- Advanced Cancer
- What is advanced cancer?
- What is metastatic cancer?
- Can advanced or metastatic cancer be prevented?
- How is advanced cancer found?
- How is advanced cancer treated?
- Surgery for advanced cancer
- Ablative techniques for advanced cancer
- Radiation therapy for advanced cancer
- Drug treatment for advanced cancer
- Clinical trials
- Complementary and alternative therapies for advanced cancer
- Managing symptoms of advanced cancer
- Problems grouped by where the cancer is
- What should you ask your doctor about your cancer?
- Coping with advanced cancer
- Sources of support
- Choices for palliative care
- Advance directives
- Additional resources for advanced cancer
- References: Advanced cancer
What is metastatic cancer?
Metastatic cancer is a cancer that has spread from the part of the body where it started (the primary site) to other parts of the body. When cancer cells break away from a tumor, they can travel to other areas of the body through either the bloodstream or the lymph system (a collection of vessels that carry fluid and immune system cells).
The Lymph System
If the cells travel through the lymph system, they may end up in nearby lymph nodes (small, bean-sized collections of immune cells) or they may spread to other organs. If the cells travel through the bloodstream they can go to any part of the body. Most often, the cancer cells break off and travel in the bloodstream. Many of these cells die, but some may settle in a new area, begin to grow, and form new tumors. This spread of cancer to a new part of the body is called metastasis.
In order for cancer cells to spread to new parts of the body, they have to go through several changes. They have to be able to break away from the original tumor and enter the bloodstream or lymph system, which can carry them to another part of the body. At some point they need to attach to the wall of a blood or lymph vessel and move through it and into a new organ. They then need to be able to grow and thrive in their new location. All the while, they need to be able to avoid attacks from the body's immune system. Going through all these steps means the cells that start new tumors may no longer be exactly the same as the ones in the tumor they started in. This may make treatment more difficult.
Even when cancer has spread to a new area, it is still named after the part of the body where it started. Treatment is also based on where the cancer started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer (not bone cancer), and the doctor will recommend treatments that have been shown to help against metastatic prostate cancer. Likewise, breast cancer that has spread to the lungs it is still called breast cancer, not lung cancer, and is treated as metastatic breast cancer.
Sometimes the metastatic tumors have already begun to grow when the cancer is first found and diagnosed. And in some cases, a metastasis may be found before the original (primary) tumor is found. If a cancer has already spread to many places before it is found, it may be very hard to figure out where it started. If this happens the cancer is called cancer of unknown primary. This is discussed in a separate document, Cancer - Unknown Primary.
Why cancer cells tend to spread to certain parts of the body
Where a cancer starts often plays a role in where it will spread. Most cancer cells that have broken free from the original tumor are carried in the blood or lymph circulation until they get trapped in the next "downstream" organ or set of lymph nodes. This explains why breast cancer often spreads to axillary (underarm) lymph nodes, but rarely to lymph nodes in the groin. Likewise, the lungs are a common site of spread (metastasis) for many cancers. This is because the heart pumps blood from the rest of the body through the lungs’ blood vessels before sending it elsewhere. The liver is a common site of spread for cancer cells that start in the colon because blood from the intestines flows into the liver.
Cancer cells often break away from the main (primary) tumor and circulate in the blood, but in most cases they don't settle in any one place. Over time, they die. When the cancer does spread to other organs it is because of certain genetic changes in the cells, which scientists are now starting to understand. Someday, they may be able to tell if a person's cancer is the type that will spread to other organs by looking for these genetic changes. Research is also focusing on treatments that block or target these genetic changes so the cancer cells cannot spread and grow.
Sometimes the patterns of spread cannot be explained by where things are in the body. Some cancer cells are able to find and invade certain sites far away from where they started. For example, advanced prostate cancer often invades the bones before spreading to other organs. This "homing" pattern may be caused by substances on the cancer cell surfaces that stick to cells in certain organs.
Which cancers spread where?
This is a brief description of where certain cancers are most likely to spread. It is not a list of every place where a cancer could spread. For more information on these cancers, see our information on the various cancer sites.
Bladder cancer tends to stay in the same area (the pelvis) and grow into nearby tissues such as the pelvic wall. It can also spread to the lungs, liver, and bone.
Brain tumors rarely spread outside the brain. They mainly grow within the brain and sometimes into the spinal cord.
Breast cancer most commonly spreads to the bones, but also can spread to the liver, lungs, and brain. As the cancer progresses, it may affect any organ. It can also spread to the skin of the chest (near where the cancer started).
Colon and rectum
The most common sites for colon or rectal cancer spread is to the liver or lungs. These cancers may also spread to nearly any other organ, including the bones and brain.
Rectal cancer can also spread within in the pelvis, where the cancer started. This can be painful because it often grows into nerves and bones in this area.
Esophageal cancer mostly grows near where it started. As it progresses, it may grow into nearby organs or major blood vessels, which can make it hard to treat.
Kidney (renal) cancer can grow where it started and invade nearby tissues. When it spreads, the lungs and bones are the most common sites.
Because they are already in the blood, leukemias can be considered to have spread throughout the body when they are diagnosed. They can progress by filling the bone marrow with leukemia cells. The normal bone marrow is replaced and cannot make new blood cells.
Some leukemias may spread outside of the blood and into the fluid that surrounds the brain and spinal cord. Tumors made up of leukemia cells can also occur in the skin or in other parts of the body, although this is not common.
Liver cancer doesn't often spread outside the liver. It tends to grow throughout the liver as it becomes advanced. If it does spread, it is most often to the lungs or bones.
Lung cancer can spread to almost any organ of the body, but most often it will spread to the adrenal glands, liver, bones, or brain. It can also spread to the other lung.
Most lymphomas tend to stay in parts of the lymph system (such as the lymph nodes, spleen, and bone marrow), although they may spread within the lymph system to distant parts of the body. They may also spread to other organs, such as the lungs or liver, if they are advanced. Some lymphomas spread to the fluid around the brain and spinal cord (the cerebrospinal fluid or CSF). This is called lymphomatous meningitis.
Some lymphomas actually start in other organs, such as the brain or stomach, and may spread from there.
Melanoma can spread anywhere in the body. It first tends to go to lymph nodes near where it started, but then can spread to the brain, lungs, liver, and bones. It can also spread to distant parts of the skin.
Mouth and throat
Cancers of the mouth, throat, or nasal passages tend to stay in the same area. When they spread, it is usually to the lungs. Less often they may spread to the liver or bones.
Multiple myeloma can cause tumors called plasmacytomas. These tumors can spread to the bones anywhere in the body, but they rarely spread to other organs.
Ovarian cancer most often spreads to the lining and organs of the belly (abdomen) and can cause a build-up of fluid and swelling in the abdomen. It can also spread to the outer lining of the lungs and cause fluid to build up there. As it becomes more advanced, it may spread to the lung and liver, or, rarely, to the brain or skin.
Pancreatic cancer mainly stays in the abdomen. It tends to grow into nearby tissues and may spread to the liver or other nearby organs. It can also spread to the lungs.
Advanced prostate cancer most often goes to the bones. Much less often, it will spread to other organs, including the lungs and liver.
Stomach (gastric) cancer tends to spread to nearby tissues and stay within the abdomen. It may also spread to the liver or distant lymph nodes. Spread to the lungs, bones, and brain is less common.
Last Medical Review: 07/17/2012
Last Revised: 07/17/2012