What Are Advanced and Metastatic Cancers?

If you or a loved one is told that you have advanced cancer, it’s very important to find out exactly what the doctor means. Some may use the term to describe metastatic cancer, while others might use it in other situations. Be sure you understand what the doctor is talking about and what it means for you.

What is advanced cancer?

Advanced cancer is most often used to describe cancers that cannot be cured. This means cancers that won’t totally go away and stay away completely with treatment. 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.

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.

Advanced cancers can be locally advanced or metastatic.

Locally advanced means that cancer has grown outside the body part it started in but has not yet spread to other parts of the body. For example, some cancers that start in the brain may be considered advanced because of their large size or closeness to important organs or blood vessels. This can make them life-threatening even though they haven’t spread to other parts of the body. But other locally advanced cancers, such as some prostate cancers, may be cured.

Metastatic cancers have spread from where they started to other parts of the body. Cancers that have spread are often thought of as advanced when they can’t be cured or controlled with treatment. 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.

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 a micrometastasis. These small areas are often too small to be seen on an imaging test. A larger area of cancer spread might be called a macrometastasis, but this term is used less often.

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

A metastatic cancer is cancer that has spread. A cancer recurrence is cancer that has returned after treatment. A second cancer is a different, unrelated cancer. The differences depend on when and where the cancer is found, and what type of cancer it is.

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.

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.

• If cancer has gone away after treatment but then comes back, it’s called a recurrent cancer. Cancer can recur in the same place it started, but it can also come back somewhere else in the body. A cancer that has come back in a different place from where it started is a metastatic recurrence.
• A second cancer is a separate type of cancer, unrelated to the first cancer. A second cancer is different from recurrence and metastasis because the cancer cells are different from the cells of the original cancer.

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. To learn more, see Understanding Recurrence and Second Cancers.

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 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 for signs 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

You might also notice symptoms if cancer has spread. General signs and symptoms of advanced and metastatic 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.
• Weight loss (without trying)
• Pain
• Shortness of breath or trouble breathing
• Finding a new lump or swollen lymph node

Advanced and metastatic cancers can cause many other symptoms, depending on the type of cancer and where it has spread.