Can an HCP explain why metastatic cancer is treated so differently to regular cancer?

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Lots of surgical and sub-surgical options are on the table before metastasis. As soon as metastasis is detected, they are all no longer an option, and chemo seems to be the only option.

I understand that after metastasis the cancer will never be cured, but I can’t get my head around why something minimally invasive & primary tumour shrinking ( like ablation ) wouldn’t still be offered.

I’ll ask again at my next doctor appt. The last appointment was with the surgeon & a very abrupt “it’s spread now, there is nothing I can do, goodbye” type thing, and I felt I was caught flat footed not knowing what to say, so I want to understand a bit better for next time.

Hello CancerCarousel

Is this your diagnosis? If so, would you like to join us on the cancer support thread? There's a few of us with metastatic cancer of different sorts.

Sorry, I don't have any useful answers. I guess the potential risks of surgery outweigh any possible benefit when there's no possibility of a cure. But as you say it's probably something you need to ask your own medical team. I'm sorry your surgeon was so abrupt about it do you have a specialist nurse who you could discuss it with instead?

Chemo is the best first line option in many cases as once you have one met, the likelihood is that there are cancer cells in other places that you can't see yet so chemo is the only thing that could treat everything.
In some cases you can have targeted treatment - radio ablation for liver mets, radiosurgery for brain mets, or microspheres for liver mets from colo rectal tumours for instance but it really does depend on the primary tumour and what other treatment has been given before.

I'm very sorry your cancer has spread, but I'm sure the oncologist will give you a treatment plan and talk through it with you

Is it because the primary tumour causes limited damage, but the metastases pose the risk?

Metastasis means the cancer has been splitting and travelled further around the body, into too many places to go surgically or with targeted treatments. It also often means there isn't much time, as each of those mini cancers will be growing into a full size one.

Strong chemo is the normal response, as it's a non-localised treatment that can attack all the cancer blobs at once.

Good luck to whoever's undergoing treatment

We are in this weird position that the chemo is prescribed by a doctor in a local cancer centre, but the surgeon is in another town in a regional centre, and they give every impression of literally not talking.

So we’ve been back & forth a few times & already had some chemo - but was expecting something a bit less abrupt from the surgeon (especially since he accepted the referral & had us travel etc!).

The next appt is back to the chemo doctor - who won’t want to talk about any surgical solutions unless we particularly push to re-open the conversation (and presumably get re-referred to the regional centre).

We understand that the cancer won’t ever disappear now - but the metastases are tiny (found by laparoscopy but invisible on scans) - and the primary tumour is huge and barely responding to chemo - so it feels weird to not try other approaches to shrink it. Pretty much everything I read excludes metastotatic cancer from most surgical interventions, even ones that are minimally invasive - & I wanted to understand why.

What type of cancer is it? You might get more information from one of the specific cancer charities.

‘Pancreo-billiary origin’. A primary tumour on the liver. A bugger to treat apparently - with very poor prognosis in general (like - months).

It’s my mum who is ill, and despite the prognosis she is bright and healthy. Coping with the chemo really well and tip-top liver function. It’s weird that it feels like the doctors are stepping back from us.

The tumour is ‘stable’ ( not growing or shrinking) under chemo. My mum (in consultation with Dr Google) wants to ask for chemoembolisation - where the chemo is injected direct into the tumour along side with some beads to block blood supply to the tumour. This can be given at the same time as regular chemo, and isn’t very traumatic - but reading about criteria for it, I think the doctor will say a flat ‘no’ because of the metastases. Is this a cost argument or a clinical outcomes argument ...?

The best answer I’ve had is (paraphrasing) that there isn’t much point, because of the horrible prognosis - though that was from the chemo doctor & I’m kicking myself for not grilling the surgeon. I guess I kind of expected him to have a few more ideas up his sleeve, since he invited us to talk . And I’m trying to be more prepared for the next meeting.

Because metastatic cancer means the cancer has spread - there are secondaries. Treatment is different because it's not just a primary tumour being treated, far more complex.

So we have chemo XXX systemically basically forever now.

Why wouldn’t you additonally attack the primary tumour directly. I understand that the trauma of surgery is not justified by the improvement in survival, but there seem to be lots of ‘keyhole’ things that can be done to the tumour (like ablation or embolisation or directly injecting the drugs) - which would have been offered before the (tiny) satellite was discovered, but are now apparently not.

Is it the risk of seeding? Is it because your life expectancy drops so much after metastasis? Is it because the surgical routes limit the tolerance to the chemo routes? Is it because the primary tumour is no longer particularly important, despite its size?

I believe that in liver, when there is a single tumour, they can remove the tumour with enough margin (ie healthy tissue) to leave an amount that will regenerate and keep the patient with liver function. But if there are already mets in the rest of the liver its not going to regenerate properly, and leave the patient in liver failure.
From what I know about embolisation, this only works in primary liver and colorectal mets which get their blood supply from one particular blood supply (there are 3 to the liver) and it could be that your mums not being this type wouldn't work.
In some tumours, controlling the primary tumour does have an effect on controlling the mets but not all of them.

But only your mums oncologist has all the information to really answer these questions in relationship to her, so write them down and ask them

When my mum was diagnosed they did an MRI, believed it was ovarian cancer, she had extensive surgery and then other treatments. It responded well so we were very positive.

Months later we discovered the ovarian cancer was secondary to stomach cancer. She never would have been given surgery had they known but it certainly seemed to buy her more time and make that time more manageable.

My husband has non operable metastatic cancer. We saw a number of specialists and they were all on agreement that the mets needed to be under control before an kind of operation.

My advice would be to choose your specialist and research who the leading consultants are and ask for referral to a big research hospital - in London that would be The Royal Marsden, UCH, possibly the Royal Free and elsewhere certainly The Christie in Manchester and there must be others.

When it’s a rare cancer than breast / bowel and prostate then I believe strongly that you need to get your mum in front of the people who are doing the research and are experts in that cancer, not a general oncologist or one working in a small Centre, they’re unlikely to know the most cutting edge advances or to access them.

I would certainly be pushing for more answers and also asking them about clinical trials.

As someone said to me at the start of my husbands journey “there is a big difference between ‘there is nothing more that we can do’ and ‘there’s nothing more that can be done’

Thank you