Does metastatic cancer have symptoms?

Some people with metastatic tumors do not have symptoms. Their metastases are found by x-rays or other tests.

When symptoms of metastatic cancer occur, the type and frequency of the symptoms will depend on the size and location of the metastasis. For example, cancer that spreads to the bone is likely to cause pain and can lead to bone fractures. Cancer that spreads to the brain can cause a variety of symptoms, including headaches, seizures, and unsteadiness. Shortness of breath may be a sign of lung metastasis. Abdominal swelling or jaundice (yellowing of the skin) can indicate that cancer has spread to the liver.

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Sometimes a person’s original cancer is discovered only after a metastatic tumor causes symptoms. For example, a man whose prostate cancer has spread to the bones in his pelvis may have lower back pain (caused by the cancer in his bones) before he experiences any symptoms from the original tumor in his prostate.

Can someone have a metastatic tumor without having a primary cancer?

No. A metastatic tumor is always caused by cancer cells from another part of the body.

In most cases, when a metastatic tumor is found first, the primary cancer can also be found. The search for the primary cancer may involve lab tests, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and other procedures.

However, in some patients, a metastatic tumor is diagnosed but the primary tumor cannot be found, despite extensive tests, because it either is too small or has completely regressed. The pathologist knows that the diagnosed tumor is a metastasis because the cells do not look like those of the organ or tissue in which the tumor was found. Doctors refer to the primary cancer as unknown or occult (hidden), and the patient is said to have cancer of unknown primary origin (CUP).

Because diagnostic techniques are constantly improving, the number of cases of CUP is going down.

If a person who was previously treated for cancer gets diagnosed with cancer a second time, is the new cancer a new primary cancer or metastatic cancer?

The cancer may be a new primary cancer, but, in most cases, it is metastatic cancer.

What treatments are used for metastatic cancer?

Metastatic cancer may be treated with systemic therapy (chemotherapy, biological therapy, targeted therapy, hormonal therapy), local therapy (surgery, radiation therapy), or a combination of these treatments. The choice of treatment generally depends on the type of primary cancer; the size, location, and number of metastatic tumors; the patient’s age and general health; and the types of treatment the patient has had in the past. In patients with CUP, it is possible to treat the disease even though the primary cancer has not been found.

Are new treatments for metastatic cancer being developed?

Yes, researchers are studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells, including new ways to boost the strength of immune responses against tumors. In addition, researchers are trying to find ways to disrupt individual steps in the metastatic process.

Before any new treatment can be made widely available to patients, it must be studied in clinical trials (research studies) and found to be safe and effective in treating disease. NCI and many other organizations sponsor clinical trials that take place at hospitals, universities, medical schools, and cancer centers around the country. Clinical trials are a critical step in improving cancer care. The results of previous clinical trials have led to progress not only in the treatment of cancer but also in the detection, diagnosis, and prevention of the disease. Patients interested in taking part in a clinical trial should talk with their doctor. 

Selected References

1. Aragon-Ching JB, Zujewski J. CNS metastasis: an old problem in a new guise. Clinical Cancer Research 2007; 13(6):1644–1647.

2. Berman AT, Thukral AD, Hwang W-T, Solin LJ, Vapiwala N. Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment. Clinical Breast Cancer 2012; epub ahead of print.

3. Breda A, Konijeti R, Lam JS. Patterns of recurrence and surveillance strategies for renal cell carcinoma following surgical resection. Expert Review of Anticancer Therapy 2007; 7(6): 847–862.

4. Bubendorf L, Schöpfer A, Wagner U, et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Human Pathology 2000; 31(5):578–583.

5. Clarke JL. Leptomeningeal metastasis from systemic cancer. Continuum 2012; 18(2):328–342.

6. Coghlin C, Murray GI. Current and emerging concepts in tumour metastasis. Journal of Pathology 2010; 222(1):1–15.

7. Deng J, Liang H, Wang D, et al. Investigation of the recurrence patterns of gastric cancer following a curative resection. Surgery Today 2011; 41(2):210–215.

8. Disibio G, French SW. Metastatic patterns of cancer: results from a large autopsy study. Archives of Pathology & Laboratory Medicine 2008; 132(6):931–939.

9. Grier J, Batchelor T. Metastatic neurologic complications of non-Hodgkin’s lymphoma. Current Oncology Reports 2005; 7(1):55–60.

10. Groves MD. Leptomeningeal disease. Neurosurgery Clinics of America 2011; 22(1):67–78.

11. Hess KR, Varadhachary GR, Taylor SH, et al. Metastatic patterns in adenocarcinoma. Cancer 2006; 106(7):1624–1633.

12. Leiter U, Meier F, Schittek B, Garbe C. The natural course of cutaneous melanoma. Journal of Surgical Oncology 2004; 86(4):172–178.

13. Leong SP, Cady B, Jablons DM, et al. Clinical patterns of metastasis. Cancer Metastasis Reviews 2006; 25(2):221–232.

14. Muresan MM, Olivier P, Leclère J, et al. Bone metastases from differentiated thyroid carcinoma. Endocrine-Related Cancer 2008; 15(1):37–49.

15. Nguyen DX, Bos PD, Massagué J. Metastasis: from dissemination to organ-specific colonization. Nature Reviews Cancer 2009; 9(4):274–284.

16. Otto CM. Cardiac masses and potential cardiac “source of embolus.” In: Textbook of Clinical Echocardiography. 4th ed. Philadelphia: Elsevier, Inc., 2009. 

17. Roth ES, Fetzer DT, Barron BJ, et al. Does colon cancer ever metastasize to bone first? A temporal analysis of colorectal cancer progression. BMC Cancer 2009; 9:274.

18. Schluterman KO, Fassas AB, Van Hemert RL, Harik SI. Multiple myeloma invasion of the central nervous system. Archives of Neurology 2004; 61(9):1423–1429.

19. Schuchert MJ, Luketich JD. Solitary sites of metastatic disease in non-small cell lung cancer. Current Treatment Options in Oncology 2003; 4(1):65–79. 

20. Shinagare AB, Ramaiya NH, Jagannathan JP, et al. Metastatic pattern of bladder cancer: correlation with the primary characteristics of the primary tumor. American Journal of Roentgenology 2011; 196(1):117–122.

21. Sohaib SA, Houghton SL, Meroni R, et al. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clinical Radiology 2007; 62(1):28–34.

22. Talmadge JE, Fidler IJ. AACR centennial series: the biology of cancer metastasis: historical perspective. Cancer Research 2010; 70(14):5649–5669.

23. Viadana E, Bross ID, Pickren JW. An autopsy study of the metastatic patterns of human leukemias. Oncology 1978; 35(2):87–96.

24. Woodward PJ, Hosseinzadeh K, Saenger JS. From the archives of the AFIP: radiologic staging of ovarian carcinoma with pathologic correlation. RadioGraphics 2004; 24(1):225–246.

25. Yachida S, Iacobuzio-Donahue CA. The pathology and genetics of metastatic pancreatic cancer. Archives of Pathology & Laboratory Medicine 2009; 133(3):413–422.

Source: National Cancer Institute