• 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.

Biomarker results to ask for: 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.

Scans and tests linked to this cancer: Comprehensive genomic profiling, Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC), CellSearch circulating tumour cell count, FES PET (oestrogen receptor imaging), Biology-guided radiotherapy (RefleXion X1, SCINTIX).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• Widespread metastatic disease: Systemic therapy chosen by the primary cancer and its biomarkers, with early palliative care; see the individual cancer pages. (Early integrated palliative care)
• Oligometastatic disease: Stereotactic ablative radiotherapy or surgery to all sites in addition to systemic therapy, in selected patients and ideally in trials. (SBRT / SABR (stereotactic radiotherapy))
• Bone metastases: Palliative radiotherapy for pain, bone-modifying agents (zoledronic acid or denosumab) to prevent fractures, radium-223 in prostate cancer. (Palliative radiotherapy, Bone-modifying agents (bisphosphonates, denosumab), Zoledronic acid, Denosumab, Radium-223 dichloride)
• Brain metastases: Stereotactic radiosurgery for limited lesions, surgery for large symptomatic ones, and brain-penetrant targeted drugs where a driver exists. (Stereotactic radiosurgery (SRS))

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.