How Is Advanced Cancer Treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Advanced cancer is not likely to be cured but it can often be controlled. You and your family should be clear about the goal of any treatment you’re having. You should know whether the goal is to try to cure the cancer, to let you live longer, or to relieve symptoms. This can sometimes be confusing because the same treatments might be used for all of these reasons.

Some people believe that nothing more can be done if the cancer cannot be cured, so they stop all treatment. Even some doctors think this way. But often there are treatments that can control symptoms. Relief from symptoms such as pain, blocked bowels, and upset stomach can help maintain or improve the quality of your life.

You have the right to make decisions about your treatment. Some people decide that the burdens of aggressive cancer treatment are not worth the possible benefits. Others want to keep on having treatment. Some people want to stay at home. Others choose to go to an assisted living center, a nursing home, or a hospice. This is a very personal issue.

If you decide that you don’t want any more treatment for your cancer, this may be hard for some of your loved ones to accept. It can help to include your family in these decisions.

Treatment Choices

Here is a brief look at the different treatments that might be used for advanced cancer. The right choice for each person depends on where the cancer started and if and how much it has spread. As a general rule, cancer that has spread will need treatment that goes throughout the body. This is called systemic treatment and examples are chemotherapy (“chemo”) and hormone therapy.

Surgery is most often used to try to cure localized cancer. It is not often used in treating advanced cancer, but may be used along with other types of treatment if there are only a few small tumors. There are also other times when surgery can be helpful, such as:

• to relieve a blocked bowel
• to put a feeding tube in place
• to give pain relief by cutting nerves or taking out tumors that press on them
• to place a small tube (catheter) into a blood vessel to give fluids or drugs
• to help stop bleeding
• to prevent or treat broken bones by putting in a metal rod

Whether surgery will be used depends a lot on the person’s overall condition. Major surgery is hardly ever done for someone who cannot get out of bed. On the other hand, surgery may be a good idea for someone who is feeling fairly well and is active.

Radiation therapy is the use of high-energy x-rays to kill cancer cells. In advanced cancer, radiation is often used to shrink tumors to reduce pain or other symptoms.

Radiation therapy can be external (given from a machine outside of the body) or internal (placing small radioactive seeds inside the body).

This treatment does have side effects, so it’s a good idea to talk to your doctor about these ahead of time.

Chemotherapy or chemo refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they reach throughout the body. This makes chemo a good treatment for cancer that is widespread. Shrinking the cancer can relieve symptoms and may prolong life.

Chemo causes side effects because it harms healthy cells as well as cancer cells. Some of the possible side effects include:

• nausea and vomiting
• loss of appetite
• hair loss (the hair grows back after treatment ends)
• mouth sores
• increased chance of infection
• bleeding or bruising after small cuts or injuries
• tiredness

Your doctor or nurse can suggest ways to ease these side effects. It is important to balance any side effects against the symptoms you are trying to relieve.

Hormone therapy is the use of drugs to stop the effect of some hormones that promote the growth of cancer cells. For example, estrogen (a hormone made by women’s ovaries) can promote the growth of many breast cancers. Male sex hormones such as testosterone promote the growth of prostate cancers. Drugs can be given that block the action of these hormones or reduce the amount that is made.

There are other drugs (bisphosphonates) that are used to treat weakened bones. The drugs help reduce bone pain and slow down bone damage caused by the cancer. These drugs also have side effects that must be taken into account. For more information, see the ACS document called Bone Metastases.

Source: http://www.cancer.org

How Is Advanced Cancer Found?

It’s hard to know who will get metastatic or advanced cancer. Some types of cancer are more likely to spread than others. One way is to look at the cancer cells under a microscope. This process is called grading the cancer. The more normal the cells look, the less likely they are to spread. Another way is to look at the size of the tumor. Also, if the cancer has spread to the lymph nodes, it is much more likely to spread to other parts of the body. Sometimes the lymph nodes are removed during surgery and looked at for cancer cells.

Even with all of this, doctors aren’t always sure whether a person’s cancer will spread or whether they already have advanced cancer. So the doctor will probably do a complete physical exam and also conduct some other tests to find the answer.

The most telling symptom of advanced cancer is loss of energy and feeling very tired. Most people with advanced cancer have a hard time doing everyday tasks. Weight loss is another sign. Shortness of breath is common with advanced lung cancer. Pain may or may not go along with advanced cancer.

As part of the physical exam, your doctor may look for signs such as fluid in the lungs or stomach area, tumor lumps on or within the body, or an enlarged liver.

Certain blood tests can point to advanced cancer. Some cancers can produce different substances or tumor markers in the blood. Blood tests can detect these markers. For more information, see the American Cancer Society document, Tumor Markers.

Pictures of the inside of the body (imaging studies) are also used to look for advanced cancer. These might include:

• chest x-rays to look for tumors in the lungs or fluid in the chest
• CT scans (computed tomography), a special type of x-ray
• MRI scans (magnetic resonance imaging), which use radio waves and strong magnets instead of x-rays
• PET scans, which use a form of sugar with a radioactive atom
• ultrasound, which uses sound waves to produce an image of the inside of the body
• radionuclide bone scans, to help show whether the cancer has spread to the bones

Often when an imaging test shows something that isn’t normal, the doctor will want to do a biopsy to find out if it is cancer. This is done by taking a small piece of tissue and looking at it under the microscope. Usually the biopsy is done by putting a needle into the spot and sucking out pieces of tissue or fluid. Often a biopsy is the only sure way to tell if the cancer has spread.

If you would like more information on any of these tests please see the ACS paper about your primary cancer site or the detailed guide to advanced cancer. You can also ask your doctor or nurse to tell you more about any tests or studies you’re going to have.

Source: http://www.cancer.org

Can Advanced or Metastatic Cancer Be Prevented?

For now, the only sure way to prevent the spread of a cancer is to find it early and remove or destroy it. The American Cancer Society recommends certain early detection tests to find cancers of the breast, prostate, colon, and cervix. But many people don’t know about, or don’t get, these tests. And because these tests aren’t perfect, some cancers can spread before they are found. There are also many cancers that can’t be found early by any of the tests we now have.

Scientists are looking for ways to keep cancer from spreading. For example, certain drugs can be given after surgery to kill cancer cells that might have broken away from the first tumor. Other drugs keep the tumors from making new blood vessels.

Source: http://www.cancer.org

Do We Know What Causes Metastatic Cancer?

How Cancer Cells Spread

Metastasis is the end result of a process that involves many steps. Cancer cells travel from the place they started through the blood or lymph vessels to other parts of the body.

• Step 1 is when some of the cancer cells begin to grow fast and become more likely to spread.
• Step 2 is when the tumor begins to grow its own blood vessels to supply blood to the tumor. This allows it to grow faster.
• Step 3 is when the fast-growing cancer cells begin to break away from the place where they started. They also change so that they can break into the walls of the blood vessels or lymph vessels to travel to other tissues.
• Step 4 involves the cancer cells being able to live in the blood stream. Most cancer cells that get into the blood or lymph vessels are killed by the immune system. But some can survive.
• Step 5 happens when these cells are able to attach to distant organs or lymph nodes.
• Step 6 is a key step in which the new tumors are able to form new blood vessels to carry food and oxygen to the cancer cells.
• Step 7 is when the cancer cells are able to keep growing in their new "home" and avoid the body's attempts to reject or destroy them.

Why Cancer Cells Tend to Spread to Certain Parts of the Body

Most cancer cells that have broken away from the place where they started are carried in the blood or lymph vessels until they get trapped in the next "downstream" lymph node or small blood vessel. This explains why breast cancer often spreads to the underarm lymph nodes but rarely to lymph nodes in the groin. Many cancers spread to the lungs because the heart pumps blood from the rest of the body through the lung's blood vessels before sending it elsewhere.

Sometimes the pattern of spread is not explained by body structure. Some cancer cells seem to "home in on" certain places, perhaps because of substances on their surfaces that stick to cells in these organs. In other cases, the organ itself may release substances that cause the cancer cells to grow faster.

Source: http://www.cancer.org

How Many People Get Advanced Cancer?

More than half a million people die of advanced cancer each year in the United States. More than 7 out of 10 of these people will be older than 65 years of age. Although more than half of all people who get cancer live 5 or more years after their cancer is found, people with advanced cancer usually live less than a year.

source: http://www.cancer.org

How Is Metastatic Cancer Different from Advanced Cancer?

Metastatic cancer is not always the same as advanced cancer. Cancer can be metastatic even if only a small amount of the cancer has spread. In many cases metastatic cancer can be treated successfully or even cured if it has not done a lot of damage. But metastatic cancer may be advanced if it has spread to many places or has greatly harmed tissues and important organs.

Most people who die from cancer have metastatic tumors. Many of the problems from cancer are caused by the cancer spreading to an important place in the body or because it has spread to many places.

source: http://www.cancer.org

What Is Recurrent Cancer?

When cancer comes back in a person who seemed to be free of cancer after treatment, it is called recurrent cancer. Cancer can come back in:

• the same place where it started or very close by
• lymph nodes near the place where it started distant organs

source: http://www.cancer.org

What Is Metastic Cancer?

Metastatic cancer is cancer that has spread from the part of the body where it started (its primary site) to other parts of the body. Keep in mind that when cancer spreads in this way it is still named after the part of the body where it started.

Sometimes the “new” tumors have already begun to grow when the cancer is first found. In some cases the metastasis may be found before the primary tumor is found. If cancer is widely spread throughout the body when it is found, it may not possible to tell where it started. This is called cancer of unknown primary. It is covered in a separate American Cancer Society document.

source: http://www.cancer.org

What Is Advanced Cancer?

Advanced cancer is cancer that has grown beyond the organ where it first started. Often it has spread to many places in the body. But advanced cancer is not exactly the same as metastatic cancer. A cancer might be called advanced if it involves a vital organ and can’t be removed.

Often the term advanced cancer means that it can’t be cured. Still, even if there is no cure, treatment can sometimes shrink the cancer, help relieve symptoms, and allow the person to live longer. Some people can live many years with advanced cancer.

In many cases, advanced cancer happens after the person has had cancer for some time and treatment is no longer working. But for some people the cancer may already be advanced when they first find out they have the disease. In any case, symptoms such as pain and depression can almost always be treated.

Source: http://www.cancer.org

What Is Cancer?

Cancer occurs when cells in a part of the body begin to grow out of control. Normal cells divide and grow in an orderly fashion, but cancer cells do not. They continue to grow and crowd out normal cells. Although there are many kinds of cancer, they all have in common this out-of-control growth of cells.

Different kinds of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That’s why people with cancer need treatment that is aimed at their kind of cancer.

Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system. They can settle in new places and form new tumors. When this happens, it is called metastasis (meh-tas-tuh-sis). Cancer that has spread in this way is called metastatic cancer.

Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer. If breast cancer spreads to the lungs, it is still breast cancer. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.

Source: http://www.cancer.org