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How cancer can spread

This page tells you about how cancers can spread. There is information about

Primary and secondary cancer

How cancer can spread to other areas of the body

Spread through the blood circulation

Spread through the lymphatic system

Micrometastases

Related information

Primary and secondary cancer

The place where a cancer starts in the body is called the primary cancer or primary site. Cells from the primary site may break away and spread to other parts of the body. These escaped cells can then grow and form other tumours, which are known as secondary cancers or metastases.

How cancer can spread to other areas of the body

Cancer cells can spread to other parts of the body through the bloodstream or lymphatic system. There they can start to grow into new tumours.

Cancers are named according to where they first started developing. For example, if you have bowel cancer that has spread to the liver, it's called bowel cancer with liver metastases or secondaries. It is not called liver cancer. This is because the cancerous cells in the liver are actually cancerous bowel cells. They are not liver cells that have become cancerous.

 

 

In order to spread, some cells from the primary cancer must break away, travel to another part of the body and start growing there. Cancer cells don't stick together as well as normal cells do. They may also produce substances that stimulate them to move. 

The diagram below shows a tumour in the cells lining a body structure such as the bowel wall. The tumour grows through the layer holding the cells in place (the basement membrane). 

 

 

Some cells can break away and go into small lymph vessels or blood vessels called capillaries in the area.

Spread through the blood circulation

When the cancer cells go into small blood vessels they can then get into the bloodstream. They are called circulating tumour cells (or CTCs).

Researchers are currently looking at using circulating tumour cells to diagnose cancer and avoid the need for tests such as biopsies. They are also looking at whether they can test circulating cancer cells to predict which treatments will work better. 

The circulating blood sweeps the cancer cells along until they get stuck somewhere. Usually they get stuck in a very small blood vessel such as a capillary.

 

 

Then the cancer cell must move through the wall of the capillary and into the tissue of the organ close by. The cell can multiply to form a new tumour if the conditions are right for it to grow and it has the nutrients that it needs.

This is quite a complicated process and most cancer cells don't survive it. Probably, out of many thousands of cancer cells that reach the bloodstream, only a few will survive to form a secondary cancer.

Some cancer cells are probably killed off by the white blood cells in our immune system. Others cancer cells may die because they get battered around by the fast flowing blood.

Cancer cells in the circulation may try to stick to platelets to form clumps to give themselves some protection. Platelets are blood cells that help the blood to clot. This may also help the cancer cells to move into the surrounding tissues.

Spread through the lymphatic system

The lymphatic system is a network of tubes and glands in the body that filters body fluid and fights infection. It also traps damaged or harmful cells such as cancer cells. 

Cancer cells can go into the small lymph vessels close to the primary tumour and travel into nearby lymph glands. In the lymph glands, the cancer cells may be destroyed but some may survive and grow to form tumours in one or more lymph nodes. Doctors call this lymph node spread.

Micrometastases

Micrometastases are areas of cancer spread (metastases) that are too small to see. Some areas of cancer are too small to show up on any type of scan.

For a few types of cancer, blood tests can detect certain proteins released by the cancer cells. These may give a sign that there are metastases in the body that are too small to show up on a scan. But for most cancers, there is no blood test that can say whether a cancer has spread or not.

For most cancers, doctors can only say whether it is likely or not that a cancer has spread. Doctors base this on a number of factors:

  • previous experience – doctors collect and publish this information to help each other
  • whether there are cancer cells in the blood vessels in the tumour removed during surgery – if cancer cells are found then the cancer is more likely to have spread to other parts of the body
  • the grade of the cancer (how abnormal the cells are) – the higher the grade, the more quickly the cancer grows and the more likely for cells to spread
  • whether lymph nodes removed during an operation contained cancer cells – if the lymph nodes contained cancer cells this shows that cancer cells have broken away from the original cancer (but there is no way of knowing whether the cells have spread to any other areas of the body)

This information is important in treating cancer. Doctors may offer extra treatment, such as chemotherapy, radiotherapy, biological therapy or hormone therapy if they suspect of micrometastases. The extra treatments may increase the chance of curing the cancer.

 

Coping with Metastatic Cancer

Approved by the Cancer.Net Editorial Board, 01/2016

When cancer spreads to a different part of the body from where it started, doctors call it metastasis. They also call it “metastatic cancer” or “stage 4 cancer.” Sometimes the term “advanced cancer” also describes metastatic cancer. But it shouldn’t be confused with “locally advanced cancer,” which is cancer that has spread to nearby tissues or lymph nodes and not throughout the body. Learn more about the basics of metastasis.

The naming of metastatic cancer can be confusing. Doctors name a metastasis for the original cancer. One way to remember this is consider a garden:  If dandelions from the lawn go to seed and grow in the rose garden, nobody calls them roses. Rather, they are dandelions spread to the rose garden. In a similar manner, breast cancer that spreads to the bone is not bone cancer, it is metastatic breast cancer.

What does it mean to have metastatic cancer?

In the past, many people did not live long with metastatic cancer. Even with today’s better treatments, recovery is not always possible. But doctors can often treat cancer even if they cannot cure it. A good quality of life is possible for months or even years.

How is metastatic cancer treated?

Treatment depends on the type of cancer, the available treatment options, and your wishes. It also depends on your age, general health, treatment you had before and other factors. Treatments for metastatic cancer include surgery, chemotherapy, hormone therapy, biologic therapy, and radiation therapy.

Goals of treatment

For many patients diagnosed with cancer, the goal of treatment is to try to cure the cancer. This means getting rid of the cancer and never having it come back. With metastatic cancer, cure may not be a realistic goal. It is reasonable to ask your doctor whether cure is the goal.

If cure is not the goal (understanding that it might be a hope, dream, or miracle and that it is reasonable to “never say never” and “never say always”), what is? The goal of treatment is to help a patient live as well as possible for as long as possible. Getting more specific, the goal can be broken down into four parts:

  • To have the fewest possible side effects from the cancer
  • To have the fewest possible side effects from the cancer treatment
  • For the patient to have the best quality of life
  • For the patient to have the longest quantity of life

Each patient emphasizes these items differently. It is important to tell your doctor and care team what is important to you.

Getting treatment for metastatic cancer can help you live longer and feel better. But getting treatment is always your decision. You can also read Making Decisions about Cancer Treatment and the ASCO Care and Treatment Recommendations for Patients. These recommendations include information on treating many types of metastatic cancer.

Living with long-term cancer

When doctors can treat metastatic cancer, your situation may be like someone with a chronic (long-term disease). Examples of chronic diseases are type 1 diabetes, congestive heart failure, and multiple sclerosis. Doctors can treat these conditions, but not cure them.

The challenges of living with cancer

Living with metastatic cancer is challenging. The challenges are different for everyone, but they can include:

  • Feeling upset that the cancer came back – You might feel hopeless, angry, sad, or like no one understands what you are going through, even family.
  • Worrying that treatment will not help and the cancer will get worse.
  • Dealing with tests, doctor’s appointments, and decisions.
  • Talking with family and friends about the cancer.
  • Needing help with daily activities, if you feel exhausted or have side effects from treatment.
  • Finding emotional and spiritual support.
  • Coping with the cost of more treatment – Even if you have insurance, it might not cover everything.

Meeting the challenges of metastatic cancer

To understand your situation, you may want to get a second opinion. Many people find that it helps to get an opinion from another oncologist, and many doctors encourage it.

Your doctor can help you cope with cancer symptoms and treatment side effects. For example, if you have pain, your treatment might include surgery to remove a tumor in a painful area. Your doctor might also prescribe pain medication or anti-nausea medication.

Deal with emotions and lifestyle changes

Coping with emotions and lifestyle challenges is an important part of living with metastatic cancer. Ways of coping include:

  • Learning about the metastasis—You might want to know everything possible, or just basic information.
  • Talking with a counselor about your situation – For example, a psychologist, psychiatrist, or oncology social worker.
  • Managing stress—From planning ahead to trying meditation and yoga, there are many options to help lower your stress level.
  • Finding meaning—Talking with a hospital chaplain, a counselor, or your religious leader can help.

Recognize your feelings and concerns

Talking about fears and concerns is important, even when treatment is working well. Tell your doctor and health care team about emotional symptoms. People may live for years with metastatic cancer. Your doctor can help you have the best quality of life possible during this time. Hospitals and medical centers have many resources for you and your family.

Family members need help, too

Your loved ones might also need help coping. Having a family member or friend with metastatic cancer is challenging, especially for people who help care for you. They can try the ways of coping above. Your doctor and health care team can suggest more help for family members. For example, support groups for family members meet in person and online.

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