talking with a counselor or social worker can help you cope with these complicated emotions. Managing stress is also an important aspect of self-care. Try practicing meditation or mindfulness, or find other ways to reduce stress and anxiety.

When should I see my healthcare provider?

You should call your healthcare provider any time you develop new symptoms. Your cancer care team can adjust your treatment to meet your specific needs.

What questions should I ask my healthcare provider?

Learning about your condition can empower you to make informed decisions. Here are some questions you may want to ask your healthcare provider:

• Are there things I can do to improve my outlook?
• What are my treatment options?
• Are there clinical trial options I can explore?
• Will palliative care continue even if I stop cancer treatments?
• How often will I need to schedule follow-up appointments?
• Do I need to consider hospice care?
• Should I choose a person to make medical decisions for me when I’m unable to make them for myself?
• What legal documents should I have in place?
• Can you recommend resources to help me cope with my diagnosis?