Combination Of Different Factors For Diagnosing Bone Metastases In Breast Cancer
In order to investigate the predictive accuracy of combining risk factors for bone metastases in patients with breast cancer, ROC analysis was conducted for different combination of risk factors . For two combinations of risk factors, combined CA153 with ALP were more accurate than other combinations for the prediction . Among the three combinations of risk factors, combined axially lymph node metastases, CA153 and ALP were the most accurate one for prediciting bone metastases . Additionally, combined axially lymph node metastases, CA153, ALP and hemoglobin had the highest predictive value among the four combinations of risk factors . Comparison of all the combining risk factors for the diagnosing, four combinations of axially lymph node metastases, CA153, ALP and hemoglobin were the most accurate one for predicting bone metastases in breast cancer, with a sensitivity of 78.5% and specificity of 87.8%.
Table 6 The analysis of predictive accuracy of combining different risk factors for bone metastases in breast cancer.Figure 2
The receiver operating characteristics of different combinations of risk factors for diagnosing bone metastases. the ROC curve of CA153+ALP. the ROC curve of axially lymph node metastases+CA153+ALP. the ROC curve of axially lymph node metastases+CA153+ALP+hemoglobin. the ROC curve of axially lymph node metastases+CA125+CA153+ALP+hemoglobin.
Extracellular Matrix Metalloproteinase Inducer
A newly discovered molecule downstream of RANKL is extracellular matrix metalloproteinase inducer /CD147, a cell surface glycoprotein that is known to induce MMPs and VEGF . While EMMPRIN is produced normally during tissue remodeling, it increases during tumor progression and metastasis. This molecule is also produced by metastatic breast cancer cells . Increased production of EMMPRIN in turn leads to increases in VEGF and MMPs. Both RANKL and VEGF can induce osteoclast formation , and MMPs play a role in bone matrix degradation.
Years On Breast Cancer With Bone Mets
Three years ago my life was changed forever when I was diagnosed with breast cancer with bone mets. Once again Id joined a club I didnt want to join the cancer club.
I remember the day as distinctly as if it was yesterday. Initially, I was told I had breast cancer, primary cancer consisting of a 21 mm mass in the right upper outer quadrant of my breast and abnormal lymph nodes. To be exact I had invasive ductal carcinoma, grade 2, ER 7/8, PR 6/8 and it was HER2+. The consultant assured me it was totally curable with treatment.
As it had spread to the lymph nodes, the hospital arranged for the following before the start of my treatment: MRI scan of breasts repeat ultrasound core of the axilla staging scans bone scan & CT chest, abdominal and pelvis
In amongst all the chaos of my cancer diagnosis I moved from North to South London and as a result changed my hospital. At my first appointment with the surgeon at my new hospital, I distinctly remember him commenting, I dont know why theyve sent you for a bone scan. 90% of the time the cancer hasnt spread and yours wont have.
And that was about as far as I understood the diagnosis. It felt a bit like information overload. Thinking I could pretend it wasnt happening to me if I didnt understand what it all meant, I lived in blissful ignorance for, well for a couple of years. I think I now understand what all the ER, PRs + and mean and will do my best to explain it.
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Risk Factors For Brain Metastasis
- a tumor with a high histological grade, which means that the cells look more irregular under a microscope and may be more likely to grow and spread quickly
- breast cancer thats already spread to nearby tissues or lymph nodes
- a breast cancer diagnosis at an early age
If youve received a breast cancer diagnosis, remember that having any of the above risk factors doesnt mean that youll certainly develop brain metastasis. It means youre at an elevated risk compared with others without risk factors.
Treatments For Bone Metastases
To understand how treatments for bone metastasis work, it can help to first understand how breast cancer cells behave in the bones.
A bone can function like a storage tank that traps and holds breast cancer cells. For some time, those cells may not cause any problems. Eventually, though, the cancer cells can hijack the normal, healthy process through which bone tissue regenerates itself.
Your bones are constantly breaking down and clearing away old cells and stimulating new cells to grow. Breast cancer cells in the bone can speed up the breakdown of normal bone tissue and weaken the bones. This is called osteolytic metastasis. Breast cancer cells also can overstimulate the production of new bone, leading to large, rigid growths. This is called osteoblastic metastasis.
Its possible to have osteolytic metastasis, osteoblastic metastasis, or a combination of both. Treatment helps slow or stop these bone metastasis cycles to reduce the risk of whats called a skeletal-related event .
hypercalcemia of malignancy, or an excessive amount of calcium in the blood
Its important to address any potential symptoms of bone metastases quickly. In addition to controlling the growth of the cancer, the goals of treatment for bone metastasis are to relieve pain, preserve function, and prevent SREs. Doctors can often stabilize bone metastases and help people manage it for long periods of time.
the cancer is growing quickly
Xgeva is given monthly as an injection under the skin.
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How Is Brain Metastasis Diagnosed
If your symptoms suggest the presence of brain metastasis, your doctor can use a variety of tests to make a diagnosis.
Initially, blood tests will be ordered to get an idea of your overall health and the function of various organs. These can include:
- a metabolic panel, which can assess liver and kidney function as well as levels of electrolytes in the blood
- a complete blood count, which measures the levels of different blood cells
- tests for breast cancer tumor markers, which are proteins that can be produced by breast cancer cells
Your doctor can use a head MRI to confirm the diagnosis of brain metastasis. This will typically be done with a contrast solution thats given via an intravenous line. Using a contrast solution can help to make the images from the MRI clearer.
The treatment thats recommended for brain metastasis can depend on a few factors, including:
- how many metastases are present in the brain
- where in the brain the metastases are located
- the HER2-positive and ER-positive status of your cancer
- whether your cancer has also metastasized to other areas of the body
- if certain genetic changes are present in your cancer
- your age and overall health
- your personal preferences
There are several potential treatment options for brain metastasis. Doctors generally divide these treatments into two categories: local and systemic.
Medications For Mild Bone Pain
Bone pain often responds to heat, or to mild pain relievers such as ibuprofen , naproxen or acetaminophen .
Although you can get these medications without a prescription, check with your health care provider before taking them. For example, if you have a low platelet count, or your kidneys are not functioning normally, or you have heart failure, your health care provider may advise you not to take ibuprofen or naproxen.
Learn more about these medications in metastatic breast cancer care.
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Bone Metastasis Characterization At Time Of Bom Diagnosis
In our sample of 1,445 patients with BOM, 808 had available information regarding type of bone metastasis at BOM diagnosis: 389 had lytic bone metastases, 270 had sclerotic/blastic metastases, and 149 had mixed bone metastases. At time of BOM diagnosis, 290 patients were found to have a single bone metastasis, whereas 1,141 patients had multiple bone metastases . Regarding the location of bone metastases at BOM diagnosis, 511 patients had bone metastases only in the axial skeleton, 153 patients had bone metastases only in the appendicular skeleton, and 770 patients had bone metastases in both the axial and appendicular skeleton . The majority of patients with a single bone metastasis had metastasis to the spine followed by metastasis to the pelvis , sternum , femur , rib , humerus , skull , mandible , clavicle , and scapula .
Drugs To Treat Bone Metastases
The drugs used most often for treating bone problems in people with bone metastases are the bisphosphonate drugs pamidronate and zoledronic acid and the drug denosumab . These drugs are given intravenously or subcutaneously . Most patients are treated once a month at first, but may be able to be treated less often later on if they are doing well. Treatment with one of these drugs can help prevent further bone damage and events related to weakened bones such as fractures, hypercalcemia, and spinal cord compression.
These treatments can have a rare but serious side effect called osteonecrosis of the jaw . Patients complain of pain and doctors find that part of the jawbone has died. This can lead to an open sore that doesnt heal or tooth loss in that area. The jawbone can also become infected. Having jaw surgery or having a tooth removed can trigger this problem. It is best to avoid these procedures while you are taking one of these medicines. One way to avoid these dental procedures is to maintain good oral hygiene by flossing, brushing, making sure that dentures fit properly, and having regular dental checkups. Any tooth or gum infections should be treated right away. If ONJ does occur, the doctor will stop the bone medicine.
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What Are Bone Metastases
Bone metastases are areas of cancer that develop when breast cancer cells travel to the bones. The tumors that develop, sometimes called lesions, can:
- Make the bones weaker and less dense. These types of tumors are called osteolytic, or simply lytic. Lytic lesions are caused by cancer cells causing old bone to break down without new bone being made, leaving weak spots or holes.
- Make the bones more dense, but not necessarily stronger. These types of tumors are called osteoblastic, or simply blastic. Blastic lesions are caused by new bone being made without old bone breaking down. This makes the bone harder, but this harder bone can still break more easily than normal bone.
Its common for people to have lytic and blastic lesions at the same time. Doctors use imaging tests, such as x-rays, to figure out the types of bone lesions a person might have. For lytic lesions, treatment may include bone-strengthening medicines called bisphosphonates. Blastic lesions can be treated with radioactive material injected into a vein, called radiopharmaceuticals. Radiopharmaceuticals can travel to bone metastases and destroy cancer cells.
How Are Bone Metastases Diagnosed
Most cases of metastatic breast cancer to the bones are diagnosed after a person tells their doctor about bone-related symptoms. Others are diagnosed when a routine follow-up test shows abnormal results. If a doctor thinks you may have bone metastases, they will order one or more tests to confirm the diagnosis.Doctors use imaging tests to create pictures of the bones and learn whether cancer has spread to them. These tests include:
Your doctor may also order a blood chemistry test to check for changes in your blood. These tests look for high levels of the mineral calcium and high levels of the enzyme alkaline phosphatase. We all need calcium and alkaline phosphatase, but too much of either in the blood could mean tumors in the bones are causing these substances to break down and get into the bloodstream.
It is important to know that bone density tests , which are frequently ordered in patients with early breast cancer to monitor the effects of hormonal medications on bone strength, do not detect bone metastases.
Sometimes, doctors diagnose bone mets by performing a bone biopsy, performed using a needle to remove a tiny piece of bone and test it for cancer cells. If you have just one suspicious area in the bones, or if its been many years since you were diagnosed with early-stage breast cancer, your doctor is more likely to recommend a bone biopsy.
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Association Between Pain And Bone Metastasis Characteristics
Based on the 767 patients with available information on both type of bone metastasis and pain status at BOM diagnosis, we found that pain was significantly associated with bone metastasis type = 10.79 p = .0045). Patients with lytic bone metastases had a significantly higher odds of pain than patients with blastic/sclerotic metastases = 10.78 p = .001 Table ). Among patients with available pain status and number of bone metastases , patients with multiple bone metastases at time of BOM diagnosis had 37% increased odds of having pain compared with patients with single bone metastasis = 4.62 p = .0316). The overall effect of location of bone metastases on pain trended toward statistical significance = 4.92 p = .0853), with higher odds of pain in patients with both axial and appendicular metastases versus those with pain confined to the axial skeleton = 4.49 p = .0340).
Overall Survival By Patient Characteristics
Race/ethnicity was significantly associated with OS = 16.17 p = .0028), with black, nonHispanic patients having a poorer OS from distant disease diagnosis compared with all other race/ethnicity groups . Median OS for black, nonHispanic patients was 3.46 years , whereas the estimated median survival for all other race/ethnicity groups was greater than 5 years. Age was also significantly associated with OS = 5.14 p = .0234). By age category , patients aged 4049 years at time of breast cancer diagnosis had significantly better OS compared with both younger and older patient groups . Smoking status and BMI were not significantly associated with OS = 2.99 p = .2247 BMI: logrank test 2 = 1.26 p = .7376).
Overall survival from first metastasis diagnosis among patients with breast cancer and boneonly metastases by age at breast cancer diagnosis . Plot was truncated at 10 years because of sparse data beyond 10 years.
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Why Does Breast Cancer Spread To Bone
Scientists think there may be a few reasons why breast cancer most commonly spreads to the bone:
- Bone is an area of high blood flow. This may make it more likely that cancer cells traveling in the bloodstream will reach and settle in bone, compared to other places in the body.3
- Cancer cells can “stick” to bone. Cancer cells may make a substance that helps them stay in the bone.1,3
- Cancer cells can grow in bone. Once in bone, cancer cells may release chemicals that help them grow into a tumor.1,3
Bone metastases are a frequent result of cancer3
Signs That Breast Cancer Has Spread To The Bone
Most aches and pains arent cancer, stresses Huston. But its important to keep an open and honest dialogue with your doctor about any unusual or persistent discomfort you may be having. He or she can determine if getting images is appropriate to rule out bone metastasis. Here are the symptoms of bone metastasis to look out for:
If you report any of the above symptoms to your doctor, he or she may want to do a thorough physical exam, blood tests, and a bone scan to check for bone metastasis. Depending on the results and where or how severe the bone pain is, he or she may also order an X-ray, PET scan, or CT scan. In some cases, a tissue biopsy is also done to confirm the diagnosis.
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Symptoms When Breast Cancer Has Spread To The Bones
The main symptoms of breast cancer that has spread to bone are:
- Pain particularly in the back, arms or legs, often described as gnawing which occurs when resting or sleeping, and may get worse when lying down especially at night
Find out more about the symptoms of secondary breast cancer.
Other possible effects include:
What Is A Metastasis
Metastasis is a word that describes the spread of cancer from its original site to another part of the body. Metastasis happens when cells break away from the original cancer site and travel to other areas of the body through the bloodstream or the lymph system. Cancer cells then settle in different tissues or organs, where they grow and form a new tumour . When breast cancer is found in parts of the body other than the breast it is called metastatic breast cancer.
A bone metastasis from breast cancer is made up of breast cancer cells. Bone is one of the most common places for breast cancer to spread.
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Bone Weakening And Fracture
Secondary breast cancer in the bone may mean the affected bones are weakened, which can increase the risk of a fracture.
If a bone has fractured you may need surgery to try to repair the fracture. You may also be given drug treatment to stop this happening in the future. You may have radiotherapy after the surgery.
Whats The Life Expectancy With Metastatic Breast Cancer In Bones
Metastatic breast cancer in the bones is not curable, and the prognosis typically isn’t as positive as earlier-stage cancers. Per the ACS, the five-year relative survival rate of a personal with distant breast cancer is 28%. That means that people with metastatic breast cancer are about 28% as likely to be alive five years after diagnosis as people who don’t have that cancer.
However, data shows that metastatic breast cancer in the bones seems to have the best survival rate compared to other types of metastatic breast cancer. A 2019 study published in the journal BMC Cancer looked at five years of data to track the survival rates of stage four breast cancer patients and calculated specific rates based on the site of metastasis. The researchers found that patients with bone metastasis had the best overall survival rate of 50.5% after three years. This means that 50.5% of patients were still alive three years after diagnosis.
Other research has estimated that the one-year survival rate of metastatic breast cancer in the bones is 51% and the five-year survival rate is 13%.
But these numbers are estimates, not foregone conclusions. A lot of factors can impact a person’s prognosis, says Dr. Lin, including the type of cancer they have, where it spread, how old they are, and any other pre-existing conditions or health problems they have. And some cancers respond better to treatment than others, which absolutely affects a person’s survival.
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