Recurrent (metastatic) cancer can cause death in two different settings:

• Localized effects occur when a single recurrent (metastatic) mass or tumor presses upon a critical part or area of the body. The human body functions on a complicated network of blood vessels, airways, nerves, and critical organs (i.e., kidneys, brain, liver) to function properly. If a recurrence manifests near or inside one of these structures, it may very well block, squeeze, or crush them in a way that can be devastating. For example, a metastatic tumor may block an airway or press on the part of the brain that controls breathing.
• Systemic effects impact the entire body rather than a specific vessel, airway, etc. Recurrent (metastatic) tumors release multiple types of molecules and/or chemicals which can cause very destructive effects on overall health as they circulate throughout the body. Some of these molecules disrupt how normal immune cells function, preventing the elimination of harmful infections. Without a well-functioning immune system, unchecked pneumonia or urinary tract infection can eventually lead to sepsis and death.
• Another group of molecules alters the balance of salts such as sodium, potassium, and calcium in our body. Without a proper balance in these salts, organs that rely on electrical signals like the heart and brain can fail.
• The third group of chemicals can wreak havoc on the blood itself, causing bleeding in some cases or generating blood clots that obstruct the flow of blood to critical organs in other cases. Finally, some of these chemicals cause patients to feel generally weak or lose their appetite, which in turn can result in a progressive decline in health due to very poor nutrition, hydration, and activity level.

The thought of dying from cancer can be extremely troubling. At the same time, we have learned that many patients feel empowered knowing with some advanced planning and the involvement of palliative care providers, the causes described above should be associated with a calm and peaceful death.