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Breast Cancer In The Liver

Liver Resections Of Isolated Liver Metastasis In Breast Cancer: Results And Possible Prognostic Factors

Doctors and patients offer hope for women with metastatic breast cancer

Malte Weinrich

1Department of General, Thoracic, Vascular and Transplantation Surgery, University Hospital Rostock, Schillingallee 35, 18057 Rostock, Germany

2Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital of the Saarland, Kirrberger Straße, 66424 Homburg/Saar, Germany

3Department of Medical Statistics, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany

Abstract

1. Introduction

Metastasis is the most common cause of death in cancer patients . Breast cancer might spread via blood stream and cause liver metastasis. This can arise simultaneously or decades after the primary tumour. Metastases are often the sole sign of recurrence of the breast cancer. References show that 212% of patients with breast cancer have liver metastasis , which, however, might be isolated in some cases. In patients with resectable colorectal liver metastasis, surgical resection is the only curative approach, if an additional nonresectable extrahepatic tumour is excluded. References report 5-year survival rates of 30 to 47% in these patients . Surgical management is therefore recommended in the German S3-guidelines for colorectal cancer . In contrast to this the data on isolated liver metastasis in breast cancer patients is not as explicit.

2. Patients and Methods

Overall survival of patients after liver resection and surgical exploration only .

4. Discussion

References

Why Does My Provider Need To Test The Metastatic Tumor

Your care team will test the metastases to figure out the biology of the tumor, which can help guide your treatment plan. Providers may test tumors for:

  • Hormone receptor status: If the cancer is hormone receptor-positive, hormonal therapy may be your first treatment.
  • HER2 status: Human epidermal growth factor receptor 2 is a protein that is overexpressed on some breast cancer cells. HER2-positive cancer responds to specific HER2-targeted therapies.
  • PIK3CA gene mutation: If a tumor is hormone receptor-positive and HER2-negative, your provider may test for this gene mutation. Specific targeted therapies can be used to treat tumors with this mutation.
  • PD-L1 status: Tumors that are hormone receptive-negative and HER2-negative may be tested for PD-L1 status. If the PD-L1 test is positive, you may be recommended to receive a combination of immunotherapy and chemotherapy.

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Thermal Ablation Or Cryoablation

Thermal ablation or cryoablation can be used alone or in combination with surgery. These procedures involve destroying cancer cells by either heating or freezing them. For example, radiofrequency ablation involves inserting a needle into individual tumours in the liver and destroying them with heat. RFA is a specialist treatment and not widely available. Your treatment team can tell you if it may be suitable for you.

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Tissue Distribution Of Metastases By Intrinsic Subtype

The seed and soil hypothesis proposes that favorable interactions between the metastatic tumor cell and the organ-specific microenvironment are required for successful expansion of cancer cells in different vital organs . Better understanding the mechanism of this interaction could greatly facilitate the uncoupling of this relationship, thereby effectively preventing and/or treating metastatic disease. Recent studies have examined the relationship between primary tumor characteristics and metastatic dissemination patterns, in order to understand this predilection. A 2011 study examining the maintenance of gene expression signatures between matched primary and metastatic breast cancer samples uncovered that > 90% of genetic signatures found in the primary tumor are maintained in distant metastases . Interestingly, the gene signatures with the highest rate of discordance between primary and metastatic samples were associated with extracellular matrix proteins, which could be a result of a direct influence of the unique ECM itself on gene expression, or simply differing levels of fibroblasts found in primary tumors versus metastases. Overall, these results confirmed that primary breast tumor gene profiles are strong predictors of metastatic behavior.

Breast Cancer Subtypes Hormonal And Her2 Status

Breast Cancer Liver Metastases: US

Although the term breast cancer is used in general, there are many different sub-types of breast cancers. The sub-types behave in different ways, with some responding better to treatments and some growing and spreading at faster rates.

Obviously, the sub-type of breast cancer affects survival rates.

There are 5 molecular types of breast cancer:-

  • Luminal A: This type of breast cancer is hormone receptor-positive and HER2 negative. Furthermore, Luminal A cancers tend to be low-grade and slow growing. These tumors respond well to hormone therapy.
  • Luminal B: These tumors are ER+ and can be HER+ or HER-. Luminal B cancers tend to grow faster, be of a higher grade and larger tumor size.
  • Triple negative/basal-like. As the name suggests these tumors are ER- PR- and HER-. Triple-negative breast cancers have a poorer prognosis and do not respond as well to treatment.
  • HER2-enriched: ER- PR- and HER2 positive. These tumors used to have a poor prognosis but since targeted therapy survival rates have improved.
  • Normal-like: These cancers are hormone receptor positive and HER2 negative. Normal-like breast cancers have a good prognosis.
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    Are There Any Statistics On Recurrence Rates Or Incidence Of Metastasis

    As mentioned, it is very difficult to find statistics on metastatic breast cancer that has recurred after initial diagnosis. However, these cases represent a large proportion of Stage IV breast cancer cases and overall deaths.

    Most of the statistical data on Stage IV or metastatic breast cancer is from those women presenting at diagnosis. According to the Metastatic Breast Cancer Network in 2012 new cases of Stage IV breast cancer were between 13,776 to 22,096.

    The number of breast cancer recurrences at Stage IV is estimated to be between 20% and 30% of all breast cancer diagnoses.

    Most Common Places It Spreads

    It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.

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    Exercise And Secondary Breast Cancer In The Liver

    Some people with secondary breast cancer in the liver have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms its important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.

    If youre currently having treatment you may need to exercise at a slightly lower level. Stop straight away if it hurts or feels like youre working too hard.

    When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.

    Newly Diagnosed Or Worried About A Symptom

    Alcohol linked to new cancer cases

    In the days or weeks after a diagnosis of secondary breast cancer, you may feel in turmoil and find it hard to think clearly.

    You can read our information for people newly diagnosed with secondary breast cancer, including where to find support.

    If you havent been diagnosed but are worried about a symptom, find out more about the signs and symptoms of secondary breast cancer.

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    When Can Metastatic Breast Cancer Occur

    Some people have metastatic breast cancer when they are first diagnosed with breast cancer . This is called de novo metastatic breast cancer.

    Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence.

    A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.

    Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but were dormant and could not be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.

    Symptoms Of Breast Cancer Metastasis To Liver

    Metastatic breast cancer may grow silently in the body while you are completely unaware. Early on in metastatic liver cancer there might not be any signs or symptoms to alert you. As the cancer grows, you may experience liver swelling. This may cause the following symptoms:

    • Bloating of your abdomen
    • Mass on upper right abdomen
    • Fever, chills, sweats
    • Confused thinking

    Knowing the early symptoms can help you find and treat breast cancer that has metastasized to the liver early on and slow the progression of the disease.

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    What Causes Breast Cancer To Metastasize Or Spread

    With any type of solid tumor like breast cancer, theres a chance that cancer cells will break free from the original tumor. These cells can circulate in the bloodstream or lymphatic system, which filters out bacteria and viruses.

    These free-floating cancer cells move through the body, eventually settling in new locations. There, they start to multiply and form new cancer tumors. More than half of people with breast cancer develop bone metastases . But cancer cells can also settle in organs. The liver is the third most common site for breast cancer metastases.

    Characteristics Of Patients In The Three Groups

    Breast Cancer Liver Metastases: US

    The 57 cases of UBCLM were randomly divided into three groups: HAIC/PVIC group, TACE group and TAE groups. The mean age of patients in each group was 55 , 52 and 51 years old, respectively. However, there were no significant differences in the clinicopathological characteristics of patients among these three groups .

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    How To Handle Emotions

    Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.

    Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.

    While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.

    Open Access License / Drug Dosage / Disclaimer

    This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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    Does Breast Cancer Screening Save Lives

    Breast cancer screeningdoes not savelives, study says. Breast cancer screening in real world situations is not effective in preventing mortality, says a US case control study. The study, one of the largest completed to date looking at the effectiveness of breast cancer screening, was published in the Journal of the National Cancer Institute .

    Forms Of Prognostic Scoring

    Treatment Options in HER2 Metastatic Breast Cancer

    Another way to predict overall outcomes for cancers is through prognostic Scoring. The prognosis for small-cell lung cancer can be done through Manchester score.

    International Prognostic Index is used for prognosis of a condition like Non-Hodgkin lymphoma. There are also certain other conditions where prognostic indicators are used like Drug mediated Liver Dysfunctions and exercise stress test after myocardial infarction. Prognostic indicators are also used to predict the overall outcome of patients with multiple myeloma.

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    Liver Cancer Survival Rates

    Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

    Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Your doctor is familiar with yoursituation ask how these numbers may apply to you.

    Will I Need More Than One Treatment For Metastatic Breast Cancer

    Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.

    When you start a treatment regimen, you and your care team will see how:

    • The cancer responds to the therapy.
    • The side effects impact you.

    If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.

    There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.

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    Conclusions And Future Perspective

    Globally, breast cancer is the most prevalent cancer in women, and metastatic disease is highly predictive of shortened survival. Improving the general survival of women with metastatic breast cancer requires more effective anti-cancer strategies in combination with current therapies or medications. Nutrition plays an important role before/during/after cancer treatment. While dietary modifications mostly have positive effects in the context of specific cancers, it is critical to optimize future investigations on metabolic therapies to understand how dietary factors and pharmacotherapies influence carcinogenesis based on tumor- and patient-related characteristics. To further improve the effects of the fasting-mimicking diet on the quality of life or cancer progression, more clinical studies are needed, as the safety and efficacy of the fasting-mimicking diet strongly depends on the tumor variety and its genotype. Understanding diet-associated molecular mechanisms involved in therapy resistance, especially the âβ-hydroxybutyrate paradox theoryâ, will help reduce mortality and morbidity associated with metastatic breast cancer and prolong the quality-adjusted life expectancy of cancer survivors.

    Can Stage 4 Breast Cancer Go Into Remission

    Secondary breast cancer in the liver

    Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.

    But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.

    Advances in stage 4 breast cancer treatments are helping to increase the length of remission.

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    Symptoms Of Liver Metastases From Breast Cancer

    When breast cancer spreads to the liver, it may not cause any symptoms. However, a variety of tests can help detect the presence of liver metastases, including liver function tests that measure enzyme activity in the liver which could reveal an abnormality prompting more extensive testing in the form of imaging.

    What Should I Ask My Healthcare Provider About Metastatic Breast Cancer

    If youve been diagnosed with metastatic breast cancer, ask your provider:

    • What are my treatment options?
    • What is my prognosis?
    • What side effects can I expect?
    • Will complementary therapy help me feel better?
    • What if I want to stop treatment?
    • How can I feel my best during treatment?

    A note from Cleveland Clinic

    Metastatic breast cancer is advanced breast cancer. Providers classify it as stage 4 breast cancer. It happens when cancer cells, often left behind after previous breast cancer treatment, start to spread to other parts of the body. While there is no cure for metastatic breast cancer, treatment can prolong your life and help you feel better. There are many medications available, so if one treatment isnt working, your care team can try a different approach. If you notice any symptoms or dont feel your best, especially if youve undergone breast cancer treatment in the past, talk to your healthcare provider.

    Last reviewed by a Cleveland Clinic medical professional on 04/14/2021.

    References

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    When Cancer Goes Beyond Your Breast

    If your doctor told you that your breast cancer has spread to other parts of your body, it’s at a more advanced stage than if it’s only in your breasts. How far it has spread is one of the things your doctor will consider when they tell you the “stage” of your cancer. It’s considered “metastatic” if it has spread far from your breasts. Every case is different. For some women, it becomes something they live with for a long time. For others, focusing on pain management and quality of life is the main goal.

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