How cancer can spread

Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

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This page tells you about how cancers can spread. There is information about

Primary and secondary cancer

The place where a cancer starts in the body is called the primary cancer or primary site. Cells from the primary site may break away and spread to other parts of the body. These cells can then grow and form other tumour. These are called secondary cancers or metastases.

How cancer can spread to other areas of the body

Cancer cells can spread to other parts of the body through the bloodstream or lymphatic system Open a glossary item. There they can start to grow into new tumours.

Cancers are named according to where they first started developing. For example, bowel cancer that has spread to the liver is called bowel cancer with liver metastases or secondaries. It is not called liver cancer. This is because the cancerous cells in the liver are cancerous bowel cells. They are not liver cells that have become cancerous.

In order to spread, some cells from the primary cancer must break away, travel to another part of the body and start growing there. Cancer cells don't stick together as well as normal cells do. They may also produce substances that stimulate them to move. 

The diagram below shows a tumour in the cells lining a body structure such as the bowel wall. The tumour grows through the layer holding the cells in place (the basement membrane). 

Some cells can break away and go into small lymph vessels or blood vessels called capillaries nearby.

Spread through the bloodstream

Cancer cells can go into small blood vessels and then get into the bloodstream. They are called circulating tumour cells (or CTCs).

Researchers are looking at using circulating tumour cells to diagnose cancer instead of a tissue sample (biopsy Open a glossary item). They are also looking at whether they can test circulating cancer cells to predict which treatments will work better. 

The circulating blood sweeps the cancer cells along until they get stuck somewhere. Often they get stuck in a very small blood vessel such as a capillary.

Then the cancer cell must move through the wall of the capillary and into the tissue of the organ close by. The cell can multiply to form a new tumour if:

  • the conditions are right for it to grow 
  • it has the nutrients that it needs.

This is quite a complicated process and most cancer cells don't survive it. Of the many thousands of cancer cells that reach the bloodstream, only a few survive to form a secondary cancer.

The white blood cells Open a glossary item in our immune system find and kill some cancer cells. Others cancer cells might die because they get battered around by the fast flowing blood.

Cancer cells in the circulation may try to stick to platelets Open a glossary item to form clumps to give themselves some protection. Platelets are blood cells that help the blood to clot. This could also help the cancer cells to move into the surrounding tissues.

Spread through the lymphatic system

The lymphatic system is a network of tubes and glands in the body that filters body fluid and fights infection. It also traps damaged or harmful cells such as cancer cells. 

Cancer cells can go into the small lymph vessels close to the primary tumour and travel into nearby lymph glands Open a glossary item. In the lymph glands, the cancer cells might die. But some may survive and grow to form tumours in one or more lymph nodes. This is called lymph node spread.

This 2 minute video is about the lymphatic system.

The lymphatic drainage system

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Read a transcript of the video.

Micrometastases

Micrometastases are areas of cancer spread (metastases) that are too small to see. They are too small to show up on any type of scan.

For a few types of cancer, blood tests can detect certain proteins that the cancer cells release. These may show that there are metastases in the body that are too small to show up on a scan. But for most cancers, there is no blood test that can say whether a cancer has spread or not.

For most cancers, doctors can only say whether it is likely or not that a cancer has spread. Doctors base this on a number of factors:

  • previous experience – doctors collect and publish this information to help each other
  • whether there are cancer cells in the blood vessels in the tumour removed during surgery – if cancer cells are found then the cancer is more likely to have spread to other parts of the body
  • the grade Open a glossary item of the cancer (how abnormal the cells are) – the higher the grade, the more quickly the cancer grows and the more likely for cells to spread
  • whether lymph nodes removed during an operation contained cancer cells – if the lymph nodes contained cancer cells this shows that cancer cells have broken away from the original cancer (but there is no way of knowing whether the cells have spread to any other areas of the body)

This information is important in treating cancer. You might have extra treatment if doctors suspect there are micrometastases. This treatment might include:

  • chemotherapy
  • radiotherapy
  • targeted treatment Open a glossary item
  • hormone therapy   Open a glossary item

The extra treatments might increase the chance of curing the cancer.

Related information

You can read detailed information about:

Cancer, the blood and circulation.

The lymphatic system and cancer

Cancer grading

Where can cancer spread

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