Metastatic Cancer: A Growing Population

Understanding metastatic cancer is essential to treating patients, helping families cope, and lending support and information to our community. While the focus in cancer care is early diagnosis, it is estimated that as many as 30% of early stage breast cancers, for example, become metastatic cancers. Yet research lags in this field. Why are some cancers more likely to metastasize than others? Why are some cancers more difficult to detect leading to a diagnosis later than we would like? And why do some cancers simply spread faster? Meanwhile, with increasing regularity, we are able to give the gift of more time to some metastatic cancer patients through treatment. Why do some people tolerate ongoing metastatic cancer care better than others?

Defined as a cancer that has spread from the primary site, or the part of the body it started, metastatic cancer in many ways remains a mystery. We know that cancer cells can break away from a primary tumor and travel to other areas of the body through the bloodstream or lymph system. And, these cells need to be able to grow and thrive in another area of the body and avoid attacks from the body’s immune system. Many of these cells die, and those that are able to grow elsewhere in the body may lie dormant for years before they begin to grow, if at all. Primary cancer cells that have metastasized to distant locations within the body may no longer be exactly the same as the cells in the tumor they started, making them harder to treat. Currently, the goal of treatment for metastatic cancer is to control the growth of the cancer, and/or to relieve symptoms. It’s a form of palliative care: improve quality of life by keeping the patient comfortable.

The physicians and staff at Turville Bay Radiation Oncology Center see metastatic cancer patients for palliative care. Radiation therapy is often used to shrink tumors, reducing pain and other symptoms. Defined as care given to patients with cancer and other debilitating diseases to relieve pain, manage symptoms, and improve quality of life, palliative care may play a part in extending life. This care is delivered by a team of people including but not limited to a physician, nurse, social worker, chaplain, and pharmacist, to patients at any age and stage of serious life-limiting illness regardless of life expectancy. Often misunderstood, palliative treatment was found to be an effective addition to standard cancer treatment for people with metastatic non-small-cell lung cancer in a groundbreaking study reported by the New England Journal of Medicine. It found that patients that received palliative care in addition to standard cancer treatment early in their care were less likely to suffer from depression and lived longer than those that received no palliative care.

While researchers are studying new ways to kill or stop the growth of primary cells and metastatic cancer cells, there is a focus on new ways to boost the immune response against tumors. With all the research, improved treatments, clinical trials, mountains of data, and teams of healthcare professionals, a growing number of patients with recurring cancers are often now living with cancer. A Stage Four diagnosis is no longer a “rapid countdown to dying,” says blogger Mary Beth Williams who was diagnosed with metastatic melanoma. A metastatic cancer may be treated with palliative care using systemic therapy (chemotherapy, biological therapy, targeted therapy or hormonal therapy) or local therapy including surgery and radiation therapy, and often a combination of these treatments. Ms. Williams describes what the staff at Turville Bay sees, as well, when she says, “…the effects of metastatic cancer play out in many different ways. Some of us get better. Some of us hold steady. And some of us die, because mortality is an inevitable side effect of living.”

“Those living with metastatic cancer have been left out of the cancer conversation. They will not survive cancer; some may live with metastatic cancer for months or even years. Their need for treatment, support and encouragement goes on while family, coworkers and friends struggle to understand the disease,” says Dr. Michelle Mackay, Medical Director at Turville Bay Radiation Oncology Center in Madison, WI. “As a community we need to educate ourselves. By doing so, we can help those with metastatic cancer, while seeking the more lasting impact of desperately needed research.”  

“Please understand that those living with metastatic cancer don’t refer to themselves as “survivors,” says Dr. James Richardson of Turville Bay. “If we work together, with the goal of prolonging survival, offering treatment that may help relieve cancer-associated symptoms, it leads to an improvement or stability in their quality of life. This care may give them time to enjoy life, but rarely cancer-free. It’s a growing population and they are in need of more research.”

This year, Turville Bay has refocused its annual Madison Area Cancer Survivor’s event on Sunday, June 5, to include those with metastatic cancer. Now called Madison’s Cancer Survivors and Thrivers Ice Cream Social, Turville Bay’s physicians and staff are rededicated to educating the public and celebrating the strides made. The Survivors and Thrivers event is free and open to all area cancer survivors and those with metastatic cancer, patients in treatment, caregivers, families, friends and healthcare providers. “This event always inspires us,” says Dr. Mackay. “We see former patients and current patients, their caregivers, kids and grandkids. We’ve shared a time in their lives and been changed by it. We want everyone to feel welcome.”