Palliative And Supportive Care
Palliative and supportive care focuses on symptom control and support.
Its extremely important for many people 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 supportive care teams are based in hospitals, hospices and the community. Your treatment team, GP or breast care nurse can refer you depending on your situation.
A Note About Statistics
Survival rates are statistics, and as such tend to tell us how the average person will do with an average triple-negative breast cancer but people and tumors arent statistics. Some people will do better and some people will do worse.
Very importantly, statistics are usually several years old. In order to calculate five-year survival rates, a person would have to have been diagnosed at least five years prior. And still there is lag time. The treatment of triple-negative breast cancer is changing, and new drugs have been approved.
How Cancers Spread To The Brain
- University of Oxford
- Research has shown for the first time how cancers that spread to the brain establish themselves and begin to grow.
Research has shown for the first time how cancers that spread to the brain establish themselves and begin to grow.
The Oxford University study, published in the journal PLoS One, has identified the mechanism that metastatic cancer cells use to anchor themselves to blood vessels in the brain. This could allow new drugs to be developed to stop cancers from spreading and growing in the brain.
Metastasis is the process where cancer breaks out from where a tumour has initially grown and spreads to other parts of the body. It is usually the reason why cancer is fatal.
Brain metastases are the most common malignant tumours of the central nervous system, outnumbering by ten times those that originate in the brain. Once such cancers have reached the brain the prognosis is not good: the median survival is 9 months with maximal treatment. Over 20% of all cancer patients will eventually develop metastatic cancer in the central nervous system.
Metastasis to the brain is essentially terminal, and very little is known about the process by which it occurs, says Dr W Shawn Carbonell, a post-doctoral research scientist at the MRC/CRUK Gray Institute for Radiation Oncology and Biology at the University of Oxford. But by quickly remedying our lack of knowledge, we hope to be able to come up with new and better ways of treating such cancers.
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Focal Treatment Of Brain Metastases
Focal treatment including surgery, WBRT, and stereotactic radiosurgery is indicated for the treatment of intracranial metastases across all intrinsic subtypes of breast cancer. However, the type of focal treatment strategy depends upon the extent of CNS disease and other disease- and patient-specific characteristics. An individualized approach is preferred, assimilating the above variables with clinical presentation. The approach to focal treatment of brain metastases in breast cancer is also based upon the intrinsic subtype of breast cancer and should be decided on a case-by-case basis. For example, salvage radiation is likely a first line-therapy among those with TNBC due to limited systemic options. However, a patient with HER2-positive disease may benefit from aforementioned systemic therapy options and may be able to forgo focal therapy.
Survival Rates For Inflammatory Breast Cancer
Inflammatory breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
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 amount 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. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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Diagnosis Of Secondary Breast Cancer
You may be diagnosed with secondary breast cancer after having tests to check a new symptom. This could be through your GP or at a breast cancer follow-up clinic. Sometimes there may be no obvious symptoms and the diagnosis is made after routine follow-up tests.
Some women who have just been diagnosed with primary breast cancer have tests that show the cancer has already spread to other parts of the body. Sometimes the secondary breast cancer is diagnosed first and tests show that it first started in the breast.
Your cancer doctor or nurse will ask you about your symptoms and general health. You may need some of the following tests:
Chemotherapy For Metastatic Brain Tumors
Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.
These drugs identify and attack cancer cells with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.
Targeted therapies used to treat metastatic brain tumors include:
- Trastuzumab for breast cancer that has spread to the brain
- Erlotinib for the most common type of lung cancer that has spread to the brain
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What Is The Prognosis For Triple Negative Breast Cancer
Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.
Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.
- Brain: 7.3%
- All less common sites: 22.4%
Invasive lobular carcinoma tends to have a significantly different pattern of metastases than ductal breast cancer. In one 2017 study, almost 70% of people with metastases from lobular carcinoma had peritoneal metastases.
For roughly a third of women , cancer spreads to multiple organs at the same time.
Breast Cancers Survival Is Influenced By Tumor Grade
Grade identifies the size and shape of the malignant breast cancer cells. At the event the breast cancer cells look very different than normal breast tissue cells, and random in appearance, they can be called, that was badly differentiated and described as âhigh gradeâ. Higher level breast cancer cells tend to really have a poorer prognosis.
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Crosstalk Between Tumor And Brain Microenvironment
Breast cancer cells also adapt to the local microenvironment in the brain and co-opt neurons, astrocytes and microglial cells to proliferate and establish metastases.
Metastatic breast cells have been shown to develop neuronal characteristics, expressing the GABAA receptor, GABA transporter, GABA transaminase, parvalbumin, and reelin, allowing them to take up GABA, shunt it to nicotinamide adenine dinucleotide phosphate production and facilitate proliferation of the tumor cells in the brain microenvironment . Kim et al. showed that murine astrocytes co-cultured in direct cell-to-cell contact with human breast cancer cells caused up-regulation of survival genes in the tumor cells, thus protecting them from the toxic effects of chemotherapy.
Zhang et al. demonstrated that microRNAs from astrocytes cause human and mouse tumor cells with normal expression of PTEN, to downregulate PTEN expression in the brain environment. The loss of this tumor suppressor gene expression allows proliferation of brain metastases. Subsequent blockade of astrocyte secretion restored PTEN and suppressed brain metastasis in vivo. Loss of PTEN is associated TNBC subtype and portends a shorter survival time. Hohensee et al. showed that upregulation of PTEN in a TNBC cell line led to reduced migration and invasion to the brain. Autocrine and paracrine activation of GM-CSF/CSF2RA and AKT/PTEN pathway on both astrocytes and tumor cells mediated this crosstalk.
Risk Factors For Triple
Doctors arent sure what makes you more likely to get triple-negative breast cancer. Not many women do it only affects up to 20% of those who have breast cancer. Youre most at risk for triple-negative breast cancer if you:
- Are African-American or Latina
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How Often Does Mbc Metastasize To The Brain
About 1 in 8 women will receive a diagnosis of invasive breast cancer during their lifetimes, the American Cancer Society reports. Invasive means that cancer cells have grown through the lining of ducts in the breast and into the surrounding tissue. By contrast, roughly 1.2 in 100,000 men will get a diagnosis of any type of breast cancer in their lifetimes.
Most people with breast cancer receive the diagnosis before their cancer has traveled to distant parts of the body. However, almost 30% of women who have a diagnosis of early stage breast cancer go on to develop MBC.
MBC metastasizes to the brain in about 1015%of cases, the advocacy organization Breastcancer.org reports. MBC may also spread to other parts of the body, such as the bones or liver.
Symptoms Of Secondary Breast Cancer
The symptoms of secondary breast cancer depend on where in the body the cancer has spread to. If it has spread to the bones there might be a painful area in a bone. If it has spread to a lung it may cause breathlessness.
Some people have general symptoms. They may feel generally unwell for no obvious reason. Tell your doctor or nurse if you have any new symptoms. If you are worried, we have more information about the symptoms of secondary breast cancer.
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Treating Metastatic Breast Cancer
If you receive a diagnosis of breast cancer thats spread to your colon, your doctor will likely order additional tests to see whether the cancer has spread to other parts of your body.
Once you know exactly whats going on, you and your doctor can discuss the best options for treatment. This may include one or more of the following therapies.
How Are Metastatic Brain Tumors Treated
Treating a brain tumor is usually only one step in treating metastatic cancer. At Yale Medicine, treatment is carefully coordinated among the neurosurgery, radiation oncology and medical oncology teams.
Traditionally, treatment for brain metastases involves radiation and surgery, since chemotherapy has limited ability to penetrate into the brain.
Patients whose brain scans reveal only a few metastases can be considered for a targeted radiation treatment called radiosurgery. At Yale Medicine, this treatment is delivered using a machine known as the Gamma Knife. If this procedure is appropriate, then imaging required for treatment, treatment planning and radiation delivery can all be done in one day. This has the advantage of minimizing interruption of chemotherapy.
For those with larger or more widespread brain tumors, Yale Medicine also offers the more comprehensive treatment options, including:
- Hippocampal sparing whole brain radiation therapy with memantine
- Surgical resection or laser ablation – guided by use of MRI in the operating room
- Microsurgical resection of tumor
Lastly, for select patients, clinical trials are available for the treatment of newly diagnosed brain metastases using chemotherapy alone. At this time, this option is available for patients with lung and melanoma brain metastases.
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Breast Cancer Cell Lines
Part of the current knowledge on breast carcinomas is based on in vivo and in vitro studies performed with cell lines derived from breast cancers. These provide an unlimited source of homogenous self-replicating material, free of contaminating stromal cells, and often easily cultured in simple standard media. The first breast cancer cell line described, BT-20, was established in 1958. Since then, and despite sustained work in this area, the number of permanent lines obtained has been strikingly low . Indeed, attempts to culture breast cancer cell lines from primary tumors have been largely unsuccessful. This poor efficiency was often due to technical difficulties associated with the extraction of viable tumor cells from their surrounding stroma. Most of the available breast cancer cell lines issued from metastatic tumors, mainly from pleural effusions. Effusions provided generally large numbers of dissociated, viable tumor cells with little or no contamination by fibroblasts and other tumor stroma cells.Many of the currently used BCC lines were established in the late 1970s. A very few of them, namely MCF-7, T-47D, MDA-MB-231 and SK-BR-3, account for more than two-thirds of all abstracts reporting studies on mentioned breast cancer cell lines, as concluded from a Medline-based survey.
Special/molecular Considerations For Therapy Selection
HER 2 positive breast cancer
Approximately 25% of patients with HER2-positive breast cancer will develop brain metastases. Those with HER2-positive disease have demonstrated a significant survival benefit with the use of systemic anti-HER2 therapy. One proposed mechanism behind the propensity of HER2-positive disease to metastasize to the brain is the inability of trastuzumab to cross the BBB.
HER2-directed therapies for breast cancer can be classified into three subgroups: monoclonal antibodies such as trastuzumab and pertuzumab, small-molecule tyrosine kinase inhibitors such as lapatinib and neratinib, and the antibody-drug conjugate ado-trastuzumab emtansine . The American Society of Clinical Oncology has recommendations on disease management for advanced HER2-positive breast cancer and brain metastases, which we have outlined in Table 1.
Lapatinib with capecitabine is considered a treatment option for progressive brain metastasis and when local therapy has failed, or re-radiation is not feasible, especially when an oral systemic treatment option is preferred. More recently, the TKI neratinib was studied in a phase II trial among 40 patients with HER2-positive breast cancer with brain metastases who had progressed after at least one line of therapy. The intracranial response rates were modest at 8% with this agent.
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How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
Is It Possible To Survive Stage 4 Breast Cancer
While there is no cure for metastatic breast cancer, it is possible to control it with treatment for a number of years. The cancer can also go into remission. There are different types of remission:
- Complete remission : when there are no cancer signs and symptoms that can be detected by tests or scans.
- Partial remission : when the cancer has partly responded to treatment. It is still present but it has gotten smaller.
It is currently not possible to predict how long remission will last. However, the repeated cycle of growing, shrinking and stabilising can mean survival for many years. New treatments also continue to be developed. Treatment can help to control the cancer, help relieve symptoms and help you live longer.
It is not always easy, but many people find that with time, they are able to adjust to their diagnosis. Despite the many challenges that metastatic breast cancer brings, people can continue to live full, meaningful lives.
What Kind Of Cancer Is Found In The Cerebellum
Cerebellar astrocytoma, the other primary type of tumor that affects the cerebellum, may be comprised of benign or malignant cells. Secondary tumors occur when cancer metastasizes from other parts of the body to the cerebellum. Skin, breast, colon, bowel, lung and kidney cancer can result in tumors within the cerebellum.
Additional Tools For Diagnosing Advanced Breast Cancer
The additional tools below are often used specifically for diagnosing advanced cancer:
Sentinel lymph node biopsy: This procedure removes sentinel lymph node cells during surgery for examination. When breast cancer spreads, it often heads first to the lymph nodes.
Chest X-ray: This detailed image of the chest may help doctors see whether cancer has spread to the bones.
Computed tomography scan: Also known as a CAT scan, this procedure takes detailed pictures of internal areas of the body using a computer linked to an X-ray machine. A dye may be used to help the organs show up more clearly in the images.
Bone scan: This procedure looks for bone metastasis, or cancer cells that have spread to the bone. A small amount of radioactive material is injected into the blood, then detected with a scanner.
Positron emission tomography scan: A PET scan is a detailed imaging tool that uses a radioactive drug, known as a tracer, to search for cancer cells within your body.
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