Treatment of Metastatic Cancer: Focus on Brain, Lung, Bone, Liver, Malignant Effusions, and Ascites

Metastatic cancer is a formidable clinical issue, involving malignant cells that travel from a primary tumor site to a distant organ. This manuscript summarizes the current treatment options for metastatic disease burdening the brain, lungs, bones, liver, malignant effusions, and ascites. Each possible metastatic site involves its own clinical considerations of tumor biology, symptom burden, and the patient's performance status. Metastatic diseases involving the brain may require corticosteroids, resection, stereotactic radiosurgery or whole brain radiation therapy, and/or systemic therapies. Metastatic disease of the lung and liver often involves a multi-modality approach that incorporates systemic chemotherapy, possibly systemic targeted agents, localized ablative therapies, and possibly palliative surgical therapy in an oligometastatic setting. Bone metastases often include a combination of analgesics, bisphosphonates or RANK ligand inhibitors, radiation, and sometimes orthopedic stabilization and reconstruction. Malignant pleural effusions and ascites are common in patients with advanced diseases and a number of procedures can be utilized including drainage procedures, intrapleural or intraperitoneal therapies and systemic therapies. Individualized, multidisciplinary care has been shown to improve symptom management and quality of life in palliative settings and may lead to a longer survival in specific circumstances.