What Are Advanced and Metastatic Cancers?

While the terms “advanced” and “metastatic” are related, they have different meanings when talking about a cancer diagnosis. Some people may use “advanced” to describe metastatic cancer, while others might use it to describe cancer that is locally advanced but hasn’t spread to other distant parts of the body. These terms can have different implications for treatment and prognosis. If you or a loved one is told that you have advanced or metastatic cancer, it’s very important to ask your doctor exactly what the terms mean in your specific case.

What is advanced cancer?

Advanced cancer is often used to describe cancers that are highly unlikely to be cured. This means that while treatable, the cancers won’t go away and stay away completely. However, some types of advanced cancer can be controlled over a long period of time and are thought of as an ongoing (or chronic) illness.  And a few may potentially be cured.

Even if advanced cancer can’t be cured, treatment can sometimes:

• Shrink the cancer
• Slow its growth
• Help relieve symptoms
• Help you live longer

For some people, the cancer may already be advanced when they first learn they have the disease. For others, the cancer may not become advanced until years after it was first diagnosed. This happens when cancers continue to grow despite treatment or spread to other parts of the body.

Depending on their size and location, advanced cancers can be described as locally advanced or metastatic:

• Locally advanced means the cancer has grown beyond the place it started and into nearby tissues or lymph nodes, but it hasn’t yet spread to distant parts of the body. Some cancers, such as locally advanced breast and prostate cancers, may be potentially curable, while other types, such as some locally advanced brain cancers, are not considered curable due to their large size or closeness to important organs or blood vessels.
• Metastatic cancers (described in more detail below) have spread from where they started to other, often distant, parts of the body. Cancers that have spread are often thought of as advanced when they can’t be cured or controlled with treatment. But not all metastatic cancers are advanced cancers. Some cancers, such as testicular cancer, can spread to other parts of the body and still be very curable based on how well they respond to certain treatments.

As advanced cancer grows, it can cause symptoms. These symptoms can almost always be managed with treatment, even when the cancer itself no longer responds to treatment.

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. Metastasis might be described based on how far from the primary site it has spread:

• Local metastasis means cancer cells have spread to nearby tissues or lymph nodes. This is an early stage of metastasis.
• Regional metastasis means the cancer has spread farther, but still in the same region of the body.
• Distant metastasis means cancer cells have spread to form tumors far from the primary site.

Metastatic cancer might also be described based on how large the new area of cancer is:

• When only a few cells have spread, it’s called micrometastasis. These small areas are often too small to be seen on an imaging test.
• A larger area of cancer spread might be called macrometastasis, but this term is used less often.

Sometimes the metastatic tumors have already begun to grow when the cancer is first found. And sometimes, a metastasis may be found before the original (primary) tumor is found. If a cancer has already spread to other parts of the body before it is first diagnosed, it may be hard to figure out where it started. Your doctor will order blood tests and imaging tests to help identify where it started.

No matter how near or far the distance, when cancer spreads to a new area, it’s still named after the part of the body where it started. For instance, breast cancer that has spread to the lungs is breast cancer in the lungs, not lung cancer. This is because the cancer is made up of breast cancer cells, even though they have spread (metastasized) outside of the breast. This distinction is important because treatment is based on where the cancer started and the type of cancer cells involved.

What’s the difference between metastatic cancer, cancer recurrence, cancer relapse, and a second cancer?

Metastatic cancer, cancer recurrence, cancer relapse, and second cancer are similar but different terms. The differences depend on when it happens in relation to treatment, where the cancer is found, and what type of cancer it is:

• Metastatic cancer is cancer that has spread.
• Cancer recurrence is cancer that has returned after a period of time following successful treatment. Cancer can recur in the same place it started (local recurrence), but it can also come back somewhere else in the body. If it recurs near the original cancer, it is called regional recurrence. If it recurs far from the original cancer, it is called distant recurrence.
• Cancer relapse is the return of cancer or its symptoms after a period of improvement without signs or symptoms of disease.
• Second cancer is a new, unrelated cancer that develops after the initial cancer. A second cancer is different from recurrence, relapse, and metastasis because the cancer cells are different from the cells of the original cancer. It can also be a late effect of your first cancer or its treatment.

If cancer is found somewhere new, your cancer team will likely do a biopsy of the new area to find out if it is a metastasis or a second cancer.

How do I know if cancer has advanced or spread?

When you are first diagnosed

If you are diagnosed with cancer, your cancer care team will do additional exams and tests to find out how advanced the cancer is and whether it has spread. This process is called staging.

During treatment

As you go through treatment, your care team will watch you closely to find out how treatment is working. If exams and tests show the cancer is growing or spreading, it might mean you need a different type of treatment.

After treatment

For months or years after treatment, you will have follow-up visits with your cancer care team to check for signs the cancer has come back. You might get imaging scans, blood tests, or other tests to look for metastasis.

Symptoms of advanced or metastatic cancer

Advanced or metastatic cancer may not always cause symptoms. When symptoms do appear, they often depend on the size and location of where the cancer has spread. Some of the more common symptoms include:

• Shortness of breath or trouble breathing, if the cancer has spread to the lung
• Pain in the affected area (especially bone)
• Headache, vision problems, dizziness, or seizures, if the cancer has spread to the brain
• Bone fractures, if the cancer has spread to the bone
• Jaundice (yellowing of skin and eyes) and abdominal (belly) swelling, if the cancer has spread to the liver

General signs and symptoms of advanced and metastatic cancer can include:

• Extreme loss of energy and feeling tired and/or weak (fatigue)
• Weight loss (without trying)
• Finding a new lump or swollen lymph node

These signs and symptoms don’t always mean cancer has advanced or spread. But it’s important to talk to your care team about any symptoms you have so the cause can be found and treated if needed.