Many cancers can often be treated successfully when detected early. Surgery, radiation and chemotherapy are all powerful tools to remove or destroy tumors in their original location. However, when cancer metastasizes, that is, when the original tumor at one place in the body breaks loose and begins growing elsewhere in the body, the treatment becomes infinitely more complex. This is the stage of metastatic or stage 4 cancer, which forms the true proving ground of modern medicine.

Metastatic cancer happens when cancer cells detach from the primary tumor, circulate in the bloodstream or lymphatic system, and develop new tumors in other tissues or organs. They are not a new type of cancer; they're the same cancer that originally occurred at the primary site.

So if colon cancer metastasizes to the liver, it's still colon cancer—not liver cancer. This makes a difference because it decides how physicians treat the disease. For example, metastatic breast cancer in the lungs is treated with breast cancer therapies, not with lung cancer drugs.

How Does Cancer Spread from One Organ to Another?

Metastasis is the biological process that begins when cancer cells become capable of invading nearby tissues. They can enter into the bloodstream or lymph system, catch a ride to other places, and take up residence in new sites. If they are successful, they will start developing new tumors.

Certain cancers follow predictable patterns of metastasis. Prostate cancer tends to spread to bone, and melanoma to brain and lung. Breast cancer prefers lymph nodes, bone, lung, and liver.

Scientists at Memorial Sloan Kettering and other elite centers are trying to figure out why some cancers prefer some organs. Genes, the immune system, and the 'soil' of the target organ (how conducive it is to cancer) all contribute. This may one day be the key to more successful prevention and earlier treatment.

Where Does Cancer Tend to Spread?

Although cancer can technically metastasize to nearly any organ in the body, some organs are more frequently involved. The lymph nodes are usually the primary location where cancer cells gain entry, serving as an initial checkpoint for the metastatic process. The liver is a common target, especially in colon, pancreatic, and stomach cancer, because of its high vascular flow and filtering function. Lungs are a frequent location, particularly in cancers originating from the breast, colon, and kidneys. Bones are frequently involved in advanced lung, breast, and prostate cancer, producing pain and architectural disturbances. The brain, on the other hand, is a frequent location of metastasis in melanoma and lung cancer patients with resultant neurological manifestations and special treatment.

Symptoms Of Metastatic Cancer

The symptoms of metastatic cancer vary greatly depending on where the cancer has spread. For instance:

• Bone metastases typically cause deep, aching pain and possibly lead to bone fractures.
• Lung metastases may cause cough, chest discomfort, or shortness of breath.
• Liver metastases can result in belly pain, jaundice, or abnormal liver enzymes in a blood test.
• Brain metastases may trigger headaches, seizures, or neurological changes.

Is Metastatic Cancer Curable?

This is where it gets complicated. A few forms of metastatic cancer are held to be potentially curable—particularly if the spread is limited and treatment is forceful. A good example is with colorectal cancer that has a small quantity of liver metastases. In these scenarios, surgical resection with chemotherapy could lead to long-term survival.

But most cancers that spread are not curable in the classical sense. That doesn't necessarily leave the patient out of luck. Many treatments try to contain the disease, alleviate symptoms, and buy time. That's called palliative care, but it doesn't mean surrendering—it means redefining success from cure to control.

Others survive for years with stage 4 cancer, particularly with the help of today's therapies such as targeted therapy and immunotherapy. Outcomes are highly variable depending on the cancer type, the degree of metastasis, and the responsiveness of the cancer to treatment.

Why Chemotherapy May Have Stopped Working For Metastatic Cancer?

Chemotherapy is still a mainstay of cancer treatment, including metastatic cancer. Chemotherapy kills rapidly dividing cells, a characteristic of cancer. However, cancer cells can become resistant to chemo drugs over time. Such resistance could be driven by genetic mutations, alterations in the tumor microenvironment, or prolonged exposure to the same agent.

Notably, it's not that chemotherapy "stops working" across the board. Rather, it might cease to work for an individual patient's cancer. When this occurs, oncologists will usually change to another drug, use combination therapies, or investigate clinical trials with newer treatments.

As Professor Ian Davis, Director of ANZUP Cancer Trials Group, explained, “We’ve known for more than 20 years that chemotherapy has significant efficacy in metastatic prostate cancer. It hasn’t stopped working—newer agents are simply expanding our arsenal.”

What Comes Next When Cancer Progresses?

Living with cancer that is advanced is coping not only with the disease but also with the emotional, physical, and practical issues associated with it. Discussions around prognosis, life quality, and treatment options become the forefront. The following is what patients and families need to remember:

• Alternatives are still present, even if a therapy stops working, another can benefit. These include clinical trials, targeted therapies, or symptom-management interventions.
• Support, counseling, support groups, and palliative care services assist patients in coping physically and emotionally.
• Quality of life takes precedence since many individuals opt for treatments that enable them to feel more like they have a sense of normalcy, even though such treatments may not guarantee a cure.

Breakthroughs in genetic testing, liquid biopsies, and tailored medicine are providing physicians with additional tools for comprehending and tackling metastatic disease. Immunotherapies—medications that utilize the body's immune system to combat cancer—are providing long-term remission to some patients who formerly had limited choices.

At the same time, targeted treatments focus specifically on the cancer cells' distinct mutations, minimizing harm to other tissue. For a few types of cancer, such as metastatic lung cancer with particular gene mutations, such targeted medicines have greatly prolonged survival.

Although chemotherapy remains pertinent, the future of cancer treatment is certainly more individualized, targeted, and patient-focused. Although it usually can't be cured, metastatic cancer isn't necessarily a death knell. With the proper treatment team, educated decisions, and emotional support, many patients still discover meaning, happiness, and even renewed vigor as they move through the treatment journey ahead.

As summer temperatures rise, so are COVID-19 cases across much of the United States. Data released by the Centers for Disease Control and Prevention (CDC) on July 18 shows that at least 26 states plus Washington, D.C. are experiencing a noticeable uptick in COVID-19 activity, especially in emergency departments.

This isn’t the first time COVID-19 has surged during the summer. Since 2020, the virus has followed a seasonal pattern, often spiking between June and August. What’s different this year is the emergence of two new variants nicknamed Nimbus and Stratus—descendants of the Omicron family—that appear to be driving the current wave.

According to CDC modeling, case trends are either growing or likely growing in more than half the country. The hardest-hit regions? The South and Southeast, including states like Arkansas, Kentucky, North Carolina, and Texas. Other states such as Illinois, Pennsylvania, and Virginia are also seeing rising trends.

In addition, the virus is likely growing in 16 more states, including California, Georgia, Michigan, New York, and Tennessee. Only one state Montana is currently seeing a likely decline.

One particularly concerning trend: a rise in COVID-related emergency department visits among children under 4 years old. Though the CDC emphasizes that overall respiratory illness activity remains low, this uptick among young children has raised red flags for pediatricians.

Dr. Kushal Agrawal, Neonatologist and Pediatrician, notes that “the virus might not be more deadly, but younger children are still vulnerable because of limited prior exposure and lower vaccine eligibility.”

What’s Fueling the Summer COVID Surge In US?

There are a number of explanations for the present summer peak in COVID-19 cases. One primary explanation is the development of new mutations—variants such as Nimbus and Stratus—that keep changing in ways that make them more contagious and able to evade immunity acquired through past infections or vaccines. Another reason is augmented travel and socialization. With most lockdowns relaxed, more individuals are spending time indoors, where there is air conditioning, and these are the perfect environments for the virus to be spread.

Moreover, pandemic fatigue caused a general reduction in the practice of wearing masks and other preventive measures, even in high-risk environments. Though it's comforting that these newer versions have not been associated with more serious illness—cough, sore throat, fever, and fatigue symptoms are still largely consistent with previous Omicron waves—the increase in cases is an unmistakable sign that we cannot become complacent, particularly when it comes to protecting children.

How to Keep Your Kids Safe This Summer?

With schools, summer camps, and playdates back in full swing, parents are understandably anxious. While most restrictions have been lifted, COVID is still very much around, and kids—especially those under 12—may remain vulnerable. Here’s how families can take action:

1. Don’t Ditch the Mask Yet

Even if mandates are gone, masks are still helpful—especially in indoor, poorly ventilated areas. Dr. Agrawal recommends, “Young children should wear masks in crowded places like malls or indoor play zones, particularly if they aren’t fully vaccinated.”

2. Prioritize Hand Hygiene

Frequent handwashing with soap or sanitizers (at least 60% alcohol) remains a cornerstone of infection control. Make it easy for kids by keeping sanitizer in their backpacks and reminding them to use it before meals.

3. Keep Sick Kids Home

It may feel like a hassle, but keeping kids at home when they have symptoms like cough, fever, or sore throat is crucial. This applies not only to COVID-19 but to other respiratory infections that tend to circulate in schools and daycare centers.

4. Improve Indoor Air Quality

Whether at home or in schools, proper ventilation can significantly reduce virus spread. Open windows, use fans, and invest in HEPA filters if feasible. Schools should prioritize classroom air circulation and filtration systems.

5. Stay Up to Date on Vaccines

This doesn’t just mean COVID shots. Flu shots and other routine immunizations help reduce overall illness, which in turn reduces strain on families and healthcare systems. The CDC still recommends COVID vaccination to prevent serious illness and hospitalization.

6. Mind Their Mental Health

COVID-19 isn’t just a physical health issue. Kids may feel anxious about getting sick or dealing with disrupted plans. Dr. Agrawal advises parents to “talk openly about their feelings, reassure them, and keep routines consistent” to create a sense of stability.

We’re not where we were in 2020. Vaccines, prior infections, and improved awareness mean the virus has less room to cause widespread chaos. But it’s not gone either.

Summer surges like this remind us that COVID-19 is still unpredictable. For families with young children, the goal should be to balance caution with normalcy. A few simple measures—masks in tight spaces, staying home when sick, hand hygiene can go a long way in ensuring kids stay healthy while enjoying their summer. As Dr. Agrawal puts it, “Let them learn, play and grow but do it wisely.”

Dr Kushal Agrawal, HOD, Department of Neonatology and Paediatrics, KVR Hospital, Kashipur.

The interesting thing about people is how unique everyone’s perspectives are. Everyone has their way of thinking, their own way of doing things as well as their own unique memories. These aspects make us human and set us apart from everyone. Can you imagine losing all of these because of a disease that robs you of your cognitive abilities? Dementia is not as uncommon as we think it is. Affecting millions, we are yet to find a cure for this disease. While researchers have identified risk factors, does changing them make any difference?

A new study asked an important question: Can making specific changes to our daily lives actually improve or protect our thinking skills as we get older, especially for those who might be at risk of memory problems or dementia?

Organized Efforts Work Better

This study involved over 2,100 older adults who faced a higher chance of their thinking skills declining. We compared two different groups over two years. One group followed a well-organized plan for healthy living. This plan included regular moderate to intense exercise, sticking to a special "MIND diet," doing activities that challenge the brain and encourage spending time with others, and regular checks on heart health. The other group got a less organized plan that they had to follow more on their own.

This was a big study where neither the participants nor the initial assessors knew which group someone was in. It took place in 5 different medical centers across the U.S. from 2019 to 2023. We included 2,111 people between 60 and 79 years old who weren't very active and didn't eat the best diet. To make sure we studied people truly at risk, they also had to have at least two other risk factors, like a family history of memory issues, heart problems, or just being older.

• Structured Group, who received a detailed, ongoing plan for exercise, diet, brain-challenging activities, social time, and heart health checks. They had more guidance and were regularly checked on.
• Self-Guided Group, who got general advice on the same healthy lifestyle areas but had less structure and fewer regular check-ins.

The main goal was to see how much a person's overall thinking ability changed each year over the two-year study. We used a combined score that looked at different brain skills like planning, remembering things, and how quickly their brain worked.

Results of the Study

Out of all the people who started, almost 90% finished the two-year assessment. Both groups showed some improvement in their thinking scores over time. However, the structured group's improvement was clearly bigger than the self-guided group's.

Interestingly, the benefits of the structured program were helpful whether or not a person carried a specific gene (APOE 4) linked to Alzheimer's risk. But, the structured program seemed to help those who had lower thinking abilities at the beginning of the study even more.

We also kept track of any problems or side effects. The structured group actually reported fewer serious and non-serious problems compared to the self-guided group. The most common health issue overall was getting COVID-19.

What This Means for You

The results clearly showed that the organized group had a noticeably better improvement in their overall thinking abilities. Their brain scores went up more each year compared to the group that followed the less organized plan. This means that having a structured approach made a bigger positive difference for their brains.

The findings suggest that if you're an older adult at risk of memory problems, a structured, more involved healthy lifestyle plan is more helpful for your thinking skills than trying to do it all on your own with less guidance. We still need more research to see how much these brain improvements affect daily life and if they last for many years.

It's really important to find ways to slow down or prevent memory loss that can lead to dementia. Things we can do in our daily lives, like changing our habits, are promising because they are usually affordable, easy to access, and safe. They offer a good way to protect our brains without relying on medicines alone.

A tiny sore in your mouth might not seem like a big deal until it starts to sting every time you eat, drink, or even breathe. Mouth ulcers are more common than we give them credit for. Usually, they’re nothing to worry about. But if they’re showing up a bit too often or staying longer than usual, it’s time to pay attention.

Here’s a look at when to shrug it off, when to switch to soup, and when to book that appointment with your dentist or GP.

Ulcers Happen But Not All Should Be Ignored

Normally, ulcers usually clear up within two weeks and are often linked to being run down or low on certain vitamins. But if that ulcer refuses to budge after three weeks, it’s not something to ignore. Cancer Research UK recommends seeing a doctor or dentist if an ulcer or a red or white patch is still hanging around after three weeks. It could be harmless, but it could also be your body waving a little red flag.

DIY Healing

Most mouth ulcers don’t need a lot to treat. The NHS says they’ll usually heal with time and a little TLC. That said, you can speed things up by not doing things that make them worse.

Skip the spicy curries, salty snacks, acidic foods, and crunchy culprits like toast or crisps. Basically, if it hurts to eat it, you shouldn’t be eating it. Hot and acidic drinks like fruit juice are also a no-go. As for toothpaste, check the label, avoid ones with sodium lauryl sulphate, a foaming agent that can irritate ulcers.

Instead, go soft and soothing. Stick to cool drinks, go for gentle foods, and switch to a soft-bristled toothbrush that won’t scratch or poke at sensitive areas. Regular dental check-ups and a balanced diet also go a long way in keeping your mouth happy.

Not All Ulcers Are Created Equal

Most of the time, ulcers are just that: temporary sores. But if you’re dealing with one that refuses to heal, is especially large or painful, or comes with other symptoms like swelling, difficulty eating, or a lump in the neck, don’t play the waiting game. It might be something more serious, like an infection or in rare cases, something that requires more thorough investigation.

Prevention

If you’ve had your fair share of ulcers and want to avoid the next round, the answer lies in prevention. Aside from dodging the usual food triggers, it helps to manage stress, get enough sleep, and eat a diet rich in iron, folate, and B vitamins. Also, drink plenty of water and make sure your mouth stays clean.

Regular dental visits help your dentist spot the early signs of anything unusual and give you personalised tips on how to avoid recurring ulcers.

Don’t Panic, But Don’t Ignore

Mouth ulcers are rarely serious. Still, it’s better to be safe than sorry. If your ulcer overstays, refuses to heal, or comes with other odd symptoms, get it checked. And while you wait it out, treat your mouth gently. Avoid fiery foods, switch to a soothing routine, and try not to poke at it with your tongue.