Advanced and Metastatic Cancer
Overview
"Advanced" and "metastatic" are related words with different meanings. Some people use "advanced" to mean cancer that has spread; others use it for cancer that has grown locally but has not spread far. The two can mean different things for treatment and outlook, so if you are told you have advanced or metastatic cancer, ask your doctor exactly what the words mean in your case.
What Is Advanced Cancer?
"Advanced cancer" often means a cancer that is very unlikely to be cured: it can be treated, but it will not go away and stay away. Some advanced cancers can be controlled for a long time, like a chronic illness, and a few may still be curable. Even when it cannot be cured, treatment can sometimes shrink the cancer, slow its growth, relieve symptoms and help you live longer.
Some people learn they have cancer when it is already advanced. For others, it becomes advanced years later, when it keeps growing despite treatment or spreads. Advanced cancer can be:
- Locally advanced — grown beyond where it started into nearby tissue or lymph nodes, but not to distant parts of the body. Some, such as locally advanced breast and prostate cancers, may be curable. Others, such as some locally advanced brain cancers, are not, because of their size or because they are close to vital organs or blood vessels.
- Metastatic — spread to other, often distant, parts of the body. Not every metastatic cancer is advanced: testicular cancer, for example, can spread and still be very curable because it responds well to some treatments.
As advanced cancer grows it can cause symptoms. These can almost always be managed, even when the cancer itself no longer responds to treatment.
What Is Metastatic Cancer?
Metastatic cancer has spread from where it started (the primary site). By distance, spread is called:
- Local — to nearby tissue or lymph nodes, an early stage of spread
- Regional — farther, but still in the same region of the body
- Distant — tumors far from the primary site
By size, a spread of only a few cells is a micrometastasis, often too small to see on imaging; a larger area is sometimes called a macrometastasis. Sometimes the new tumors are already growing when cancer is first found, and sometimes a metastasis is found before the primary tumor. Then blood tests and imaging help find where it started. However far it spreads, a cancer keeps the name of where it started: breast cancer in the lungs is still breast cancer, because it is made of breast cancer cells, and treatment is based on that.
Metastasis, Recurrence, Relapse and Second Cancer
- Metastatic cancer has spread.
- Recurrence is cancer that comes back after successful treatment — in the same place (local), nearby (regional) or far away (distant).
- Relapse is the return of cancer or its symptoms after a period of improvement with no signs of disease.
- A second cancer is a new cancer, unrelated to the first and made of different cells. It can be a late effect of the first cancer or its treatment.
When cancer is found in a new place, a biopsy of that area usually shows whether it is a metastasis or a second cancer.
How You Know Whether Cancer Has Spread
At diagnosis, exams and tests show how far the cancer has gone — this is staging. During treatment, your team watches whether treatment is working; growth or spread may mean a change of treatment. After treatment, follow-up visits for months or years, with scans, blood tests and other tests, look for signs that the cancer has returned.
Advanced or metastatic cancer does not always cause symptoms. When it does, they depend on where it has spread: shortness of breath (lungs); pain, especially in bone; headache, vision problems, dizziness or seizures (brain); broken bones (bone); yellow skin and eyes (jaundice) and a swollen belly (liver). General signs include extreme tiredness or weakness (fatigue), weight loss without trying, and a new lump or swollen lymph node. These signs do not always mean the cancer has spread, but tell your care team about any symptom.
Questions to Ask Your Doctor
- When you say my cancer is advanced or metastatic, what exactly do you mean in my case?
- Is my cancer considered curable, controllable over the long term, or neither?
- What can treatment do for me now — shrink the cancer, slow it, or relieve symptoms?
- If cancer is found somewhere new, how will you tell whether it is a spread or a second cancer?
- Which symptoms should I watch for, and how can they be managed?
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