Some cancers are more likely to spread than others. But it is hard to know who will develop metastatic or advanced cancer. One way is to compare how closely the cancer cells look like normal cells (this is called grade). The more normal the cells look, the less likely it is that the cancer will spread. Another way is related to the size of the tumor. A larger tumor is often more likely to have spread. Also, if the cancer is found to have spread to nearby lymph nodes, it is much more likely to spread to distant sites. This may not be known until after surgery that includes removing lymph nodes to be looked at under the microscope.

Even when these things are known, doctors aren’t always sure if a person’s cancer will spread or whether they already have advanced cancer. Most of the time, your doctor will look at your history and give you a physical exam. You will have some blood tests and imaging studies. Putting all this information together, your doctor may be able to tell if you have advanced cancer.

Signs and symptoms

Here we will talk about some of the signs of advanced cancer and ways it may be found.

Signs of advanced cancer:

• The most telling symptom is losing your energy and feeling tired (fatigued) and weak. This can get so bad that you may have a hard time doing everyday tasks like bathing or getting dressed. People with advanced cancer often need help with these things. At some point, it gets so bad that they spend much of their time in bed.

• Unexplained weight loss

• Pain may go along with advanced cancer, but this is not always true.

• Shortness of breath is common when a cancer has spread to the lungs.

For more about symptoms, please see the section, "Managing physical problems of advanced cancer."

Physical exam

Along with asking about your symptoms, your doctor can learn a lot by examining you. Your doctor may find signs of problems caused by advanced cancer, such as:

• fluid in your lungs
• fluid in your belly (abdominal cavity)
• lumps (tumors) on or within your body
• an enlarged liver

Blood tests

Certain blood tests can point to advanced cancer. Test results of liver function are often very abnormal if the cancer has spread to the liver. Some types of cancer put out a substance called a tumor marker. Examples are PSA (prostate-specific antigen) if you have prostate cancer, or CEA (carcinoembryonic antigen) if you have colon cancer. The level of these substances in the blood can be very high in advanced cancer. There are many other tumor markers for other cancers. For more information, see our document, Tumor Markers.

Imaging tests

Many of the tests used to find advanced cancer may have also been done when you were first diagnosed with cancer. You can learn more about these and other imaging tests your doctor may want you to have in our document, Imaging (Radiology) Tests.

Chest x-ray: A chest x-ray can find tumors in your lungs or fluid in your chest.

CT (computed tomography) scan: The CT scan uses x-rays to show a slice or cross-section of your body. The image shows your organs and soft tissues more clearly than standard x-rays. Because the picture is created by a computer, it can be enlarged to make it easier to read and interpret.

Instead of taking 1 picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine takes pictures of many slices of the part of your body that is being studied.

CT scans can also be used to guide a biopsy needle to remove a tissue sample (called a CT-guided biopsy). To do this you stay on the CT scanning table while a radiologist moves a biopsy needle toward the mass. CT scans are repeated until the doctors are sure that the needle is within the area of concern. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue) is taken out and looked at under a microscope.

CT scans take longer than regular x-rays. You may need to lie still on a narrow table for 15 to 30 minutes while the scan is done. But just like other computerized devices, they are getting faster. Also, you might feel a bit confined by the large, doughnut-shaped ring that the table moves through while the pictures are being taken. You may hear buzzing and clicking as the scanner switches on and off.

In some cases you may get an IV (intravenous) injection of a contrast agent, or dye, which helps better outline structures in your body. You will need an IV line through which the contrast dye is injected. The injection can cause some flushing. Some people are allergic and get hives. Rarely, people have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may also be asked to drink 1 to 2 pints of a contrast solution. This helps outline the intestine so that it is not mistaken for tumors.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. This produces pictures of cross-sectional slices of the body like a CT scanner, but it can also produce slices that are parallel with the length of your body. The procedure creates pictures of soft tissue parts of the body that are sometimes hard to see using other imaging tests. A contrast material might be injected just as with CT scans, but this is done less often. MRI scans are very helpful in looking at the brain and spinal cord.

MRI scans are a little more uncomfortable than CT scans. First, they take longer -- often up to an hour, but sometimes even longer. Also, you have to be placed inside tube-like equipment, which is confining and can upset people with a fear of enclosed spaces. If you have a strong fear of enclosed areas, you could look for a facility that has an open MRI (one without an enclosed tube). Many cities have at least one MRI center that has an open MRI,

The MRI machine also makes a thumping noise like a washing machine that you may find annoying. Some places give you headphones with music to block this out. Most people don't have any trouble with the MRI experience, but you should feel free to talk to your doctor or nurse about any concerns you have. You will be able to talk to the technician the whole time you are getting an MRI.

PET (positron emission tomography): PET uses a form of radioactive sugar (glucose). A special camera can detect the radioactivity. Because cancer cells grow quickly, they absorb high amounts of the radioactive sugar. PET is useful when your doctor thinks the cancer has spread but doesn't know where. PET scans can be used instead of several different x-rays because it scans your whole body.

Ultrasound: Ultrasound uses sound waves to make pictures of a body part. The computer shows the pictures on a screen. Ultrasound is useful for finding out if some tumors are likely to be cancer or not. This is a very easy test to take, and it uses no x-rays. You just lie on a table while a technician moves a flat wand over your skin.

Radionuclide bone scan: This procedure helps show whether a cancer has spread to your bones. You will be given an IV (intravenous) injection of radioactive substance. The injection itself is the only uncomfortable part of the scanning procedure. The amount of radioactivity used is low compared with the much higher doses used in radiation therapy, and it does not cause any side effects.

The radioactive substance is attracted to diseased bone cells throughout your entire skeleton. A special camera picks up these areas and a computer turns them into two- or three-dimensional (3D) pictures. Areas of diseased bone are seen on the bone scan image as dense gray to black areas, called "hot spots." These areas may suggest cancer is present, but arthritis, infection, or other bone diseases can also cause hot spots. The pattern of these other diseases is usually different from the pattern caused by cancer. To distinguish among these conditions, the cancer care team may use other imaging tests or take bone biopsies. Bone scans can find the spread of cancer much earlier than regular x-rays. And they can also be used to track how these areas respond to treatments.

Sometimes bone scans do not find areas of spread to the bones. This happens most often if the area of cancer in the bone is osteolytic, which means it destroyed or dissolved the bone. In some patients, radioactivity will not show up in areas of bone that have been totally destroyed by the cancer.

Biopsy

Often when an imaging test finds something that isn’t normal, the doctor will want to be sure that it is cancer. This is done be taking a small piece of tissue and looking at it under the microscope. This is called a biopsy. Usually a needle is put into the spot and fluid, bits of tissue, or a core of tissue is pulled out. These samples are then looked at under a microscope. It is important that your doctor knows whether the cancer has spread and often a biopsy is the only way to know for sure.

Last Medical Review: 01/28/2009
Last Revised: 01/28/2009