dt_toronto_geek
Superstar
I think what Cohen means is that the second tumour grew from primary tumour cells that migrated to a new site. So yes, it's a mets. But my wife (a past cancer patient) tells me this can be a localized event - that involvement of lymph nodes is not systemic and the cancer cells are not travelling around the whole body. I don't know where this fits on the Duke ranking of stages, but I think the difference between stage 3 and stage 4 has to do with the level lymphatic (is that the right word?) engagement. I could be wrong, though.
As the cancer has advanced from the primary site to a second site, this is considered stage 4 - it can also be called advanced or metastatic cancer. Stage 2/3 is cancers or tumors that are larger in size, have grown more deeply into nearby tissue, and have spread to lymph nodes, but not to other parts of the body.