Breast Cancer Metastasis: Secondary Sites
Over the years there have been significant improvements and advancements in the diagnosis and treatment of breast cancer. Indeed, breast cancer is now considered to be a manageable disease.
However, there are still over half a million deaths worldwide from breast cancer and over 90% of these women die of metastasis. Consequently, research into metastasis is of vital importance in overcoming deaths from metastatic breast cancers.
Stage IV or metastatic breast cancer, as mentioned earlier, are cancer cells that have spread from the breast to distant sites around the body. Common secondary sites are:-
- Bone: .
- Lungs
- Liver
Drug Treatment Before Surgery
You might have chemotherapy as a first treatment to shrink the cancer down.
You might have hormone therapy first if your cancer cells have hormone receptors. But you usually only have this if chemotherapy isnt suitable.
If your cancer cells have particular proteins called HER2 receptors you might also have a targeted cancer drug called trastuzumab .
These treatments might shrink the tumour enough to allow your surgeon to remove just the area of cancer. This is called breast conserving surgery or a wide local excision.
If the cancer doesnt shrink enough, you need to have the whole breast removed . You may be able to have a new breast made . Do speak to your surgeon about this.
Before your surgery the lymph nodes in the armpit are checked for cancer cells.
You usually have radiotherapy to the breast after surgery.
The Tnm Staging System
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M.
The T category describes the original tumor:
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HER2 status: are the cancer cells making too much of the HER2 protein?
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Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes
Adding information about tumor grade, hormone-receptor status, HER2 status, and possibly Oncotype DX test results has made determining the stage of a breast cancer more complex, but also more accurate.
In general, according to experts, the new staging system classifies triple-negative breast cancer at a higher stage and classifies most hormone receptor-positive breast cancer at a lower stage.
You also may see or hear certain words used to describe the stage of the breast cancer:
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Distant: The cancer is found in other parts of the body as well.
The updated AJCC breast cancer staging guidelines have made determining the stage of a cancer a more complicated but accurate process. So, the characteristics of each stage below are somewhat generalized.
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Symptoms Of Secondary Breast Cancer
Secondary breast cancer means that a cancer that began in the breast has spread to another part of the body. Secondary cancer can also be called advanced or metastatic cancer.
It might not mean that you have secondary breast cancer if you have the symptoms described below. They can be caused by other conditions.
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Breast Cancer With Possible Spread To Lymph Nodes In Neck
Hi, I have been really worried. Last year I was diagnosed with BC Her2+ and I had chemo Fec-T and radiotherapy. I started zolendronic acid on Friday and I am still on Herceptin. Yesterday I went for an ultrasound to my neck. The radiologist spoke of finding 3 enlarged lymph nodes I think at the base of my neck. I am so worried it has come back and that prognosis will be poor. Has anyone had anything similar? IN other ways I am feeling well. Thank you. Xx
Hi Sunny-day
Im sorry to hear that the radiologist found some enlarge lymph nodes on your recent ultrasound. Its understandable that youre cconcerned about what these may be and what they may mean given that youve had breast cancer.
I would say that we seem to have a lot of posts here on the forum at the moment from people who have swollen lymph nodes so try to stay positive and remember that there could be a number of reasons other than cancer for this problem.
Have you spoken to your GP or Consultant about these findings? Its certainly worth giving them a call to talk things through and see if they feel further investigation is needed.
Keep in touch and let us know how you get on.
Best wishes,
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Lymphedema Evaluation: What To Expect At Your Appointment
The lymphedema specialist conducts a thorough evaluation to figure out if you have lymphedema and whether its mild, moderate, or severe. At your first appointment, its important to answer all the lymphedema specialists questions so you can both decide on the best treatment options for you.
Let the lymphedema specialist know your complete medical history and breast cancer history. Share specific details regardless of how long ago you were diagnosed, including the type and location of the breast cancer, the number of lymph nodes removed, the type of surgery you had, and any additional treatments you had, such as radiation therapy or chemotherapy. If possible, take your medical records with you.
Tell the specialist about any symptoms youve noticed, such as heaviness, tingling, or swelling. It also makes sense to tell your therapist if you notice symptoms when you exercise or when its very hot outside. These activities can cause an increase in lymph production. Andrea Cheville, MD, a physiatrist at Mayo Clinic, recommends keeping a diary of symptoms to share with the specialist.
Let the specialist know of any pain you feel in the affected area, what the pain feels like and how intense it is, and how long the pain lasts. Sometimes if there is inflammation in the arm, causes more production of lymph, and if we can solve that then we can solve the problem, says Dr. Cheville.
Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
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Where Does Breast Cancer Spread To
Breast cancer cells seem to prefer to settle into:-
- long bones in the arms and legs
- ribs
- skull
With an osteolytic metastasis, the cancer kind of eats away at the bone, creating holes.
With an osteoblastic bone metastasis, the bone mineral density actually increases, but this can cause the bones to fracture more easily. This requires a little more explanation. Breast cancer metastases tend to be lytic when they are untreated, and then they become densely sclerotic as they respond to treatment.
Even if no treatment is given yet, an osteoblastic metastasis from breast cancer generally indicates that the persons own body is trying to fight cancer with some success.
A CT scan may also be used to check for metastasis to the lungs or liver. A CT scan is essentially an X-ray linked to a computer. The breast cancer doctor injects a contrast dye agent into the bloodstream and this makes any cancer cells in the liver and chest easier to see.
Local And Regional Recurrence
Breast cancer that comes back in the skin of the breast where the cancer was first removed, or in the operation scar, is known as a local recurrence.
Breast cancer may also come back in the lymph nodes in the armpit, behind the breast bone, or in the lower part of the neck. This is called regional recurrence. If cancer cells are blocking the lymph nodes in the armpit, fluid can build up in the arm causing swelling known as lymphoedema.
Local and regional recurrences are not secondary breast cancer, as the cancer has not spread to another organ in the body.
These recurrences are usually less serious than secondary breast cancer. But you will usually have tests to find out if the cancer has spread to other parts of the body.
A local or regional recurrence that hasnât spread anywhere else in the body may be treated with surgery, if possible, or with radiotherapy. Your treatment will depend on the treatments you received to remove and treat the primary breast cancer.
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How Lymphedema Happens
To understand how and why lymphedema happens, it can help to know about how the lymphatic system works.
The lymphatic system works with the cardiovascular system to maintain the balance of fluid in your body. Both systems supply the bodys tissues and organs with nutrients and also remove waste products.
The cardiovascular system kicks things off with the heart, which pumps oxygen- and protein-rich blood out through the arteries and into the bodys tissues and organs. The veins carry blood containing carbon dioxide and other waste products back to the heart.
About 90% of the blood gets sent back to the heart through the veins. But the remaining 10% is a fluid that leaks out into the bodys tissues through very tiny blood vessels called capillaries. This fluid called lymph contains protein, waste, cellular debris, bacteria, viruses, and excess fat that are all too big to get back into the veins.
As the lymph makes its way back toward the heart, it has to pass through the lymph nodes small, round masses that filter out bacteria, waste, and other toxins and also contain infection-fighting white blood cells. The lymph nodes play a key role in recognizing and destroying these substances, while also signaling the body to launch an immune response when needed.
Lymphedema happens when the lymphatic system becomes damaged or overwhelmed and cant clear lymph fast enough, so the fluid builds up and causes swelling.
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fever or flu-like symptoms
Stage 3 Breast Cancer
Stage 3 breast cancer has spread outside the breast but not to distant sites. The cancer is typically in nearby lymph nodes or skin.
Stage 3 breast cancer is typically harder to treat than earlier stages. This, however, ultimately depends on several factors, including:
- hormone receptivity
- cancer grade
- cancer type
A doctor can help a person better understand the stage of cancer and how that will affect treatment options and their outlook.
Healthcare professionals distinguish between the following stages of stage 3 breast cancer:
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What Are Lymph Nodes
You have hundreds of lymph nodes throughout your body. Your lymph nodes are part of your lymphatic system, which, in turn, is part of your immune system.
Lymph nodes are little bean-shaped structures that contain immune cells that help fight infection. Theyre connected by a system of lymph vessels that carry fluid throughout your body. As fluid passes through your lymph nodes, they filter out harmful substances.
Cancer spreads when cancer cells break away from the primary tumor. In breast cancer, these cells are most likely to reach the lymph nodes closest to the affected breast.
Usually, these lymph nodes are under the arm, but there are also clusters of lymph nodes near the collarbone and breastbone.
The ones that are closest to your breast are called sentinel lymph nodes. The nodes under your armpit are called axillary lymph nodes.
Even if cancer has reached nearby lymph nodes, it doesnt mean it has spread to other areas. But cancer that reaches the lymph system or bloodstream has a greater potential to travel to other parts of the body.
Breast cancer that has spread to lymph nodes may be treated more aggressively than if it hadnt reached these nodes.
The 5-year survival rate for breast cancer that hasnt reached nearby lymph nodes is 99 percent versus 86 percent when it has.
Types Of Lymph Node Surgery
Even if the nearby lymph nodes are not enlarged, they will still need to be checked for cancer. This can be done in two different ways. Sentinel lymph node biopsy is the most common way and only a few lymph nodes are removed. But in some cases, an axillary lymph node dissection , which removes more lymph nodes, might be needed.
Lymph node surgery is often done as part of the main surgery to remove the breast cancer, but sometimes it might be done as a separate operation.
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A Lot To Learn About Alnd In Other Patients
Its important for doctors and patients to understand that these results can only be applied to women whose breast cancer and treatment regimen match those of the participants in the trial, the papers authors cautioned.
The results should not be used to direct the care of women with palpable axillary lymph nodes, women who had breast tumors larger than 5 cm in diameter, women with three or more positive sentinel lymph nodes, women who received chemotherapy or hormone therapy before surgery, and women who underwent mastectomy instead of breast-conserving surgery with radiation, they wrote.
We still have a lot to learn about ALND in other settings, commented Dr. Giuliano.
One trial, currently underway in Europe, is examining whether ALND can be skipped in some women who have a mastectomy for early-stage breast cancer, but results are not expected for years.
But for now, according to Edward Livingston, M.D., and Hsiao Ching Li, M.D., of the University of Texas Southwestern Medical Center, authors of an accompanying editorial, The ACOSOG Z0011 trial has shattered a century of belief that all cancer containing axillary lymph nodes must be removed in women with breast cancer.
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Breast Cancer Doubling Time
An important way to think about how fast a breast cancer grows is by looking at what’s called the volume doubling time. Growth rate is a part of tumor doubling time, which is exactly what it sounds like. It is the amount of time it takes for a tumor to double in size.
It would be unethical to leave a cancer untreated to see how rapidly it will grow, so researchers estimate the doubling time. However, when looking at these models, it becomes clear that doubling time estimates vary from study to study.
A 2018 study estimated doubling time by looking at serial ultrasounds in 265 people with invasive breast cancer to see if there were differences among breast cancer subtypes. These images were taken between diagnosis and surgery. The results suggest that growth varied significantly based on the breast cancer subtype and the role of estrogen receptors in those subtypes.
During an average interval of 57 days, 36% of tumors did not change in size, while 64% grew. Of those tumors that increased in size, the average gain in volume was 34.5%. Tumors that were triple negative had greater increases in volume and shorter doubling times than those that were estrogen receptor positive and HER2 negative tumors.
A similar 2016 study looked at growth in 323 people, based on ultrasound images taken between diagnosis and surgery over a 31 day period, On average, the tumors grew from 1.47 centimeters to 1.56 cm in diameter. The daily growth rate based on type was:
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Regional Recurrence Within Three Years Carries A Less Favorable Prognosis But Overall Survival Statistics Are Still Good
Generally speaking, if the breast cancer returns regionally lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer.
Five-year overall survival after an isolated chest wall recurrence is 68% and after intra-breast recurrence it is 81%.
In one 2010 medical research study, the ten year overall survival rate was estimated at 84% for women without recurrence. However, this figure goes down to 49% for women with a locoregional recurrence and 72% for women with a second primary tumour.
A large 2015 study examined the impact of the time of the disease free interval on survival rates. For women with a locoregional recurrence that happened in the first 18 months, the ten year overall survival rate is around 30%. The overall 10 year survival rate for those whose recurrence happened within 3 years goes up to 50%. Furthermore, for those who suffered a recurrence after 3 years the ten year overall survival rate increases to 70%.
This recent study clearly demonstrates that the longer the time span since the primary prognosis and treatment to the recurrence, the better the long-term prognosis.
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The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occurred locally and after five years.
However, women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds.
What Are Cancer Survival Statistics
A key part of making a prognosis is looking at survival rates. These are numbers researchers collect over many years in people with the same type of cancer. These numbers are based on large groups of people. For breast cancer, there are two main measurements:
Breast cancer survivalrates reflect the percentage of women who are alive 5 years or longer after their diagnosis. This means the numbers are based on women who were found to have breast cancer at least 5 years ago. Advances in diagnosing and treating cancer have led to steadily improving survival rates, so the outlook for women diagnosed today is likely better.
Relative survival rates donât take into account the cause of death. Theyâre a measure of the percentage of people with cancer who have lived for a certain time after diagnosis, compared with people who did not have cancer.
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