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Diagnosis & Treatment

Metastatic Cancer

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Diagnosing Metastatic Cancer

Diagnosis

If you’ve received a cancer diagnosis, your doctors will check to see if it’s metastasized to other parts of the body. This will help determine your cancer stage (Stage I-IV) and the next steps in your treatment plan.

At NewYork-Presbyterian, we may suggest certain imaging tests and procedures, including:

What tests might be used

  • Imaging: CT scans, MRIs, PET scans, bone scans, or ultrasounds allow doctors to see abnormalities and identify cancer location and size.
  • Biopsy & Pathology: A sample of a mass or bone marrow or lymph node or sometimes body fluids may be examined by a pathologist to confirm the diagnosis of cancer or extent of spread. 
  • Laboratory Tests: Doctors collect and examine samples of blood, urine, or other bodily fluids. Tests can reveal elevated enzymes, protein levels, or other abnormalities that may provide additional information about the cancer.
  • Biomarker & Genomic Testing: Specialized testing looks for specific gene changes or protein patterns in cancer cells that make them different from normal cells. These results can help predict how aggressive the cancer may be.

Blood and urine tests

Blood and urine tests can determine if certain enzymes or protein levels are elevated and rule out whether advanced cancer is in the body, including in the liver, kidney, or bones. The presence of tumor markers for ovarian, breast, prostate, and colon cancers can be found to help monitor the spread.

Blood and urine tests are not always effective, as a noncancerous condition can yield the same result as a cancerous one.

Imaging tests

Imaging tests can reveal if a tumor’s cancer cells have metastasized in other parts of the body. There are a range of imaging tests utilized, including:

  • CT scans may reveal additional tumors in the liver, lungs, or lymph nodes. They can also determine if there are abnormalities in the abdomen, pelvis, head, neck, or chest.
  • Ultrasonography (ultrasound) can tell the difference between solid masses (potential cancer) and fluid-filled cysts in the abdomen
  • MRI uses magnetic fields to pick up soft-tissue contrasts and provides a highly detailed image. It can determine metastases in areas like the brain and spinal cord.
  • Bone scans utilize a radioactive tracer, injected into the body. The tracer collects in parts of the bone and is examined by a specialized camera. The camera can pick up “hot spots,” signaling an abnormality in the bone.
  • PET scan (positron emission therapy), in which a small amount of dye containing radioactive sugars is injected into the body. Cancer cells will absorb the dye and register as bright spots, helping locate and measure tumors, and reveal abnormalities in the bone.

Biopsy

If a metastatic tumor is suspected, your doctor may order a biopsy. This procedure is performed by extracting a sample of cells. This can be done in various ways—by fine needle, incision, scraping, endoscopically, or laparoscopically. A pathologist will analyze cell samples to look for abnormal growth and tumor markers.

How is Metastatic Cancer Treated?

Treatment

Metastatic cancer treatments can depend on where original cancer began. Meaning if cancerous liver cells have metastasized elsewhere in the body, the new site will receive the same treatment protocol used for liver cancer.

Treatment methods for metastatic cancer can include:

Metastatic cancer treatments can depend on the specific cancer type, including:

  • Brain metastasis - Cancer that has spread to the brain may be treated with radiation therapy, chemotherapy, steroid, or surgery
  • Bone metastasis - Radiation therapy may be used if the bone tissue is weak or the patient is experiencing pain. If no pain is present, drug therapy may be recommended.
  • Liver metastasis - Depending on the number of tumors and the type of cancer in the liver, treatments may include surgery, chemotherapy, image-guided interventional therapies (radiofrequency ablation/RFA), and targeted therapy
  • Lung metastasis - Treatment may include a combination of radiation therapy, chemotherapy, immunotherapy, surgery, and a thoracentesis procedure to alleviate breathing issues due to fluid build-up in the lungs
  • Breast metastasis - Often treated with hormonal therapy, in combination with targeted therapy and, occasionally, chemotherapy

Aggressive treatment options such as chemotherapy, combined with immunotherapy and targeted therapy, are typically used to treat metastatic cancers.

The cancer care team at NewYork-Presbyterian will develop a custom treatment plan to fight your cancer, care for the whole body, and provide you relief from any side effects.

How doctors choose a treatment plan

At NewYork-Presbyterian, metastatic cancer treatment is highly individualized and often involves a combination of multiple types of therapy. Our multidisciplinary care teams consider several factors, such as the primary cancer type and previous treatments, and work closely with you to align treatment with your needs and goals.

  • Primary Cancer Type: Treatment protocol depends on the place where the cancer originated, since different types of cancer respond better to different therapies. For instance, radiation therapy is a common treatment for metastatic prostate cancer but is rarely used to treat metastatic ovarian cancer. 
  • Extent of Spread: The number of tumors, the organs involved, and whether the spread is limited or widespread can all influence treatment. If cancer has spread to nearby tissues or lymph nodes, local therapies may be used. If cancer has spread to distant organs, systemic treatments such as chemotherapy may be recommended. 
  • Biomarkers: Since cancer cells can differ at the molecular level, biomarker testing looks for specific gene mutations, protein expressions, or other cellular information that may help predict how the cancer will behave and which treatments are most likely to work. In some cases, these tests are used to track how effective treatment is over time.
  • Prior Treatments: The effectiveness of previous therapies, presence of side effects, and sequence of therapies help guide next steps. If cancer progressed significantly during a treatment or the patient experienced major adverse effects, a different approach may be recommended.
  • Patient Goals & Health Status: The patient’s age, general health, and personal priorities are central to treatment decisions. Some patients may focus on slowing cancer growth as much as possible. Others prioritize minimizing side effects and maintaining quality of life. Some patients may choose to enroll in clinical trials.

Therapy options

Systemic therapy

Systemic therapy is any type of treatment that targets the entire body and attacks cancer cells in the process. Chemotherapy is a form of systemic therapy because it circulates throughout the bloodstream to destroy cancer cells in various locations. Systemic therapies can be oral, intravenous or subcutaneous. These involve chemotherapy, targeted therapies or immunotherapies.

Radiation

Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells by causing small breaks in the cells’ DNA.

Surgery/ablation

For some types of metastatic cancer, surgery is performed to remove tumors. As a minimally invasive alternative, ablation is a procedure that uses extreme temperatures (heat or cold) to destroy cancer cells.

Supportive/palliative care

Palliative care, also known as supportive care or symptom management, focuses on improving quality of life and helping the patient live as comfortably and as long as they can. It can involve physical, emotional, spiritual, social, and financial support, and it differs from hospice care in that it is provided at any stage of a serious illness.

 

This content has been reviewed by the following medical editors.

Rutika J. Mehta, M.B., B.S., MD, MPH

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Trust NewYork-Presbyterian for Metastatic Cancer Treatment

At NewYork-Presbyterian, we understand the difficult concerns and emotions that can come with a cancer diagnosis. Our doctors and oncologists are familiar with the signs and symptoms of metastasis. Our caring multidisciplinary cancer teams are here to provide expert diagnosis and treatment options with the goal of improving your quality of life and increasing longevity.

Contact NewYork-Presbyterian to make an appointment with one of our cancer care specialists.