One line per cancer, from its own record, on the treatments that act on advanced disease. Open a card for the map and the ranked sites.
What helpsGemcitabine-cisplatin with durvalumab or pembrolizumab, then drugs matched to the FGFR2, IDH1, HER2 or NRG1 changes found in about 40% of intrahepatic tumours.
▸Show Hide the map for Biliary tract cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Liver (intrahepatic spread)most common
- Regional and distant lymph nodesmost common
- Peritoneumcommon
- Lungscommon
- Boneless common
What helpsEnfortumab vedotin with pembrolizumab, which nearly doubled survival over chemotherapy (EV-302); erdafitinib for FGFR3 alterations; HER2 and TROP2 ADCs in trials.
▸Show Hide the map for Bladder & urothelial cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Distant lymph nodesmost common
- Lungscommon
- Livercommon
- Bonecommon
- Peritoneumless common
- Brainrare
What helpsPembrolizumab with chemotherapy and bevacizumab first line, tisotumab vedotin second line; chemoradiation with brachytherapy cures most locally advanced disease.
▸Show Hide the map for Cervical cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Pelvic and para-aortic lymph nodesmost common
- Lungscommon
- Bonecommon
- Liverless common
- Peritoneumless common
What helpsResection or ablation of limited liver and lung metastases can still cure; chemotherapy with EGFR or VEGF antibodies, encorafenib-cetuximab for BRAF, immunotherapy for dMMR disease, KRAS G12C and HER2 combinations.
▸Show Hide the map for Colorectal cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Livermost common
- Lungscommon
- Peritoneumcommon
- Distant lymph nodescommon
- Boneless common
- Brainrare
- Liver: Portal venous drainage sends colon cancer to the liver first; resectable liver metastases can be cured
- Lungs: Rectal cancers reach the lung more often than colon cancers (systemic venous drainage)
- Peritoneum: Commoner in right-sided and mucinous tumours
What helpsChemotherapy with dostarlimab or pembrolizumab first line, lenvatinib-pembrolizumab second line, T-DXd for HER2-positive serous tumours.
▸Show Hide the map for Endometrial cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Pelvic and para-aortic lymph nodesmost common
- Vagina (local recurrence)common
- Peritoneumcommon
- Lungscommon
- Liverless common
- Boneless common
- Peritoneum: Serous and carcinosarcoma histologies behave like ovarian cancer
What helpsChemotherapy plus nivolumab or pembrolizumab, trastuzumab or zanidatamab for HER2, zolbetuximab for Claudin 18.2, T-DXd second line; peritoneal-directed therapy is an active front.
▸Show Hide the map for Gastric & gastro-oesophageal junction cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Peritoneummost common
- Livermost common
- Distant lymph nodescommon
- Lungsless common
- Ovaries (Krukenberg tumour)less common
- Boneless common
- Peritoneum: Diffuse-type tumours seed the peritoneum; staging laparoscopy looks for it
- Liver: Intestinal-type tumours favour the liver
What helpsResection, radiotherapy with temozolomide and TTFields; vorasidenib for IDH-mutant glioma; locoregional CAR-T and focused-ultrasound drug delivery in trials.
▸Show Hide the map for Glioma & glioblastomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Elsewhere in the brain (white matter tracts, corpus callosum)most common
- Spinal cord and leptomeningesless common
- Outside the nervous systemrare
- Elsewhere in the brain (white matter tracts, corpus callosum): Infiltrates along white matter; recurrence is usually within 2 cm of the original site
- Outside the nervous system: Extracranial metastasis is exceptional; lymph node spread does not occur because the brain has no conventional lymphatics
What helpsPembrolizumab with or without chemotherapy first line; neck dissection or radiotherapy clears nodes; EGFR-directed bispecifics with PD-1 blockade are in phase 3.
▸Show Hide the map for Head and neck squamous cell carcinomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Cervical lymph nodes (levels I-V)most common
- Lungscommon
- Boneless common
- Liverless common
- Distant lymph nodesless common
- Cervical lymph nodes (levels I-V): Neck node status is the main prognostic factor and decides neck dissection or radiotherapy
- Lungs: The commonest distant site; also where second primary cancers from smoking appear
What helpsAtezolizumab-bevacizumab, durvalumab-tremelimumab or nivolumab-ipilimumab; radioembolisation and TACE for liver-confined disease; transplant after downstaging in selected patients.
▸Show Hide the map for Hepatocellular carcinomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Elsewhere in the liver and portal veinmost common
- Lungscommon
- Regional lymph nodescommon
- Bonecommon
- Adrenal glandsless common
- Peritoneumless common
- Elsewhere in the liver and portal vein: Intrahepatic spread and portal vein invasion dominate and drive staging
What helpsT-DXd with pertuzumab first line; tucatinib and T-DXd reach brain metastases, so radiation can often be deferred; palbociclib maintenance for HR-positive disease.
▸Show Hide the map for HER2-positive breast cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Bonemost common
- Livercommon
- Lungscommon
- Braincommon
- Distant lymph nodescommon
- Brain: Brain metastases occur in a large share of patients over the disease course; CNS activity of newer anti-HER2 drugs matters
What helpsCDK4/6 inhibitors with endocrine therapy first, then drugs matched to ESR1 or PIK3CA/AKT changes found in a blood test, then T-DXd or TROP2 ADCs; bone-protecting drugs keep the skeleton strong for years.
▸Show Hide the map for HR-positive / HER2-negative breast cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Bonemost common
- Livercommon
- Lungs and pleuracommon
- Distant lymph nodescommon
- Brainless common
- Ovaries and peritoneum (lobular)rare
- Bone: 65-75% of patients with advanced disease develop bone metastases. Often the first and only site for years
- Ovaries and peritoneum (lobular): Invasive lobular carcinoma favours serosal and gynaecological sites
What helpsNivolumab-ipilimumab (about half of patients alive at ten years), BRAF/MEK inhibitors, lifileucel TIL therapy and RP1 after PD-1 failure; brain MRI at staging and radiosurgery for brain metastases.
▸Show Hide the map for MelanomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Skin and soft tissue (in-transit, satellite)most common
- Regional then distant lymph nodesmost common
- Lungscommon
- Livercommon
- Braincommon
- Boneless common
- Small bowelless common
- Liver: Uveal melanoma spreads almost exclusively to the liver
- Brain: One of the cancers most likely to reach the brain; brain MRI is part of stage IV staging
What helpsNivolumab-ipilimumab or pembrolizumab with chemotherapy first line; mesothelin CAR-T delivered into the pleural space and PRMT5 inhibitors for MTAP-deleted tumours are in trials.
▸Show Hide the map for MesotheliomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Pleura and chest wall (local spread)most common
- Other lungcommon
- Peritoneumcommon
- Liverless common
- Bonerare
- Pleura and chest wall (local spread): Grows along the pleura and into the chest wall and diaphragm; distant spread is late
What helpsQuadruplet induction, transplant, CD38 antibodies, BCMA CAR-T and bispecifics control marrow disease; bone-protecting drugs and radiotherapy treat lesions.
▸Show Hide the map for Multiple myelomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Bone (lytic lesions: spine, skull, ribs, pelvis)most common
- Soft tissue plasmacytomasless common
- Blood (plasma cell leukaemia)rare
- Bone (lytic lesions: spine, skull, ribs, pelvis): Myeloma is a marrow cancer; bone lesions are part of the disease definition (CRAB criteria), not metastases in the usual sense
What helpsInduction chemotherapy, transplant, radiotherapy and anti-GD2 antibodies clear marrow and bone disease in most children; GD2 CAR-T has produced lasting remissions at relapse; stage MS liver disease in infants can regress on its own.
▸Show Hide the map for NeuroblastomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Bone marrowmost common
- Bone (skull, orbit, long bones)most common
- Lymph nodescommon
- Livercommon
- Orbit and skinless common
- Bone marrow: Marrow involvement defines stage M; MIBG scans and marrow biopsies are part of staging
- Liver: Massive liver involvement in infants (stage MS) can regress on its own
- Orbit and skin: Periorbital bruising (raccoon eyes) and blue skin nodules in infants
What helpsSomatostatin analogues, 177Lu-DOTATATE selected by SSTR PET, liver-directed therapy, cabozantinib and everolimus; alpha-emitting PRRT is in phase 3.
▸Show Hide the map for Neuroendocrine tumoursThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Livermost common
- Mesenteric and distant lymph nodescommon
- Bonecommon
- Peritoneumless common
- Lungsless common
- Liver: Liver metastases drive carcinoid syndrome; SSTR PET maps them and Lu-177 dotatate treats them
What helpsA matched pill for each driver (osimertinib, lorlatinib, selpercatinib and others, most of which reach the brain), PD-(L)1 immunotherapy for the rest, ADCs after progression, and SBRT for a few sites.
▸Show Hide the map for Non-small-cell lung cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Other lung and pleuramost common
- Bonemost common
- Braincommon
- Livercommon
- Adrenal glandscommon
- Distant lymph nodescommon
- Brain: Adenocarcinoma and EGFR- or ALK-driven tumours spread to the brain often; brain MRI is part of staging
What helpsChemotherapy plus PD-1 blockade first line, HER2-directed drugs for adenocarcinoma, and the bispecific ADC iza-bren, the first to improve survival after immunotherapy in squamous disease.
▸Show Hide the map for Oesophageal cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Livermost common
- Distant lymph nodesmost common
- Lungscommon
- Bonecommon
- Adrenal glandsless common
- Brainrare
What helpsPlatinum chemotherapy with PARP-inhibitor maintenance, HIPEC at interval surgery, and for platinum-resistant disease mirvetuximab (FRα-high), relacorilant-paclitaxel and pembrolizumab-paclitaxel (PD-L1-positive).
▸Show Hide the map for Ovarian cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Peritoneum and omentummost common
- Pleura (malignant effusion)common
- Liver surface, then parenchymacommon
- Retroperitoneal lymph nodescommon
- Lungsless common
- Brainrare
- Peritoneum and omentum: Spreads by shedding cells into the abdominal cavity rather than through the blood; ascites is common
What helpsFOLFIRINOX or gemcitabine-nab-paclitaxel, then daraxonrasib, the RAS inhibitor that nearly doubled survival in previously treated disease (RASolute 302); olaparib maintenance for BRCA carriers.
▸Show Hide the map for Pancreatic ductal adenocarcinomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Livermost common
- Peritoneumcommon
- Lungscommon
- Distant lymph nodescommon
- Boneless common
- Liver: Most patients with metastatic disease have liver involvement
- Lungs: Lung-only spread carries a better prognosis
What helpsAndrogen deprivation with an AR pathway inhibitor, docetaxel, PARP inhibitors for HRR mutations, radium-223 for bone-predominant disease and 177Lu-PSMA-617 selected by PSMA PET; bone-protecting drugs throughout.
▸Show Hide the map for Prostate cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Bone (spine, pelvis, ribs)most common
- Distant lymph nodescommon
- Liverless common
- Lungsless common
- Brainrare
- Bone (spine, pelvis, ribs): 65-75% of patients with advanced disease develop bone metastases. Typically bone-forming (sclerotic) lesions; PSMA PET finds them early
- Liver: Liver spread marks aggressive, often neuroendocrine-like disease
What helpsImmunotherapy doublets (nivolumab-ipilimumab or immunotherapy plus a VEGF TKI) with durable remissions in about a fifth of patients; belzutifan later; SBRT or surgery for a few sites.
▸Show Hide the map for Renal cell carcinomaThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Lungsmost common
- Bonecommon
- Distant lymph nodescommon
- Livercommon
- Adrenal glandsless common
- Brainless common
- Pancreas and thyroid (late, unusual sites)rare
- Bone: Bone-destroying (lytic) lesions
- Pancreas and thyroid (late, unusual sites): Renal cell carcinoma is known for late spread to odd sites years after nephrectomy
What helpsLung metastasectomy is standard and can cure; doxorubicin-based chemotherapy, imatinib and its successors for GIST, afami-cel TCR-T for synovial sarcoma.
▸Show Hide the map for SarcomasThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Lungsmost common
- Boneless common
- Liver (GIST, leiomyosarcoma of the gut)less common
- Lymph nodesrare
- Lungs: Sarcomas spread through the blood almost exclusively to the lungs; lung metastasectomy is standard
- Lymph nodes: Except epithelioid, synovial, rhabdomyosarcoma and clear cell subtypes
What helpsChemo-immunotherapy first, then tarlatamab, the DLL3 T-cell engager that improved survival at relapse; MRI surveillance or cranial irradiation protects the brain.
▸Show Hide the map for Small-cell lung cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Brainmost common
- Livermost common
- Bone and marrowcommon
- Adrenal glandscommon
- Distant lymph nodescommon
- Brain: About half of patients without prophylactic cranial irradiation develop brain metastases within 3 years. The reason cranial irradiation or MRI surveillance follows a response
What helpsRadioactive iodine treats spread that still takes up iodine; lenvatinib, selpercatinib (RET), dabrafenib-trametinib (BRAF) and redifferentiation for refractory disease. Neck-node spread has little effect on survival.
▸Show Hide the map for Thyroid cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Cervical lymph nodesmost common
- Lungscommon
- Bonecommon
- Brainrare
- Liverrare
- Cervical lymph nodes: Papillary cancer spreads to neck nodes early and often, with little effect on survival
- Lungs: Follicular cancer favours blood-borne spread to lung and bone
What helpsSacituzumab govitecan and datopotamab deruxtecan (TROP2 ADCs) first line, pembrolizumab with chemotherapy for PD-L1-positive disease, T-DXd for the third of tumours that are HER2-low; ADC activity in the brain is being tested.
▸Show Hide the map for Triple-negative breast cancerThe sites decide which scans are done at staging and follow-up, and every site listed has a treatment approach.
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
- Lungsmost common
- Braincommon
- Livercommon
- Bonecommon
- Distant lymph nodescommon
- Lungs: Visceral spread earlier and more often than in HR-positive disease
- Brain: Higher brain-metastasis rate than other breast subtypes