`
`Metastatic Cancer - National Cancer Institute
`
`Metastatic Cancer
`
`What Is Metastatic Cancer?
`The main reason that cancer is so serious is its ability to
`spread in the body. Cancer cells can spread locally by moving
`into nearby normal tissue. Cancer can also spread regionally,
`to nearby lymph nodes, tissues, or organs. And it can spread
`to distant parts of the body. When this happens, it is called
`metastatic cancer. For many types of cancer, it is also called
`stage IV (four) cancer. The process by which cancer cells
`spread to other parts of the body is called metastasis.
`
`When observed under a microscope and tested in other ways,
`metastatic cancer cells have features like that of the primary
`cancer and not like the cells in the place where the cancer is
`found. This is how doctors can tell that it is cancer that has
`spread from another part of the body.
`
`Metastatic cancer has the same name as the primary cancer.
`For example, breast cancer that spreads to the lung is called
`metastatic breast cancer, not lung cancer. It is treated
`as stage IV breast cancer, not as lung cancer.
`
`In metastasis, cancer cells break away
`from where they first formed (primary
`cancer), travel through the blood or
`lymph system, and form new tumors
`(metastatic tumors) in other parts of
`the body. The metastatic tumor is the
`same type of cancer as the primary
`tumor.
`
`Sometimes when people are diagnosed with metastatic
`cancer, doctors cannot tell where it started. This type of
`cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for
`more information.
`
`When a new primary cancer occurs in a person with a history of cancer, it is known as a second primary cancer.
`Second primary cancers are rare. Most of the time, when someone who has had cancer has cancer again, it
`means the first primary cancer has returned.
`
`How Cancer Spreads
`
`Metastasis: How Cancer Spreads
`
`https://www.cancer.gov/types/metastatic-cancer
`
`1/4
`
`MYLAN PHARMS. INC. EXHIBIT 1093 PAGE 1
`
`
`
`4/14/2017
`
`Metastatic Cancer - National Cancer Institute
`
`During metastasis, cancer cells spread from the place in the body
`where they first formed to other parts of the body.
`
`Cancer cells spread through the body in a series of steps. These steps include:
`
`1. Growing into, or invading, nearby normal tissue
`2. Moving through the walls of nearby lymph nodes or blood vessels
`3. Traveling through the lymphatic system and bloodstream to other parts of the body
`4. Stopping in small blood vessels at a distant location, invading the blood vessel walls, and moving into the
`surrounding tissue
`5. Growing in this tissue until a tiny tumor forms
`6. Causing new blood vessels to grow, which creates a blood supply that allows the tumor to continue
`growing
`
`Most of the time, spreading cancer cells die at some point in this process. But, as long as conditions are
`favorable for the cancer cells at every step, some of them are able to form new tumors in other parts of the
`body. Metastatic cancer cells can also remain inactive at a distant site for many years before they begin to grow
`again, if at all.
`
`Where Cancer Spreads
`Cancer can spread to most any part of the body, although different types of cancer are more likely to spread to
`certain areas than others. The most common sites where cancer spreads are the bone, liver, and lung. The
`following list shows the most common sites of metastasis, not including the lymph nodes, for some common
`cancers:
`
`Common Sites of Metastasis
`
`Cancer Type
`
`Main Sites of Metastasis
`
`Bladder
`
`Bone, liver, lung
`
`Breast
`
`Bone, brain, liver, lung
`
`https://www.cancer.gov/types/metastatic-cancer
`
`2/4
`
`MYLAN PHARMS. INC. EXHIBIT 1093 PAGE 2
`
`
`
`4/14/2017
`
`Metastatic Cancer - National Cancer Institute
`
`Cancer Type
`
`Main Sites of Metastasis
`
`Colon
`
`Liver, lung, peritoneum
`
`Kidney
`
`Adrenal gland, bone, brain, liver, lung
`
`Lung
`
`Adrenal gland, bone, brain, liver, other lung
`
`Melanoma
`
`Bone, brain, liver, lung, skin, muscle
`
`Ovary
`
`Liver, lung, peritoneum
`
`Pancreas
`
`Liver, lung, peritoneum
`
`Prostate
`
`Adrenal gland, bone, liver, lung
`
`Rectal
`
`Liver, lung, peritoneum
`
`Stomach
`
`Liver, lung, peritoneum
`
`Thyroid
`
`Bone, liver, lung
`
`Uterus
`
`Bone, liver, lung, peritoneum, vagina
`
`Symptoms of Metastatic Cancer
`Metastatic cancer does not always cause symptoms. When symptoms do occur, their nature and frequency will
`depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:
`
`Pain and fractures, when cancer has spread to the bone
`Headache, seizures, or dizziness, when cancer has spread to the brain
`Shortness of breath, when cancer has spread to the lung
`Jaundice or swelling in the belly, when cancer has spread to the liver
`
`• • • •
`
`https://www.cancer.gov/types/metastatic-cancer
`
`3/4
`
`MYLAN PHARMS. INC. EXHIBIT 1093 PAGE 3
`
`
`
`Metastatic Cancer - National Cancer Institute
`4/14/2017
`Treatment for Metastatic Cancer
`Once cancer spreads, it can be hard to control. Although some types of metastatic cancer can be cured with
`current treatments, most cannot. Even so, there are treatments for all patients with metastatic cancer. The goal
`of these treatments is to stop or slow the growth of the cancer or to relieve symptoms caused by it. In some
`cases, treatments for metastatic cancer may help prolong life.
`
`The treatment that you may have depends on your type of primary cancer, where it has spread, treatments
`you’ve had in the past, and your general health. To learn about treatment options, including clinical trials, find
`your type of cancer among the PDQ® Cancer Information Summaries for Adult Treatment and Pediatric
`Treatment.
`
`When Metastatic Cancer Can No Longer Be Controlled
`If you have been told you have metastatic cancer that can no longer be controlled, you and your loved ones may
`want to discuss end-of-life care. Even if you choose to continue receiving treatment to try to shrink the cancer or
`control its growth, you can always receive palliative care to control the symptoms of cancer and the side effects
`of treatment. Information on coping with and planning for end-of-life care is available in the Advanced Cancer
`section.
`
`Ongoing Research
`Researchers are studying new ways to kill or stop the growth of primary and metastatic cancer cells. This
`research includes finding ways to help your immune system fight cancer. Researchers are also trying to find
`ways to disrupt the steps in the process that allow cancer cells to spread. Visit the Metastatic Cancer Research
`page to stay informed of ongoing research funded by NCI.
`
`Related Resources
`Advanced Cancer
`Coping with Advanced Cancer
`
`Updated: February 6, 2017
`
`Most text on the National Cancer Institute website may be reproduced or reused freely. The National Cancer Institute
`should be credited as the source. Please note that blog posts that are written by individuals from outside the
`government may be owned by the writer, and graphics may be owned by their creator. In such cases, it is necessary to
`contact the writer, artist, or publisher to obtain permission for reuse.
`
`https://www.cancer.gov/types/metastatic-cancer
`
`4/4
`
`MYLAN PHARMS. INC. EXHIBIT 1093 PAGE 4
`
`