How is advanced cancer found?
Some cancers are more likely to spread than others. But it’s hard to know who will develop advanced cancer.
One way is to compare how closely the cancer cells look like normal cells under a microscope. This is called the grade of the cancer. The more normal the cells look, the less likely it is that the cancer will spread. Another way to predict cancer spread is related to the size of the tumor. A larger tumor often is more likely to have spread. For some cancers, certain types (based on the way the cells look under a microscope) are more likely to spread. Also, if the cancer has spread to nearby lymph nodes, it’s much more likely to have spread to distant sites. This may not be known until after surgery that includes removing lymph nodes so they can be looked at under a 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 first ask about your medical history (including your symptoms) and give you a physical exam. You may also have some blood tests and imaging tests. Putting all this information together, your doctor may be able to tell if you have advanced cancer.
Signs and symptoms of advanced cancer
General signs and symptoms of advanced cancer can include:
- Loss of energy and feeling tired and/or 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, they may need to spend most of their time in bed. It’s important to note that some cancer treatments can cause this symptom, too.
- Weight loss (without trying).
- Pain, such as back pain (if the cancer has spread to the spine) or abdominal (belly) pain.
- Shortness of breath, especially when a cancer has spread to the lungs.
Advanced cancers can also cause many other symptoms, depending on the type of cancer and where it has spread. For more about symptoms, please see Managing symptoms of advanced cancer, by location and Managing general symptoms of advanced cancer.
Along with asking about your symptoms, a lot can be learned 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
- Weakness or numbness in your legs
Tests to find advanced cancer
Certain blood tests can point to advanced cancer. For example, results of liver function tests are often abnormal if the cancer has spread to the liver. High blood calcium levels can mean that the cancer has spread to bones.
Tumor markers: Some types of cancer cause substances in the blood called tumor markers to rise. Examples of tumor markers are PSA (prostate-specific antigen) for prostate cancer and CEA (carcinoembryonic antigen) for colon cancer. The level of these substances in the blood can sometimes be very high in advanced cancer. High levels of tumor markers can lead your doctor to suspect that your cancer has come back or spread, but further testing is needed to confirm the diagnosis.
There are many other tumor markers for other cancers. To learn what tumor markers may be used for your type of cancer, see our document about that cancer.
Imaging tests create pictures of the inside of your body. 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 Imaging (Radiology) Tests.
Some of the imaging tests used might include:
- Regular (plain) x-rays
- CT (computed tomography) scan
- MRI (magnetic resonance imaging)
- PET (positron emission tomography) scan
- Bone scan
Looking for cancer cells in body tissues and/or fluids
Biopsy: Often when an imaging test finds something that isn’t normal, the doctor will need to make sure that it’s cancer. This can often be done by taking out a small piece of the abnormal area and looking at it under the microscope to see if there are cancer cells in it. This is called a biopsy. Often, a thin, hollow needle is put into the area and fluid, cells, bits of tissue, or a cylinder of tissue is pulled out. It’s important that your doctor knows whether the cancer has spread, and often a biopsy is the only way to know for sure. Sometimes surgery is needed to remove a piece of tissue for testing, but this is done less often for cancer that has spread.
Bone marrow aspiration and biopsy: If your doctor suspects that cancer has spread to the bone marrow (the tissue inside some bones that makes new blood cells), he or she will need to take samples of the bone marrow for testing. Bone marrow samples are obtained from 2 tests, aspiration and biopsy that are usually done at the same time.
Most often, the samples are taken from the back of the pelvic (hip) bone while you lie on a table (either on your side or on your belly). The doctor will clean the skin over the hip and then numb the area and the surface of the bone with a local anesthetic. This may cause a brief stinging or burning sensation.
For aspiration, a thin, hollow needle is then inserted into the bone and a syringe is used to suck out a small amount of liquid bone marrow (about 1 teaspoon). Even with an anesthetic, most patients still have some brief pain when the marrow is removed.
A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow (about 1/16th inch in diameter and ½ inch long) is removed with a slightly larger needle that is twisted as it is pushed down into the bone. This causes a feeling of pressure, and rarely may also cause some brief pain. Once the biopsy is done, pressure will be applied to the site to help prevent bleeding.
Lumbar puncture (spinal tap): If your doctor suspects that cancer has spread to the fluid or tissues (the meninges) that surround the brain and spinal cord, they will remove some of the fluid to see if it contains cancer cells. Most often this is done with a test called a lumbar puncture (spinal tap). (The fluid around the brain and spinal cord is called cerebrospinal [suh-REE-bro-spy-nuhl] fluid or CSF.)
Most often for this test, you lie on your side with your knees pulled up to your chest. The doctor first numbs an area in your lower back near the spine. A thin, hollow needle is then placed between the bones of the spine and into the area around the spinal cord. Some fluid is then collected as it drips out through the needle. (Less often this test is done with the patient sitting up, bent over a table.) The fluid is sent to a lab to be checked under a microscope for cancer cells. Other tests may be done on the fluid as well.
Paracentesis: If fluid has built up in the abdominal cavity (called ascites), it can be removed using a needle and sent to the lab to look for cancer cells. Sometimes ultrasound (an imaging test that uses sound waves) is used to place the needle in the fluid. This is most often done using local anesthetic (numbing medicine). Only a small amount of fluid (less than a tablespoon) is needed to look for cancer spread, but much larger amounts can be removed to help the patient feel better when the fluid is causing discomfort.
Thoracentesis: If fluid has built up in the space around the lung, it can be removed using a needle and then sent to the lab to look for cancer cells. Sometimes ultrasound (an imaging test that uses sound waves) is used to place the needle in the fluid. This is most often done using local anesthetic (numbing medicine). Only a small amount of fluid (less than a tablespoon) is needed to look for cancer spread, but much larger amounts can be removed to help the patient feel better when the fluid is making the patient short of breath.
- 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, by location
- Managing general symptoms of advanced cancer
- What should you ask your doctor about advanced cancer?
- Coping with advanced cancer
- Sources of support
- Choices for palliative care
- Advance directives
- Additional resources for advanced cancer
- References: Advanced cancer