Treatment For Physical Symptoms
Several medications can help relieve pain. 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.
Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
Stages Of Breast Cancer: Stage Iiic
Stage IIIc breast cancers basically involve tumors of any size with significant metastases to:-
- the lymph nodes behind the sternum
- lymph nodes under the arm
- the lymph nodes above or below the collarbone
The extent and depth of lymph node involvement make these patients unsuitable candidates for surgical treatment as a primary mode of therapy.; Chemotherapy is the treatment of choice for women with stage IIIb and IIIc breast cancers.
However, up to 70% of patients with stage III breast cancers who have chemotherapy remain alive and disease-free after 7 years.
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Stage Ii Breast Cancer
There are basically four sub-categories of breast cancer within the category of stage II.;;Breast tumors in the Stage II classification are:
- A breast tumor that is 2cm in diameter or less.;BUT;the cancer cells have already spread to the lymph nodes.
- OR;a breast tumor that is larger than 5 cm;but has not yet spread to the lymph nodes.
- OR;breast tumors in between 2 cm and 5 cm in diameter; -whether there is evidence of spread to the lymph nodes or not.
There are actually quite a number of specific subcategories and letters and numbers to indicate a more precise description of the breast cancer at Stage II.;;.
In summary, stage II breast cancer is of intermediate size and threatening to spread. Without a doubt, staging for stage II breast cancers requires a thorough investigation of potential metastases.
Survival Rates for Stage II Breast Cancer
The average survival rate;for stage II breast cancers is about 93% after five years and about 75% after 10 years. The rate of local recurrence is about 16% for stage II breast tumors.; Furthermore, only about 16% of stage II breast cancers either have or will develop lymph node metastasis.
See also our new up-to-date survival rates by stage;OR our general survival rates for breast cancer
A baseline bone scan is unlikely to detect bone metastasis with stage 2 tumors, but they are usually necessary just to be sure.
Treatment for Stage II Breast Cancer
A Little Bit About The Internal Mammary Lymph Nodes
The internal mammary nodes are located behind the ribs. Ribs are made of bone, but in the front, they turn into cartilage just before they join the sternum.
So, each;rib;attaches to the sternum;with cartilage and each of these cartilage bars is around 5 cm long.; Thus, it can be very difficult to remove an internal mammary node. There is an internal mammary artery and vein along with the lymph ducts and other veins.
If you need to remove an internal mammary node, the cartilage in front needs to be cut out. Cartilage, unfortunately, does not grow back or heal and this will leave a gap which makes the rib essentially useless.
So, it is a judgement call by the surgeon as to whether or not one should attempt a surgical approach to remove internal mammary nodes with positive metastasis.; This is because surgical removal is just too damaging to the function of the chest and ribs.
However, electron beam radiotherapy is an effective treatment for internal mammary nodes.; ;The electrons penetrate to about the correct depth to reach the internal mammary nodes.
Treatment of Stage IIIa Breast Cancer
The treatment for women with stage IIIa breast cancers tends to be a modified radical mastectomy and locoregional radiotherapy.
Often, chemotherapy is given as adjuvant therapy, but in some cases , pre-operative chemotherapy is also recommended. Breast conservation is generally not a good option with stage IIIa breast cancers.
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What Is Metastatic Breast Cancer In Bones
Metastasis describes the spread of cancer from where it started to another part of the body. This happens when cancer cells break from the primary tumor and enter the lymph system or bloodstream. From there, they can travel throughout the body and form new tumors.
Metastatic breast cancer in bones is not the same as bone cancer. Its made up of breast cells, not bone cells. Its also called stage 4 or advanced breast cancer.
A 2019 research review showed that bone is the most common site of breast cancer metastasis. Breastcancer.org says that for more than half of women with metastatic breast cancer, bones are the first site of metastasis. The bones most likely to be affected are:
- ribs
- long bones in your arms and legs
Other common sites of breast cancer metastasis include your liver and lungs.
Signs and symptoms vary depending on where the cancer has spread and how big the tumors are.
What Are The Signs That Breast Cancer Has Spread
Metastatic breast cancer is a secondary cancer the cancerous cells originate in breast tissue and then travel to other parts of the body.;The most common areas of breast cancer metastasis are the bones, lungs and liver.
Following an initial breast cancer diagnosis, a patient will receive a personalized monitoring plan for metastatic reoccurrence from their care team.;Depending on the specific parts of the body affected, the symptoms of metastatic breast cancer can vary.
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Breast Subtypes And Prognosis Of Breast Cancer Patients With Initial Bone Metastasis: A Population
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Background: Metastatic breast cancer is a highly heterogeneous disease and bone is one of the most common metastatic sites. This retrospective study was conducted to investigate the clinical features, prognostic factors and benefits of surgery of breast cancer patients with initial bone metastases.
Methods: From 2010 to 2015, 6,860 breast cancer patients diagnosed with initial bone metastasis were analyzed from Surveillance, Epidemiology, and End Results database. Univariate and Multivariable analysis were used to identify prognostic factors. A nomogram was performed based on the factors selected from cox regression result. Survival curves were plotted according to different subtypes, metastatic burdens and risk groups differentiated by nomogram.
Our study has provided population-based prognostic analysis in patients with initial bone metastatic breast cancer and constructed a predicting nomogram with good accuracy. The finding of potential benefit of surgery to overall survival will cast some lights on the treatment tactics of this group of patients.
Relieving Symptoms Of Advanced Breast Cancer
Treatment to relieve symptoms depends on where the cancer has spread. For example, pain from bone metastases may be treated with radiation therapy, drugs called bisphosphonates such as pamidronate or zoledronic acid , or the drug denosumab . For more, see our information about the treatment of bone metastases.
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Univariable And Multivariable Analysis
In univariate analysis, we found that patients of older age, black race, higher grade tumors, HR/HER2 subtype, high T stage , unmarried status, uninsured status, visceral involvement , no primary tumor surgery displayed worse OS .
Table 2 Univariate and multivariate cox progression of OS and BCSS of breast cancer patients with initial bone metastasis.
These statistically significant factors were included in the multivariate analysis. Patients older than 60 years old , black race , T3 stage were significantly related to worse OS. Compared with HR+/HER2 patients, HR+/HER2+ and HR/HER2+ subtype showed improved OS , while HR/HER2 subtype demonstrated the worst outcome . Social factors like marital status and insurance status were also associated with OS.
Among the 6,860 patients with bone metastatic lesions, 4096 cases demonstrated bone-only metastasis and 2,764 cases displayed concurrent visceral metastases. The outcome was much worse when combining visceral metastases . In terms of BCSS, univariate and multivariate results identified the same prognostic factors as OS .
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 If Cancer Has Spread To The Bones
You may have any of these symptoms if your cancer has spread to the bones:
- an ache or pain in the affected bone
- breaks in the bones because they are weaker
- breathlessness, looking pale, bruising and bleeding due to low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells
Sometimes when bones are damaged by advanced cancer, the bones release calcium into the blood. This is called hypercalcaemia and can cause various symptoms such as:
- tiredness
Treatment Options For Stage Iv Breast Cancer
For women with stage IV breast cancer, systemic therapies are the main treatments. These may include:
- Some combination of these
Surgery and/or radiation therapy may be useful in certain situations .
Treatment can often shrink tumors , improve symptoms, and help women live longer. These cancers are considered incurable.
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How Effective Are Treatments For Bone Metastases
Although current treatments for bone metastases are unable to completely remove all cancer cells, many women with bone metastases can live for many years with extremely good quality of life.
The effect of bone metastasis on your prognosis is individual and depends on what type of cancer you have, where it has spread to and how you respond to various treatments. The main aim of any treatment is to control pain and other symptoms so you can enjoy your day-to- day activities as much as possible.
Stage Iii Breast Cancer; Locally Advanced
A stage 3 breast cancer is sometimes referred to as a locally advanced breast cancer.
Stage III breast cancers are actually a heterogeneous group of cancers but account for about 7% of all initial breast cancer diagnosis.
Basically, a stage III breast cancer is one in which there is:-
- a primary tumor of greater than 5cm in diameter with no apparent metastasis
- OR the tumor is between 2cm and 5cm in diameter with evidence of rather significant metastasis.
Another way of looking at it is that stage III breast cancers either have a large but operable breast tumor .; Or sometimes Stage III breast cancers present with a medium-size breast tumor which is more difficult to fully treat and cure with surgery alone.
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Metastatic Breast Cancer Symptoms In The Liver:
This can be a bit trickier to identify because the symptoms can be similar to other stomach and gastrointestinal issues, says Dr. Taiwo. Often a person will have abdominal pain, nausea, and vomiting, or even jaundice , depending on how much the cancer has spread in the liver. By the time that a patient tends to present with symptoms, they already have a fairly significant burden of disease, she saysmeaning that their cancer has already progressed to make them very sick.;
How Are Bone Metastases Treated
Although it is not possible to cure bone metastases, they are not usually life-threatening. Many women enjoy active lives for many years after bone metastases are diagnosed.
Treatments for bone metastases aim to improve your quality of life by reducing symptoms, such as pain or bone fractures. Treatment will depend on:
- which bones are affected
- whether your bones have been weakened and are in danger of breaking
- characteristics of your original breast cancer, such as type of tumour and the type of receptor the tumour had or HER2 receptor)
- other treatments you have had for primary or secondary breast cancer
- systemic cancer treatments which work on the whole body.
Treatments are often very effective in stopping the growth or decreasing the size of cancerous deposits in the bones. Current treatments are not usually able to completely remove all cancer cells from the bones.
There are three types of treatment for bone metastases:
- treatments to control pain
- local treatments for the bones which are directed at a single bone or area
- systemic cancer treatments (such as
- hormone-blocking therapy, HER2-blocking drugs and chemotherapy) which work on the whole body.
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Stages Of Breast Cancer: Stage Iiib
A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast.; A stage IIIb designation also applies if there is evidence of either
- axillary lymph node metastasis
- internal mammary node metastasis
presenting in such a way as to suggest that total surgical removal is not possible.
There is a unique type of breast cancer,; inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage;IIIb at least.
Where In The Body Does Breast Cancer Spread
In theory, breast cancer can spread to any part of the body, but it most commonly spreads to the lymph nodes, lungs, liver, bones and sometimes the brain. Keep in mind though, that even if your breast cancer spreads to other areas of your body, its still considered breast cancer. For example, if breast cancer spreads to your lungs, it does not mean that you now have lung cancer too.
If your breast cancer has moved to other parts of your body, you might experience symptoms relating to the area it has spread to, but not always.
Here Dr. Roesch explains how metastatic breast cancer can affect different parts of the body:
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Common Sites Of Metastasis
- 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.
Outlook Once Cancer Has Spread To The Bones
The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.
The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.
Rapidly treating bone metastasis can lead to a
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What Are The Localized Symptoms Of Metastatic Breast Cancer
Metastatic breast cancer most often spreads to the bones, lungs, liver, and brain. It doesn’t spread exclusively to those locations, but these are the most common sites of metastasis.
Most metastatic breast cancer patients don’t experience symptoms in their breasts, says Dr. Taiwo. That’s because in the majority of cases of metastatic breast cancer, a person was previously diagnosed with an earlier-stage breast cancer and received localized treatment to their breasts. Only a minority of metastatic breast cancer patients are initially diagnosed with stage 4 cancer; if they have a breast mass, it likely isn’t painful, she says. Very rarely does a breast cancer mass grow to the point where it becomes ulcerous and painful.;
Thus, most symptoms of metastatic breast cancer vary depending on where the cancer has spread. Someone who has cancerous lesions in their bone will have a different set of symptoms than someone whose cancer has metastasized to their brain or liver. Here’s an overview of the different symptoms for these common sites.;
What Does Metastatic Bone Pain Feel Like
Bone pain is the most common symptom of metastatic bone cancer. It may be the first sign of metastases. Bone metastases are most likely to occur in the spine, ribs, hips, upper leg, upper arm, and skull.
Sometimes the pain can be sharp. Other times its a dull ache. There may also be some swelling at the site of the pain. Many people find the pain can be worse at night.
In earlier stages, the pain is more likely to come and go. As cancer grows, pain may become more constant. Depending on the site of the bone cancer, movement can increase the pain. Sometimes the pain persists no matter what youre doing or what position youre in.
Bone cancer pain can be caused by:
- inflammation from the cancer cells
- changes in bone structure
- a bone fracture
When cancer cells start growing in bones, they can cause a lot of damage. The affected bones may become very fragile. Even normal daily movements can cause bones to fracture or break.
The most common sites of bone fractures are the arms, legs, or back. Sudden intense pain can be a sign of a broken bone. If this happens, its important to seek medical attention.
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