The first 60 days: 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. Below, week by week, is what OnCo's record of Metastatic cancer (cancer that has spread) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Widespread metastatic disease.
- SurgeonNamed in the standard of care for: Oligometastatic disease, Brain metastases.
- Medical oncologistNamed in the standard of care for: Widespread metastatic disease, Oligometastatic disease, Bone metastases.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Oligometastatic disease, Bone metastases.
- Palliative and supportive care teamNamed in the standard of care for: Widespread metastatic disease, Bone metastases.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Bone metastases, Liver metastases, Lung metastases.
- Is germline (inherited) genetic testing recommended for me or my family?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?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?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?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?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?Guideline options include: Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists.
Any stage
- Are there clinical trials I could join, for example of SABR-COMET: stereotactic ablative radiotherapy for oligometastatic cancer, SBRT / SABR (stereotactic radiotherapy), Circulating tumour DNA (ctDNA), Pembrolizumab?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?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?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?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?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- A Clinical Study of Patritumab Deruxtecan to Treat Breast Cancer (MK-1022-016)Phase 3 · recruiting · NCT07060807An Open-label, Randomized, Phase 3 Study to Evaluate Patritumab Deruxtecan Monotherapy Versus Treatment of Physician's Choice in Hormone Receptor-positive, HER2-negative Unresectable Locally Advanced or Metastatic Breast Cancer (HERTHENA-Breast04).
- A Clinical Study to Compare BupiZenge With Lidocaine for Pain Due to Oral Mucositis in Patients With Head and Neck Cancer.Phase 3 · recruiting · NCT07672236A Randomized, Open-label, Phase III Trial to Assess the Efficacy and Safety of BupiZenge Compared to Lidocaine for Pain Associated With Oral Mucositis in Head and Neck Cancer
- A Phase Ⅲ Clinical Study of Combined Cisplatin Versus Placebo Combined With Intracavitary Cisplatin Injection in the Treatment of Malignant Pleural EffusionsPhase 3 · active · NCT04914598A Randomized, Controlled, Double-blind, Multi-center Phase Ⅲ Registration Clinical Study of Combined Cisplatin Versus Placebo Combined With Intracavitary Cisplatin Injection in the Treatment of Malignant Pleural Effusions
- A Phase III Clinical Trial of a 11-valent Recombinant Human Papillomavirus Vaccine (Hansenulapolymorpha) in Chinese Women Aged 9-45 YearsPhase 3 · recruiting · NCT05262010A Multicenter Randomized, Blinded, Placebo-controlled Phase III Clinical Trial Evaluating the Protective Efficacy, Safety and Immunogenicity of a 11-valent Recombinant Human Papillomavirus Vaccine (Hansenulapolymorpha) in Chinese Women Aged 9-45 Years
- A Phase Ⅲ Study of Hemay022 in Combination With AI In Advanced Breast CancerPhase 3 · recruiting · NCT06313983A Phase Ⅲ Randomized, Open Label, Parallel, Multicenter To Assess Efficacy and Safety Study of Hemay022 in Combination With AI In Postmenopausal HER2+/ER+ Advanced Breast Cancer Patients Treated With Trastuzumab-containing Regimens
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Metastatic cancer (cancer that has spread): the full pageMetastatic 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Metastasis: Cancer that has spread from where it started to distant parts of the body, travelling through the blood or lymph.
- Palliative: Treatment aimed at relieving symptoms and improving quality of life rather than curing the disease.
- Stereotactic radiosurgery (SRS): A single high dose of radiation delivered to a brain tumour or metastasis by beams converging from all sides, so the target gets a destructive dose while the surrounding brain gets little; no scalpel is involved despite the name.
- Leptomeningeal disease: Cancer cells spreading in the fluid and membranes that bathe the brain and spinal cord, rather than as a solid lump.
- Radiation necrosis (brain): Death of brain tissue months to years after radiosurgery or high-dose brain radiotherapy, which can look exactly like tumour growing back on a scan.
- Oligometastatic disease: Cancer that has spread to only a few places, which may still be curable by treating each spot.
- Brain metastases (intracranial disease): Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer.
- Bone metastases and skeletal-related events: Cancer spread to the bones, most common in prostate, breast, lung, kidney and thyroid cancer and myeloma.
- Circulating tumour DNA (ctDNA): Circulating tumour DNA (ctDNA) consists of fragments of DNA shed by tumour cells into the blood, detectable with sensitive sequencing.
Every term links to the glossary.