Table of ContentsView AllTable of ContentsWhat Is Metastatic Adenocarcinoma?TypesSpreadSymptomsCausesDiagnosisStagingTreatmentPrognosisSecond OpinionsCoping
Table of ContentsView All
View All
Table of Contents
What Is Metastatic Adenocarcinoma?
Types
Spread
Symptoms
Causes
Diagnosis
Staging
Treatment
Prognosis
Second Opinions
Coping
Metastatic adenocarcinomaoccurs when cancer that affects glandular tissues spreads (metastasizes) to other parts of the body. Glandular tissues are those that secrete a substance such as milk or mucus. Most breast and colon cancers, and some lung cancers, areadenocarcinomas.
Some of the time, these cancers are metastatic (stage 4) at the time of diagnosis. At other times, they represent a progression or recurrence of a previous early-stage tumor.
Verywell / Jessica Olah
Since these cancers have spread beyond the original area, local treatments such as surgery are less effective and these cancers are no longer considered curable. That said, there are now a number of different treatments that can extend length and quality of life (sometimes very significantly) as well as longer-term control of the spread. So, although these tumors aren’t considered curable, they can be very treatable.
This article will look at the types of metastatic adenocarcinomas, the areas of the body where each type is most likely to spread, why cancer spreads, and treatment options.
Adenocarcinoma vs. CarcinomaCarcinoma is the most common form of cancer, which develops in skin tissues and the tissues that line organs. Adenocarcinoma is a subtype of carcinoma that develops in the mucus glands that line the insides of organs, such as the lungs, prostate, colon, and breasts.
Adenocarcinoma vs. Carcinoma
Carcinoma is the most common form of cancer, which develops in skin tissues and the tissues that line organs. Adenocarcinoma is a subtype of carcinoma that develops in the mucus glands that line the insides of organs, such as the lungs, prostate, colon, and breasts.
Adenocarcinomas are cancers that arise in glandular cells (mucus-secreting cells) such as milk ducts and the digestive tract.
Metastatic adenocarcinomas are tumors that have spread beyond the tissue in which they originate to other parts of the body. If metastases occur in local lymph nodes, they are considered stage 3 tumors for some cancers, such as colon cancer. Cancers that have spread at a distance to other organs are considered stage 4 tumors.
With metastatic or stage 4 adenocarcinomas, the tumor may be any size and involve (or not involve) any lymph nodes, but it has spread (metastasized). In common parlance, metastatic cancer refers to distal metastases, i.e., stage 4 cancer.
How Adenocarcinomas Spread
Adenocarcinomas can metastasize to other regions of the body in these three ways:
Adenocarcinoma can sometimes lay dormant for an extended period of time before recurring in a distant location (now metastatic adenocarcinoma). For example, early-stage breast adenocarcinomas that areestrogen receptor-positiveare actually more likely to recur in a distant location after five years than in the first five years following a diagnosis. This is calledlate recurrence.It’s not known exactly why this occurs.
Why Does Cancer Come Back?
Types of Metastatic Adenocarcinoma
Physicians use the term “primary cancer” to describe the original tumor. For example, a tumor that starts in lung tissue is considered a primary lung adenocarcinoma. A lung cancer that spreads to the liver would be called “lung adenocarcinoma metastatic to the liver,” not liver cancer. Since the cells in the liver are lung cells, it would be treated as lung cancer, not as liver cancer.
With some cancers, such as breast and colon cancers, the majority of the tumors are adenocarcinomas. In contrast, only around 40% of lung cancers are adenocarcinomas.
Cancers of Unknown Primary OriginIt has been found that some cancers can start spreading at distance without becoming clinically apparent in their original location. With newer types of testing, the original site of so-called cancers of an unknown primary site is found more often than in the past.When the precise origin is not found, cancers of unknown origin are treated with generic chemotherapy like a combination of Carboplatin and paclitaxel, for example.
Cancers of Unknown Primary Origin
It has been found that some cancers can start spreading at distance without becoming clinically apparent in their original location. With newer types of testing, the original site of so-called cancers of an unknown primary site is found more often than in the past.When the precise origin is not found, cancers of unknown origin are treated with generic chemotherapy like a combination of Carboplatin and paclitaxel, for example.
It has been found that some cancers can start spreading at distance without becoming clinically apparent in their original location. With newer types of testing, the original site of so-called cancers of an unknown primary site is found more often than in the past.
When the precise origin is not found, cancers of unknown origin are treated with generic chemotherapy like a combination of Carboplatin and paclitaxel, for example.
Where Adenocarcinomas Spread
While most cancers have the ability to spread to nearly any area of the body (and sometimes do), each type of cancer has particular organs or tissues to which it is most likely to spread. For each type of primary adenocarcinoma, the most common sites of metastases (in addition to lymph nodes) include:
Uncommonly, some adenocarcinomas may spread to the skin, muscles, and various regions of the digestive tract.
Another type of metastases,leptomeningeal metastases, do not form a tumor. Instead, cancer cells circulate throughout the brain in the cerebrospinal fluid. They are most commonly associated with breast cancer and lung cancer.
What Are the Symptoms of Metastatic Adenocarcinoma?
Symptoms of metastatic adenocarcinoma may includesymptoms related to the primary cancer(for example, a cough with lung cancer) or general symptoms, including:
Symptoms may also be related to metastases to specific sites. These symptoms may be thefirst sign of metastatic adenocarcinoma, especially with cancers such as lung adenocarcinoma. Symptoms based on metastatic site include:
Causes of Metastatic Adenocarcinoma
The question as to why some adenocarcinomas metastasize (spread) and some do not is a critical question in oncology. At the current time, roughly 90% of cancer deaths occur because of metastases, and once these tumors have spread to distant sites, a cure is rarely possible.
Known factors that can affect whether a cancer will metastasize or not include:
Research is currently looking at factors that might initiate the metastatic process, how a tumor manages to avoid the immune system both initially and after traveling to a new site, and the role of normal cells around a tumor (the tumor microenvironment) in establishing a new site for growth.
How Metastatic Adenocarcinoma Is Diagnosed
The diagnostic process for metastatic adenocarcinoma can vary depending on the type of the primary cancer.
A careful history of symptoms, past medical history, and family history of any medical conditions is a crucial first step in diagnosing these cancers. It’s especially important to note any history of cancer in the past.
Labs and Tests
A number of lab tests are usually done if metastatic adenocarcinoma is suspected:
Other tests, including histochemistry and molecular profiling (such as next-generation sequencing), may be done depending on the primary tumor type.
Imaging Studies
Imaging studies are often needed both in the diagnosis of metastatic adenocarcinoma and to stage the disease. Scans might include:
Biopsy
Abiopsy(removing a sample of tissue for examination in a lab) is important both to confirm the diagnosis and to do further testing on the cancer cells. The type of biopsy will depend on the location of the primary tumor (if known) as well as metastases.
A biopsy from an area of metastasis may also be done to confirm that it is related to the primary tumor rather than a second primary cancer. For instance, one study looked at people with breast cancer who developed a lung nodule. In 64%, the new nodule was related to spread from the primary breast cancer. But in 26% of the study participants, the nodule was an unrelated new primary lung cancer.
Aliquid biopsymay also be recommended for some people. This is a blood test that looks for tumor DNA that is circulating in the bloodstream, and will often detect DNA in metastatic adenocarcinoma.
Every Cancer Is DifferentAnother reason to evaluate tissue from a site of metastasis is that cancer cells continually evolve and develop new mutations.An example can be seen with breast cancer. In some cases, the initial breast tumor is estrogen receptor-positive but metastasis to the lungs may be estrogen receptor-negative (and vice versa). This is referred to as discordance and may affect how a cancer is treated after it has metastasized.
Every Cancer Is Different
Another reason to evaluate tissue from a site of metastasis is that cancer cells continually evolve and develop new mutations.An example can be seen with breast cancer. In some cases, the initial breast tumor is estrogen receptor-positive but metastasis to the lungs may be estrogen receptor-negative (and vice versa). This is referred to as discordance and may affect how a cancer is treated after it has metastasized.
Another reason to evaluate tissue from a site of metastasis is that cancer cells continually evolve and develop new mutations.
An example can be seen with breast cancer. In some cases, the initial breast tumor is estrogen receptor-positive but metastasis to the lungs may be estrogen receptor-negative (and vice versa). This is referred to as discordance and may affect how a cancer is treated after it has metastasized.
Staging Metastatic Adenocarcinoma
To stage a cancer diagnosis, a physician will consider:
Based on their analysis, the physician will assign one of the following stages:
A higher stage means the cancer is more extensive. Also, stage cancers are typically harder to treat and require more aggressive treatments.
How Metastatic Adenocarcinoma Is Treated
The goal when treating metastatic adenocarcinomas differs from that of early-stage tumors. With early-stage tumors, the goal is to cure the cancer, if possible. For that reason, aggressive therapy is usually used to try to eradicate the tumor and any lingering cancer cells.
With metastatic adenocarcinoma, the goal is to control the cancer with as little treatment as possible to minimize side effects and maximize quality of life. More aggressive treatment doesn’t usually extend survival, but it can increase side effects.
There are exceptions to this general rule. For example, if a new therapy is expected to be approved in the near future, more aggressive therapy may be used to attempt to get to that point.
There are three primary approaches to cancer treatment, including local treatment, systemic treatments, and palliative therapy.
Local Treatment
Local treatment is designed to get rid of a tumor where it originated. This includes therapies such as surgery, radiation therapy, andablativetherapies(such as treatment to cut blood supply to the tumor).
While local treatments are most often used to treat early-stage cancers, surgery or radiation may be used to reduce the size of a tumor and control symptoms.
A relatively new approach, and one that can increase survival in some cases, is treating isolated areas of metastases oroligometastases(cancer cells that have traveled and formed new tumors). For example, isolated (or a few) brain metastases due to lung cancer or breast cancer are sometimes treated either with surgery or a specialized form of radiation (stereotacticbody radiotherapyor cyber knife).
Systemic Treatments
Systemic treatments are used to treat cancer cells no matter where they are in the body. These include:
Palliative Therapy
Palliativetherapyis a third category that is used to control the symptoms of cancer and cancer treatments but is not designed to address the cancer itself.
Local therapies may be used to control the symptoms of cancer. Many cancer centers now offer palliative care consultations with a team that works to maintain a person’s quality of life via treatments ranging from pain control to spiritual support.
While metastatic adenocarcinoma may not be curable, it is treatable, and treatments can often both extend a person’s life expectancy and reduce the symptoms of cancer.
Cancer prognosis depends on numerous factors, including the type of cancer a person has, its stage, and the individual’s overall health before the cancer diagnosis was made. Prognosis can vary dramatically between types of cancer.
For example, the five-year survival rate for people diagnosed with metastatic lung or bronchus cancer is about 8.9%.In comparison, the five-year survival rate for people diagnosed with metastatic breast cancer is about 31.9%.
Giving an accurate prognosis can be difficult for even the most experienced oncologists. Furthermore, researchers at Johns Hopkins Armstrong Institute for Patient Safety and Quality found that cancers are one of the top misdiagnosed medical conditions, making it all the more important to get a second opinion.
Getting a Second Opinion
With treatments improving rapidly, it’s hard for anyone to stay on top of all of the research. For this reason, getting a second opinion is often considered a standard of care.
Many people opt for a second opinion at one of the larger National Cancer Institute–designated cancer centers. Fortunately, many of these centers now provide remote consults so people don’t need to travel unless they are certain the treatment is right for them.
Coping: Living Well With Cancer
If you or a loved one is diagnosed with metastatic adenocarcinoma or an earlier cancer returns at a distant location, coping with an incurable disease is challenging. The importance of having a support system around you during this time can’t be stressed enough.
While family and friends can be an excellent source, having the opportunity to talk with others facing a similar journey is critical. Many online communities are now available for advanced adenocarcinomas or your healthcare team may be able to refer you to a local in-person support group.
The financial stress of cancer is also very real for many people. Talking with a social worker at your cancer center may help you find resources for financial support you’d otherwise overlook.
Summary
Metastatic adenocarcinoma is a cancer that originates in glandular cells (mucus-secreting cells) such as milk ducts, the digestive tract, or lungs and has spread or metastasized beyond the tissue in which it began. Adenocarcinomas can spread at any stage of the disease or they can lay dormant for an extended period of time before recurring in a distant location.If metastatic adenocarcinoma is suspected, your healthcare provider will make a diagnosis and stage the disease. While most metastatic adenocarcinomas are not considered curable, there are treatment options that can extend survival and improve quality of life. Treatment options may include chemotherapy, immunotherapy, hormone therapy, and targeted therapy, depending on the type of adenocarcinoma.
24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ganest K, Massague J.Targeting metastatic cancer.Nat Med.2021;27(1):34-44. doi:10.1038/s41591-020-01195-4
UPMC.Adenocarcinoma.
National Cancer Institute.Cancer Classification.
Kumar V, Abbas AK, Aster JC, et al., eds.Robbins & Cotran Pathologic Basis of Disease. Tenth edition. Elsevier; 2021.
Gaikwad A, Souza CA, Inacio JR, et al.Aerogenous metastases: a potential game changer in the diagnosis and management of primary lung adenocarcinoma.AJR Am J Roentgenol. 2014;203(6):W570-W582. doi:10.2214/AJR.13.12088
Pan H, Gray R, Braybrooke, J, et al.20-year risks of breast-cancer recurrence after stopping endocrine therapy at 5 years.The New England J Med. 2017;377:1836-1846. doi:10.1056/NEJMoa1701830
Zappa C, Mousa SA.Non-small cell lung cancer: current treatment and future advances.Transl Lung Cancer Res. 2016;5(3):288-300. doi:10.21037/tlcr.2016.06.07
Bast RC, ed.Holland-Frei Cancer Medicine. 9th edition. John Wiley & Sons, Inc; 2016.
Qaseem A, Usman N, Jayaraj J, Janapala R, Kashif T.Cancer of unknown primary: A review on clinical guidelines in the development and targeted management of patients with the unknown primary site.Cureus. 2019 Sep;11(9):e5552. doi:10.7759/cureus.5552
Riihimaki M, Thomsen H, Sundquist K, Sundquist J, Hemminki K.Clinical landscape of cancer metastases.Cancer Med.2018;7(11):5534-5542. doi:10.1002/cam4.1697
Taillibert S, Chamberlain MC.Leptomeningeal metastasis.Handb Clin Neurol. 2018;149:169-204. doi:10.1016/B978-0-12-811161-1.00013-X
Koch Institute for Integrative Cancer Research at MIT.Metastasis.
National Cancer Institute.How cancer is diagnosed.
Almuradova E, Cicin I.Cancer-related hypercalcemia and potential treatments.Front Endocrinol. 2023 Mar;14(1):1-9. doi:10.3389/fendo.2023.1039490
Jameson JL, Fauci A, Hauser S, Longo A, Loscalzo J.Harrison’s Principles of Internal Medicine, 20th Edition. McGraw-Hill Education, 2018
Caparica R, Mak MP, Rocha CH, et al.Pulmonary nodules in patients with nonpulmonary cancer: not always metastases.J Glob Oncol.2016;2(3):138-144. doi:10.1200/JGO.2015.002089
Mount Sinai.Understanding cancer staging.
University of Rochester Medical Center.Grading and staging of cancer.
Otake S, Goto T.Stereotactic radiotherapy for oligometastasis.Cancers (Basel). 2019;11(2):133. Published 2019 Jan 23. doi:10.3390/cancers11020133
Pacheco JM, Gao D, Smith D, et al.Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer.J Thorac Oncol. 2019;14(4):691-700. doi:10.1016/j.jtho.2018.12.014
National Cancer Institute.Lung and bronchus cancer.
National Cancer Institute.Cancer stat facts: Female breast cancer.
Johns Hopkins Medicine.Johns Hopkins Medicine researchers identify health conditions likely to be misdiagnosed.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
