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.
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.
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.
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