{"entity":{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","aka":["Metastatic Cancer","Secondary cancer","Advanced cancer","Stage 4 cancer","Stage IV cancer","Cancer that has spread"],"tldr":"Metastatic cancer means the original cancer has spread to other parts of the body, most often the bones, liver, lungs or brain. It keeps the name of where it started, is treated with therapies that reach the whole body, and can increasingly be controlled for years; with limited spread it is sometimes treated with the aim of cure.","summary":"Metastasis is the process by which cancer cells leave the original tumour, travel through blood or lymph and grow in another organ. A breast cancer that has spread to the liver is still breast cancer and is treated with breast cancer drugs, which is why this page points to the cancer-specific pages for treatment. What metastatic cancers share is the intent and the tools: systemic therapy (chemotherapy, targeted drugs, hormone therapy, immunotherapy) rather than surgery alone; radiotherapy and bone-strengthening drugs for bone metastases; radiosurgery or surgery for brain metastases; and early palliative care alongside treatment, which improves quality of life and in some studies survival. Two ideas have changed the outlook: many metastatic cancers are now chronic conditions controlled for years, and oligometastatic disease, spread limited to a few sites, is increasingly treated with stereotactic radiotherapy or surgery to every site with the aim of long remission, as the SABR-COMET trial suggested. Circulating tumour DNA is beginning to detect and monitor spread from a blood sample.","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Metastasis","links":[{"label":"NCI: Metastatic cancer","url":"https://www.cancer.gov/types/metastatic-cancer"}],"tags":["umbrella"],"related":["cancer-of-unknown-primary"],"cancers":[],"sections":[],"technologies":["sbrt","stereotactic-radiosurgery","palliative-radiotherapy","bone-modifying-agents","palliative-care","ctdna"],"targets":[],"drugs":["zoledronic-acid","denosumab","radium-223"],"companies":[],"institutions":[],"pathways":[],"terms":["metastasis","oligometastatic","bone-metastases","brain-metastases","leptomeningeal-disease","palliative-treatment"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"notes":[],"group":"other","burden":"Most cancer deaths follow metastasis rather than growth of the original tumour; how often a cancer spreads, and where, depends on the primary site.","subtypes":["Bone metastases","Liver metastases","Lung metastases","Brain metastases and leptomeningeal disease","Peritoneal metastases","Oligometastatic disease (limited spread)","Cancer of unknown primary (spread found before the origin)"],"biomarkers":["Imaging (CT, PET, MRI) and biopsy of a metastatic site to confirm the primary and re-test targets","Circulating tumour DNA","Site-specific markers such as bone scan uptake or alkaline phosphatase"],"standardOfCare":[{"setting":"Widespread metastatic disease","approach":"Systemic therapy chosen by the primary cancer and its biomarkers, with early palliative care; see the individual cancer pages.","refs":["palliative-care"]},{"setting":"Oligometastatic disease","approach":"Stereotactic ablative radiotherapy or surgery to all sites in addition to systemic therapy, in selected patients and ideally in trials.","refs":["sbrt"]},{"setting":"Bone metastases","approach":"Palliative radiotherapy for pain, bone-modifying agents (zoledronic acid or denosumab) to prevent fractures, radium-223 in prostate cancer.","refs":["palliative-radiotherapy","bone-modifying-agents","zoledronic-acid","denosumab","radium-223"]},{"setting":"Brain metastases","approach":"Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists.","refs":["stereotactic-radiosurgery"]}],"stateOfArt":[],"history":[{"year":1889,"title":"Paget's seed and soil hypothesis","note":"Stephen Paget proposed that cancers spread to organs whose environment suits them, the founding idea of metastasis research.","refs":[]},{"year":2002,"title":"Zoledronic acid approved for bone metastases","note":"Bisphosphonates, then denosumab, cut fractures and other skeletal events from bone metastases.","refs":["zoledronic-acid","denosumab"]},{"year":2019,"title":"SABR-COMET reports","note":"Randomised phase 2 trial in which stereotactic radiotherapy to all sites of oligometastatic disease was associated with longer survival, launching phase 3 trials of the approach.","refs":["sbrt"]}],"pipeline":[],"openProblems":["Metastasis itself has no approved drug: treatments target the growing cells, not the spreading.","Which patients with limited spread truly benefit from treating every site is still being tested in phase 3 trials."]},"route":"/cancers/metastatic-cancer/","neighbours":{"cancer":[{"id":"cancer-of-unknown-primary","kind":"cancer","name":"Cancer of unknown primary (CUP)","route":"/cancers/cancer-of-unknown-primary/"}],"technology":[{"id":"bone-modifying-agents","kind":"technology","name":"Bone-modifying agents (bisphosphonates, denosumab)","route":"/technologies/bone-modifying-agents/"},{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","route":"/technologies/palliative-care/"},{"id":"palliative-radiotherapy","kind":"technology","name":"Palliative radiotherapy","route":"/technologies/palliative-radiotherapy/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"term":[{"id":"bone-metastases","kind":"term","name":"Bone metastases and skeletal-related events","route":"/terms/bone-metastases/"},{"id":"brain-metastases","kind":"term","name":"Brain metastases (intracranial disease)","route":"/terms/brain-metastases/"},{"id":"ctdna","kind":"term","name":"Circulating tumour DNA (ctDNA)","route":"/terms/ctdna/"},{"id":"leptomeningeal-disease","kind":"term","name":"Leptomeningeal disease","route":"/terms/leptomeningeal-disease/"},{"id":"metastasis","kind":"term","name":"Metastasis","route":"/terms/metastasis/"},{"id":"oligometastatic","kind":"term","name":"Oligometastatic disease","route":"/terms/oligometastatic/"},{"id":"palliative-treatment","kind":"term","name":"Palliative","route":"/terms/palliative-treatment/"},{"id":"stereotactic-radiosurgery","kind":"term","name":"Stereotactic radiosurgery (SRS)","route":"/terms/stereotactic-radiosurgery/"}],"drug":[{"id":"denosumab","kind":"drug","name":"Denosumab","route":"/drugs/denosumab/"},{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"},{"id":"zoledronic-acid","kind":"drug","name":"Zoledronic acid","route":"/drugs/zoledronic-acid/"}]}}