Metastatic cancer

Metastatic cancer describes a tumour that has spread to a different part of the body than where it started. It also known as Stage IV (4) cancer and often referred to as advanced cancer. The term is relevant to all types of cancers. 

A metastatic diagnosis may come years after your initial cancer or you can have metastatic disease at the time of your diagnosis, which is called de novo metastatic disease. With advances in research and treatment, people are living longer and better with metastatic disease.

What are my treatment options for metastatic cancer?

Treatment options for your metastatic cancer will depend on several factors, including the type of cancer, the extent and location of metastasis, your overall health, and your own preferences. 

The main goal of treatment for metastatic disease is to slow the growth of the cancer, increase survival length and improve the quality of your life by managing symptoms.

All treatment decisions for metastatic cancer should be made in close consultation with your medical oncologist and multidisciplinary team. What treatment you are offered will be based on personalised recommendations given your specific diagnosis, stage, and overall health.

Cancer treatment research is constantly evolving with new treatments and interventions being developed and tested regularly. Over time or as the cancer responds or progresses new therapies and treatments might become available. Therefore, Inherited Cancers Australia encourages ongoing communication with your healthcare team to help make informed decisions and adjust treatment as needed.

Read more here about the common options for cancer treatment

Where can I get support?

It can take some time to process a diagnosis and treatment plan so often it can help to connect with support to help you come to terms with your diagnosis, learn how to live well with metastatic disease and to understand what your future holds.

There are many places you can turn to for support, including your medical team, cancer nurse, GP and of course, the Inherited Cancers Australia community. It is important to be gentle with yourself and reach out for support when you need it and ask your medical team anything you are unsure about.

I want to explore clinical trials

For people with a metastatic or advanced diagnosis, being part of a clinical trial can provide you with access to novel treatment options and offer hope by providing treatments and therapies that can potentially allow you to live well for longer. It also provides you with the opportunity to contribute to ongoing cancer research efforts and support others who have had a similar diagnosis.

Click here to view our page on trials and research.

What classifies as de novo cancer?

De novo cancer means you are diagnosed with stage IV or metastatic cancer from the very beginning. At your first diagnosis, the cancer has already spread beyond its initial site (e.g. breast, ovary, prostate) and into more distant parts of the body (e.g lung, liver, bone).

Getting a cancer diagnosis can be scary and for those with a de novo diagnosis, it can be completely overwhelming and cause a lot of anxiety. It is best to speak to your doctor about how you are feeling as they can provide referrals to other health professionals who specialise in supporting people through a difficult cancer diagnosis.

You can connect with the Inherited Cancers Australia community to learn about other people’s experiences in living through and managing an advanced cancer diagnosis.

What are my treatment options for de novo cancer?

One benefit of being new to the cancer health care system is that there might be more treatment options available to you as your cancer and body has not been exposed to any anti-cancer treatments before. 

The main goal of treatment for de novo cancer is to control the cancer. Treatment options for de novo cancer can vary widely depending on the type and stage of cancer, as well as the patient's overall health and individual circumstances.

To help you live well and live longer, it is likely that treatment for de novo cancer will be continuous. Similar to someone with a chronic disease who needs lifelong treatment to manage the condition, so too does someone with de novo metastatic cancer. 

If one treatment is no longer working effectively, your treatment team may switch to a new treatment and this will likely continue. With support from your treatment team, your cancer may never go away completely, but you can live well for longer with a de novo diagnosis. 

Read more here about the common options for cancer treatment

What is advanced care planning?

Advanced care planning is the process of having conversations and making plans about your future healthcare and treatment. Advanced care planning lets you have your say should you become seriously ill, unable to communicate your wishes or in the context of end-of-life situations. 

The goal of advanced care planning is to ensure that any medical care you receive aligns with your values, wishes and the medical outcomes you deem acceptable. 

Advanced care planning is important for several reasons:

• Empowerment – It empowers you to have a say in your medical care. Allowing you to remain autonomous and have your dignity respected even in challenging circumstances
• Helps support loved ones – Having a clear Advanced Care Plan can aid your loved ones to become more accepting of the care and treatment you receive. It can also help alleviate some of the stress and uncertainty that they may face when having to make difficult medical decisions on your behalf
• Ensures treatment alignment – An Advanced Care Plan helps ensure that medical treatments and interventions align with your personal beliefs and preferences, helping improve satisfaction with the end-of-life care you receive by ensuring that healthcare professionals are not providing unwanted treatment. 
• Promotes communication – Open conversations about end-of-life preferences can improve communication among family members and healthcare providers. It can help your wider support team understand your preferences and how to meet these.

Key components of advanced care planning include:

• Discussion of values and preferences – An Advanced Care Plan begins with open and honest conversations about your values, beliefs, and personal preferences about medical treatments, life-sustaining interventions, and your quality of life. This can include topics such as resuscitation (CPR), mechanical ventilation, ongoing treatment and hospice care
• Pick a healthcare proxy – A proxy is someone who you nominate to make decisions on your behalf should you become unable to do so yourself. Decide on a person (often a family member or close friend) who you would like to make medical decisions on your behalf.
• Creating advance directives – In order for your preferences to be legally binding an Advanced Care Directive is required. This is a legal document that specifies the types of treatment you would like to receive or avoid in relation to your cancer or any other medical condition you may have. See Advanced Care Planning Australia for information about what is legally binding in your state or territory. [https://www.advancecareplanning.org.au]
• Documenting preferences – Ensure your preferences are discussed with your healthcare team and documented in your medical records. This makes sure your treatment wishes are honoured by your medical team
• Review and updates – As your treatment or disease progresses or goes into remission, ensure your Advanced Care Plan represents any changes in your preferences or values accordingly.

Any adult, regardless of age or health status, can engage in discussions about healthcare treatment and end-of-life care to be better prepared for the unexpected. For those with a cancer diagnosis, it can be something that you should start considering from the outset of your initial diagnosis. These conversations can be hard and take some time to work through.

Advanced Care Planning Australia provides more information about how to think and talk about advance care planning, including information about how to ensure advance care planning documents are legal in your state or territory. 

For more information on metastatic cancer, see our Resources Hub.