Clinically Speaking: Questions and Answers About Metastatic Cancer

Hearing the words, “You have cancer,” has become an unfortunate reality for many women in the U.S. Research shows 4 out of 10 women will be diagnosed with cancer at some point in their lifetime — and an estimated 972,000 new cases will be diagnosed this year.

Everything about cancer is scary — especially the fact that almost all cancers have the potential to spread throughout the body. When this happens, it’s called metastatic cancer, also known as stage 4, and it’s harder to treat than cancer that hasn’t spread.

Despite the challenges of metastatic cancer, research shows advancements in treatment options are helping people live longer and have a better quality of life overall.

Read: Do You Know Someone Who Has Cancer? Here’s How You Can Help. >>

In an effort to spread awareness about the disease, we asked oncologist Shikha Jain, M.D., about the facts and what you need to know about metastatic cancer.

​What is metastatic cancer?

Cancer is a disease that starts when cells in the body begin to grow and make copies of themselves. Metastatic cancer is cancer that has spread from the site where it began. One analogy would be to think of your body as a neighborhood and each organ is a house. Each house has its own set of residents (cells) that usually stay in that house. But if some residents start to misbehave (cancer cells) and decide to move to another house and cause trouble, those would be metastatic diseases. For example, if breast cancer moves to a second location from where it started, like the lungs or bones, it is considered metastatic cancer. This is not a new lung or liver or bone cancer, but breast cancer that has metastasized.

Watch: Resources for Patients with Metastatic Breast Cancer >>

​How does cancer spread?

Cancer can spread in different ways depending on the type of cancer. Some cancers spread through the bloodstream and some through the lymphatic system, which are the tissues and organs in your body that help you fight diseases. When they leave the original site of the tumor and find a new place to make copies of themselves, they can create tumors in new locations and can continue to spread to other organs.

​What are the most common sites of metastasis?

In general, it’s most common for cancer to metastasize to the lungs, liver, brain and bones. However, the most common sites of metastasis also depend on the type of cancer. For example, colon cancer most commonly spreads to the liver and then to the lungs. Breast cancer commonly spreads to the bones.

​Does metastatic cancer cause symptoms?

Metastatic cancer can cause symptoms depending on where the cancer has spread to. For example, if the cancer spreads to the bone it can cause pain and, in some cases, weakened bones and fractures. Cancer that spreads to the liver can cause abdominal pain, fluid buildup in the abdomen, jaundice (yellowing of the skin and eyes) and loss of appetite and weight. Cancer that has spread to the lungs can cause shortness of breath, chest pain and coughing up blood. Brain metastatic disease can cause headache attacks, dizziness, blurry vision and other neurologic symptoms. Symptoms of metastatic cancer can sometimes be vague or mimic other conditions. This can make getting a diagnosis challenging.

​How is metastatic cancer treated?

Metastatic cancer can be treated in a variety of ways and can include whole-body therapies such as chemotherapy, targeted therapy or immunotherapy, surgery, radiation or other local therapies. The treatment of metastatic cancer depends on the location as well as the type of cancer being treated.

Chemotherapy uses drugs to directly kill cancer cells or stop them from growing. These drugs can either be given via an IV or as pills. They then travel through the bloodstream making them especially effective in treating cancer that has spread to other parts of the body.

Hormone therapy can be used for cancers that are sensitive to hormones, such as some types of breast cancer and prostate cancer. These therapies can block the hormones that can fuel cancer growth.

Targeted therapy is a type of treatment that uses drugs to target specific molecules that can impact cancer growth and spread. They are designed to attack cancer cells and cause less damage to normal cells, with a goal of minimizing side effects.

Immunotherapy agents are drugs that help a person’s own immune system to fight cancer cells.

Read: New Treatments for Metastatic Breast Cancer >>

Radiation and surgery are sometimes options for localized disease. Radiation uses high energy rays to kill cancer cells or shrink tumors. Surgery can be performed in certain cases to remove specific tumors, especially if they are causing symptoms or complications.

​What are tips to engage in shared decision-making about treatment options for metastatic cancer?

Shared decision-making is about working together with your healthcare team to find the best treatment plan for you. Communicating openly and researching the type, stage and treatment options available to you can help you take an active role in your healthcare decisions.

When doing your research, use reliable sources such as the American Cancer Society and National Cancer Institute and write down a list of questions and concerns for your healthcare provider (HCP) to discuss at your office visit. Also write down your treatment goals and what’s most important to you during treatment (quality of life, managing side effects, etc.).

During the visit, ask about all available treatment options and any clinical trials, including the benefits, risks and potential side effects to each one. Don’t be afraid to ask the HCP to explain something you may not understand, and be open and honest about any fears or concerns. The more details you can share about your life, work and your day-to-day schedule, the easier it will be to create a personalized plan that will fit into your life.

​What are ways to manage symptoms of metastatic cancer?

There are many ways to manage symptoms of metastatic cancer including medication and lifestyle choices.

For mild pain, over-the-counter (OTC) medications such as ibuprofen and acetaminophen can help. Severe pain may require prescription pain medications or a procedure like a nerve block or an epidural.

For fatigue, try conserving energy by prioritizing tasks and pacing yourself throughout the day. A balanced diet and light exercise can also help boost energy levels. If weight loss and loss of appetite are a problem, try eating smaller, more frequent meals throughout the day or ask your HCP about appetite stimulants and/or working with a dietician to help create a meal plan that works for you.

Dietary changes like avoiding spicy foods and foods with a strong smell can also help reduce nausea. And OTC or prescription anti-nausea medications may help with an upset stomach and vomiting.

Breathing problems can happen when cancer moves to the lungs. Inhalers and steroids can help open up airways and reduce inflammation. Supplemental oxygen can help people breathe more comfortably.

Living with metastatic cancer affects mental health too. Support groups and talking to a therapist or counselor can help with the emotional challenges. And mind-body exercises such as meditation and mindfulness can help reduce stress and improve overall well-being.

​Is palliative care an option for people with metastatic cancer?

Palliative care is an excellent option for people with metastatic cancer. This specialized type of medical care focuses on providing relief from symptoms and its goal is to improve overall quality of life.

Read: What’s the Difference Between Hospice and Palliative Care? >>

Palliative care can be included in a care plan at any time or stage of a diagnosis or illness. Palliative care teams can help with everything from symptom management and emotional and psychological support to communication and decision-making, coordinating care and support for families.

This educational resource was created with support from Exelexis, a HealthyWomen Corporate Advisory Council member.