Metastatic cancer (cancer that has spread)
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.
Overview
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.
State of the art
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Most cancer deaths follow metastasis rather than growth of the original tumour; how often a cancer spreads, and where, depends on the primary site.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Systemic therapy chosen by the primary cancer and its biomarkers, with early palliative care; see the individual cancer pages.
Stereotactic ablative radiotherapy or surgery to all sites in addition to systemic therapy, in selected patients and ideally in trials.
Palliative radiotherapy for pain, bone-modifying agents (zoledronic acid or denosumab) to prevent fractures, radium-223 in prostate cancer.
Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists.
Subtypes & biomarkers
top- 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)
- 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
How often this target appears
- 1889Paget's seed and soil hypothesis
Stephen Paget proposed that cancers spread to organs whose environment suits them, the founding idea of metastasis research.
- 2002Zoledronic acid approved for bone metastases
Bisphosphonates, then denosumab, cut fractures and other skeletal events from bone metastases.
- 2019SABR-COMET reports
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.
Open problems and what is being done
Metastasis itself has no approved drug: treatments target the growing cells, not the spreading.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Bone-modifying agents (bisphosphonates, denosumab)Standard of care
- DenosumabApproved
- Palliative radiotherapyStandard of care
- Radium-223 dichlorideApproved
- SBRT / SABR (stereotactic radiotherapy)Standard of care
- Zoledronic acidApproved
In trials- ACTIONRecruiting
- CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target)Phase 1
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- DESTINY-Breast12Positive
- DYNAMICPositive
- EF-14Positive
Ideas and roadmaps- A billion-dollar prize for the first durable cure of a lethal metastatic cancer
- A blood test for the pre-metastatic niche
- A global rapid tissue donation network for metastatic disease
- A national rapid research autopsy network for end-stage cancer
- A regulatory endpoint for drugs that block spread, not tumours
- A ring-fenced metastasis programme with metastasis-specific endpoints
Background: Circulating tumour DNA (ctDNA), Metastasis, Oligometastatic disease, Blood-brain barrier (BBB), EGFRvIII. Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Which patients with limited spread truly benefit from treating every site is still being tested in phase 3 trials.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Bone-modifying agents (bisphosphonates, denosumab)Standard of care
- DenosumabApproved
- Palliative radiotherapyStandard of care
- Radium-223 dichlorideApproved
- SBRT / SABR (stereotactic radiotherapy)Standard of care
- Zoledronic acidApproved
In trials- ACTIONRecruiting
- CAR-T for glioma (IL13Rα2, GD2, EGFRvIII, multi-target)Phase 1
- CIRCULATE-Japan (GALAXY / VEGA / ALTAIR)Active
- DESTINY-Breast12Positive
- DYNAMICPositive
- EF-14Positive
Ideas and roadmaps- A billion-dollar prize for the first durable cure of a lethal metastatic cancer
- A blood test for the pre-metastatic niche
- A global rapid tissue donation network for metastatic disease
- A national rapid research autopsy network for end-stage cancer
- A regulatory endpoint for drugs that block spread, not tumours
- A ring-fenced metastasis programme with metastasis-specific endpoints
Background: Circulating tumour DNA (ctDNA), Metastasis, Oligometastatic disease, Blood-brain barrier (BBB), EGFRvIII. Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Trials
topTrials recruiting now
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Expert centres
topExpert centres
- via SBRT / SABR (stereotactic radiotherapy)
- Aarhus University HospitalAarhus, DKvia SBRT / SABR (stereotactic radiotherapy)
- American Society for Radiation OncologyArlington, VA, USvia SBRT / SABR (stereotactic radiotherapy)
- Apollo Hospitals (Apollo Cancer Centres)Chennai, INvia SBRT / SABR (stereotactic radiotherapy)
- via SBRT / SABR (stereotactic radiotherapy)
- Canadian Cancer Trials Group (CCTG)Kingston, ON, CAvia SBRT / SABR (stereotactic radiotherapy)
- Centre Oscar LambretLille, FRvia SBRT / SABR (stereotactic radiotherapy)
- via SBRT / SABR (stereotactic radiotherapy)
- Christian Medical College, VelloreVellore, INvia Early integrated palliative care
- Comprehensive Cancer Center Freiburg (CCCF)Freiburg im Breisgau, DEvia SBRT / SABR (stereotactic radiotherapy)
- European Society for Radiotherapy and OncologyBrussels, BEvia SBRT / SABR (stereotactic radiotherapy)
- Fundación Arturo López PérezSantiago, CLvia SBRT / SABR (stereotactic radiotherapy)
- Hacettepe University Cancer InstituteAnkara, TRvia SBRT / SABR (stereotactic radiotherapy)
- Hadassah Medical CenterJerusalem, ILvia SBRT / SABR (stereotactic radiotherapy)
- via SBRT / SABR (stereotactic radiotherapy)
- HealthCare Global EnterprisesBengaluru, INvia SBRT / SABR (stereotactic radiotherapy)
- Hokkaido University HospitalSapporo, JPvia SBRT / SABR (stereotactic radiotherapy)
- Hospital Universitari i Politècnic La FeValencia, ESvia SBRT / SABR (stereotactic radiotherapy)
- IRCCS Humanitas Research HospitalRozzano (Milan), ITvia SBRT / SABR (stereotactic radiotherapy)
- Koo Foundation Sun Yat-Sen Cancer CenterTaipei, TWvia SBRT / SABR (stereotactic radiotherapy)
- Li Ka Shing FoundationHong Kong, HKvia Early integrated palliative care
- Rajiv Gandhi Cancer Institute and Research CentreNew Delhi, INvia SBRT / SABR (stereotactic radiotherapy)
- via SBRT / SABR (stereotactic radiotherapy)
- Sunnybrook Odette Cancer CentreToronto, ON, CAvia SBRT / SABR (stereotactic radiotherapy)
- TROG Cancer ResearchNewcastle, NSW, AUvia SBRT / SABR (stereotactic radiotherapy)
- UMC Utrecht Cancer CenterUtrecht, NLvia SBRT / SABR (stereotactic radiotherapy)
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer CenterBaltimore, MD, USNCI comprehensivevia SBRT / SABR (stereotactic radiotherapy)
- Velindre Cancer CentreCardiff, GBvia SBRT / SABR (stereotactic radiotherapy)
- via SBRT / SABR (stereotactic radiotherapy)
Questions to ask
topQuestions to ask your oncologist about Metastatic cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Imagingand 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), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Bone metastases, Liver metastases, Lung metastases.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Widespread metastatic disease
- For my situation (widespread metastatic disease), which of the standard options do you recommend and why?Why: Guideline options include: Systemic therapy chosen by the primary cancer and its biomarkers, with early palliative care; see the individual cancer pages.
Oligometastatic disease
- For my situation (oligometastatic disease), which of the standard options do you recommend and why?Why: Guideline options include: Stereotactic ablative radiotherapy or surgery to all sites in addition to systemic therapy, in selected patients and ideally in trials.
Bone metastases
- For my situation (bone metastases), which of the standard options do you recommend and why?Why: Guideline options include: Palliative radiotherapy for pain, bone-modifying agents (zoledronic acid or denosumab) to prevent fractures, radium-223 in prostate cancer.
- Am I a candidate for Zoledronic acid, Denosumab, Radium-223 dichloride, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Brain metastases
- For my situation (brain metastases), which of the standard options do you recommend and why?Why: Guideline options include: Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Metastasis itself has no approved drug: treatments target the growing cells, not the spreading”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Which patients with limited spread truly benefit from treating every site is still being tested in phase 3 trials”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
6targets
1drugs
3companies
3terms
8Latest papers
topQuery for this cancer: (TITLE:"Metastatic cancer" OR ABSTRACT:"Metastatic cancer" OR TITLE:"cancer that has spread" OR ABSTRACT:"cancer that has spread" OR TITLE:"Metastatic Cancer" OR ABSTRACT:"Metastatic Cancer" OR TITLE:"Secondary cancer" OR ABSTRACT:"Secondary cancer" OR TITLE:"Advanced cancer" OR ABSTRACT:"Advanced cancer" OR TITLE:"Stage 4 cancer" OR ABSTRACT:"Stage 4 cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Metastatic cancer (cancer that has spread), not a curated reading list.
Similar pages
not linked directly; found by shared links- TermWhole-brain radiotherapy (WBRT)
Shares Leptomeningeal disease, Stereotactic radiosurgery (SRS), Brain metastases (intracranial disease).
- TreatmentIbandronic acid
Shares Zoledronic acid, Denosumab, Bone-modifying agents (bisphosphonates, denosumab).
- TreatmentPamidronate
Shares Zoledronic acid, Denosumab, Bone-modifying agents (bisphosphonates, denosumab).
- TermStereotactic body radiotherapy (SBRT / SABR)
Shares Stereotactic radiosurgery (SRS), Bone metastases and skeletal-related events, Oligometastatic disease, SBRT / SABR (stereotactic radiotherapy).
- TechnologyCancer pain management
Shares Radium-223 dichloride, Palliative radiotherapy, Bone-modifying agents (bisphosphonates, denosumab), Early integrated palliative care.
- TermCNS penetration (brain-penetrant drugs)
Shares Leptomeningeal disease, Brain metastases (intracranial disease).
- TermSystemic versus local therapy
Shares Palliative, Metastasis, Oligometastatic disease, SBRT / SABR (stereotactic radiotherapy).
- TargetRANK ligand (RANKL)
Shares Denosumab, Bone-modifying agents (bisphosphonates, denosumab).