Treatment For Physical Symptoms
The American Cancer Society urge that a person should not have to endure pain in the final months and days of life.
Many people find relief with opioid medications, but these can cause side effects such as fatigue and constipation. A person may use opioids in combination with other pain relief medications, such as acetaminophen or ibuprofen.
Other drugs, such as antidepressants and antiseizure medications, can also treat certain types of pain.
Doctors can also prescribe medications for nausea and vomiting. Some drugs for treating nausea can make a person drowsy. However, these drugs may help people eat and drink more or simply make it easier for them to function and interact with other people.
Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.
People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.
The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
For Family And Friends
Caring for a loved one with stage 4 breast cancer has special challenges as well. Fortunately, organizations such as CancerCare now offer support groups design for loved ones who are caring for someone with cancer. In addition to caring for yourself , its helpful to learn about metastatic breast cancer.
Common things that people learn about cancer usually refer to an early-stage disease, and myths about metastatic breast cancer can be painful for those living with advanced disease. For example, one of the things not to say to someone with metastatic breast cancer is, When will you be done with treatment?
For the most part, people with metastatic breast cancer will require some type of treatment for the rest of their lives.
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How Does Cancer Spread Or Metastasize
The spread of cancer usually happens through one or more of the following steps:
- Cancer cells invade nearby healthy cells. When the healthy cell is taken over, it too can replicate more abnormal cells.
- Cancer cells penetrate into the circulatory or lymph system. Cancer cells travel through the walls of nearby lymph vessels or blood vessels.
- Migration through circulation. Cancer cells are carried by the lymph system and the bloodstream to other parts of the body.
- Cancer cells lodge in capillaries. Cancer cells stop moving as they are lodged in capillaries at a distant location and divide and migrate into the surrounding tissue.
- New small tumors grow. Cancer cells form small tumors at the new location
How Is A Local Recurrence After Lumpectomy Diagnosed
After a diagnosis of early stage breast cancer, any remaining breast tissue should be evaluated annually with scans .
Most local recurrences within the breast after lumpectomy are detected on routine annual breast imaging, which usually takes the form of mammography and ultrasound, and on occasions MRI.
If you have a local recurrence or new primary breast cancer, you may find symptoms similar to an initial breast cancer. This includes:
- A new lump in the breast, armpit area or around the collarbone
- A change in breast size or shape
- Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple
- Clear or bloody nipple discharge
- Changes to the skin including redness, puckering or dimpling
- Breast tenderness or pain
Once a local recurrence has been diagnosed, we do tests to see whether there are signs of cancer elsewhere in the body. These may include a chest X-ray, CT scan, bone scan or PET scan, and blood tests , then we have to figure out how best to treat the tumour in the breast. Usually in these cases we do a mastectomy, as the prior less drastic surgery and radiation didnt take care of it.
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Liver Resections Of Isolated Liver Metastasis In Breast Cancer: Results And Possible Prognostic Factors
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
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
Can Chemo Cure Liver Metastasis
If your cancer has spread to your liver, youll want to know what treatments are available. You can undergo surgery or chemotherapy. Surgical resection is the standard treatment, although it lacks robust evidence of its benefits. Alternatively, you can try palliative local treatments such as transarterial embolization or selective internal radiotherapy. You can also try percutaneous thermal ablation.
If the metastasis is small, your doctor may opt for stereotactic radiotherapy, a type of radiotherapy that uses very precise imaging to deliver high doses of radiation to the tumor while sparing the surrounding tissue. Another option is intrahepatic chemotherapy, which involves giving chemotherapy directly into the liver through a catheter. It targets the main blood supply to the liver.
Liver metastasis is a particularly dangerous form of cancer that can impair liver function and threaten a patients life. It is the second-leading cause of death in patients with metastatic breast cancer. The survival rate is low, with a median survival of only 18 to 24 months. A five-year survival rate of approximately 27% and a ten-year survival rate of less than 10%, according to Cancer Statistics Australia. And even if you manage to survive this form of breast cancer, youll still experience a progressive disease for many years.
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Living With Metastatic Breast Cancer
It can be upsetting for you, your family, and other loved ones to learn that breast cancer has spread to other areas of the body. But there are ways to manage your feelings, get support, figure out how to talk about the diagnosis with family and friends, and work after being diagnosed.
Its not always easy to balance your sexual needs with the physical and emotional challenges of a metastatic breast cancer diagnosis. You can manage the sexual issues that can often come up with a metastatic breast cancer diagnosis.
Talk To Your Care Team
Whether youve already been diagnosed with metastatic breast cancer or you’re concerned about it due to a past early-stagediagnosis, its important to talk to your care team if you have a new symptom that is unusual for you.
Many of the symptoms we talk about on this page can have other causes besides metastatic breast cancer. Headaches, body aches, or a cough are fairly common and can be caused by non-cancerous conditions. Also, if youre currently receiving cancer treatments or finished them recently, you could still be experiencing side effects from those. Still, if you have a new symptom, share it with your care team and ask if an exam or testing makes sense.
It can be helpful to track any symptoms over time, either by writing them down or creating a file on your computer or phone. This way, you and your doctor can understand more about what youre experiencing, such as when it happens and if it happens during or after a specific activity.
If your symptom is sudden, severe, or way out of the ordinary for you, your care team may decide to investigate right away. If its milder and comes and goes, your team might ask you to track your symptom for several days to a couple of weeks to see if it improves on its own. Remember that you know the most about what does feel normal for you.
Pallav Mehta, MD
Two to three weeks is my personal cutoff, since most things tend to resolve on their own in a few weeks, Dr. Mehta says.
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Aggressive And Advanced Metastatic Breast Cancer
Habibi says the most extreme situations involve patients who are diagnosed with a very fast, aggressive breast cancer that has already spread to multiple organs and begins to overwhelm the body. For those patients, palliative care is important, concentrating on local control, pain management and avoiding bleeding and infection.
Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
biopsy of any suspicious area
a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
When breast cancer spreads to other parts of the body, its important to confirm whether the cancer has certain characteristics that may influence your treatment options, such as HER2 status and hormone receptor status. If you have been diagnosed with metastatic breast cancer years after an early-stage breast cancer diagnosis, it may seem logical to assume that the hormone receptor status and HER2 status are the same. But research has shown that the hormone receptor status and HER2 status of early-stage breast cancer can be different than that of a metastatic recurrence.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report.
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Symptoms Of Skin Metastases
Symptoms of skin metastases include:
- a change in the colour of the skin
- a firm, painless nodule or a number of nodules of different sizes
Sometimes the symptoms of skin metastases, such as redness and inflammation, may look like an infection of the skin called cellulitis.
Skin metastases can also cause lymphoedema, which is swelling of the arm, hand or breast area.
Other possible symptoms include:
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Living With Stage : The Breast Cancer No One Understands
Editorâs note: Weâre bringing back this piece from October 2014 for Metastatic Breast Cancer Awareness Day and to honor Jody Schoger, featured in the story. Schoger died of metastatic breast cancer in May. Want to learn more about MBC? Look for our tweets at the Northwest Metastatic Breast Cancer Conference this Saturday at Fred Hutch.
A no-nonsense Texan of 60 years, Jody Schoger* has a very no-nonsense way of educating people about her metastatic breast cancer.
Ã¢Someone will say, Ã¢When are you done with treatment?Ã¢ and IÃ¢ll tell them, Ã¢When IÃ¢m dead,Ã¢Ã¢ said Schoger, a writer and cancer advocate who lives near Houston. Ã¢So many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.Ã¢
An estimated 155,000-plus women in the U.S. currently live with Ã¢mets,Ã¢ or metastatic breast cancer. This type of cancer, also called stage 4 breast cancer, means the cancer has metastasized, or traveled, through the bloodstream to create tumors in the liver, lungs, brain, bones and/or other parts of the body. Between 20 and 30 percent of women with early stage breast cancer go on to develop metastatic disease. While treatable, metastatic breast cancer cannot be cured. The five-year survival rate for stage 4 breast cancer is 22 percent median survival is three years. Annually, the disease takes 40,000 lives.
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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.
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:
Before starting any integrative therapies, however, ask your care team for advice on which ones are most suited to you and fit into your overall treatment plan, as well as how to do them safely.
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How Often Does It Happen And Why
Metavivor, an organization dedicated to researching MBC, states that 1 in 8 women will develop breast cancer during their lifetime. Of those, about 1 in 3 will experience metastasis.
For men, about 1 out of 1,000 will develop breast cancer during their life, but under 2% will experience metastasis.
The liver is the third most common area that MBC affects. Researchers are still not certain exactly how breast cancer spreads to the liver.
The current hypothesis indicates that it spreads to the liver when the cancer cells and liver are compatible. This is known as the seed and soil hypothesis.
research from 2015 , the exact mechanics of how breast cancer spreads to the liver are still not known.
However, in one 2019 study, researchers found that a few distinguishing factors may place a person at higher risk of developing liver metastasis. These include:
- number of lymph node metastases
Earlier or more frequent screening for liver metastasis may help improve outlook because a doctor may find the tumor sooner.
Can Liver Metastases Be Removed
Liver metastases of breast cancer are a common problem. These metastases often start in the liver, and then spread to other organs. They are most commonly found in the breast but can also occur in the pancreas, kidney, and esophagus. Liver metastases are more common in Europe and the United States. They are difficult to diagnose because the symptoms are vague and hard to spot.
In the majority of cases, liver metastases are not removable, even when the cancer has spread to the liver. However, some surgeons are investigating liver transplants for patients with colon cancer who have spread to the liver. Liver transplants can be dangerous, and patients must be healthy to have them. In addition, patients with liver metastases do not qualify for a priority transplant list. This means that they must find a family member or friend who is willing to donate a part of their liver.
Although liver metastases can be removed, the treatment will depend on the primary cancer site and the extent of liver metastases. If there is limited spread to the liver, chemotherapy can still be used. If the liver metastases are small and localized, surgical removal of tumors may be an option.
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Prognostic Model And Validation
In the multivariate Cox regression model, molecular subtypes , MFI, sites of extrahepatic metastasis , and liver function tests were associated with OS . Specifically, the death risk of HR negative and HER2 negative patients increased compared to HR or HER2 positive counterparts. The length of MFI also had a significant impact on the survival of BCLM patients, and therefore, the survival of patients with a long MFI was shortened in comparison with patients with de novo MBC, and patients with a short MFI had more than twice the risk of death relative to them. In addition, presence of extrahepatic metastasis and abnormal liver function were all correlated with an unfavorable prognostic impact on OS. This prognostic model had the area under the curve of time-dependent ROC at 1 year OS with 0.78 in the training set and 0.80 in the validation set, indicating this model had a good discrimination . The bootstrapping method was used to confirm the stability of our prognostic model in the training set, and the final results were rather robust . Calibration curves of the prognostic model for 1 year and 3 year OS in the training set as well as 1 year OS in the validation set showed its good concordance .
Table 2. Multivariate Cox regression model .
Figure 1. Time-dependent ROC curves of the prognostic model in the training set and the validation set . Overall survival from metastasis of the three prognostic groups in the training and validation set .