What Are The Risk Factors
According to Research from 2015Trusted Source, 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:
- age
- number of lymph node metastases
- tumor size
Earlier or more frequent screening for liver metastasis may help improve outlook because a doctor may find the tumor sooner.
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.
What Treatments May I Be Offered
Treatment for secondary breast cancer in the liver aims to relieve symptoms and slow down the growth of the cancer.
Treatments can be given alone or in combination.
When making decisions about how best to treat you, your treatment team will consider factors such as:
- how extensive the cancer is within the liver
- whether the cancer has spread to other organs
- any symptoms you have
- what treatment youve had in the past
- the features of the cancer
- whether youve been through the menopause
- your general health
Your specialist should discuss any recommendations for treatment with you and take into account your wishes. Theyll talk with you about your options, explain what the aim of your treatment will be and help you weigh up the potential benefits against the possible side effects you may have.
Hormone therapy is used to treat breast cancers that are oestrogen receptor positive.
If you had a biopsy or surgery for primary breast cancer, the tissue removed will have been tested to see if it is ER+. However, in some people the oestrogen receptors change during the development of secondary breast cancer. Because of this, your doctor may discuss performing a biopsy to retest for hormone receptors.
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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.
Symptoms Of Skin Metastases
Symptoms of skin metastases include:
- a change in the colour of the skin
- a lasting rash
- 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:
- odour
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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:
How Is Metastatic Breast Cancer Diagnosed
If you have symptoms of metastatic breast cancer, your provider may recommend tests including:
- Blood tests, including complete blood count and comprehensive metabolic panel.
- Imaging studies, including MRI, CT, bone scan and PET.
- Bronchoscopy, which uses a scope to look inside your lungs this can be done if there is a concerning spot in the lungs.
- Biopsy to remove tissue from a suspicious area and analyze it.
- A tap to remove fluid from an area with symptoms. For example, pleural tap removes fluid from the lung area. Spinal tap removes fluid from the spinal cord area.
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Breast Cancer Subtypes Hormonal And Her2 Status
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:-
How Do Breast Cancers Spread
Cancer cells break away from the primary tumor, entering the bloodstream or the lymphatic system. As large vessels narrow, cancer cells stop traveling and lodge themselves in a new area. Then they begin dividing and moving into surrounding tissue. The cancer cells take over the new area, crowding out healthy cells and forming a new tumor. Cancer cells are insidious because the new tumor can set up its own network of blood vessels to obtain nutrients for growth and further spread.
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How Do Breast Cancers Start
The human body is made of countless cells that reproduce, by splitting, to replace or repair other cells. New cells usually work like their parent cells. Sometimes, however, a new cell has an error. Not all cells with errors are bad some are harmless, or benign. Others, however, reproduce rapidly and harm healthy cells. The offensive cells are said to be malignant because they dont function like healthy parent cells.
Living With Stage : The Breast Cancer No One Understands
Editor’s note: We’re 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.
âSomeone will say, âWhen are you done with treatment?â and Iâll tell them, âWhen Iâm dead,ââ said Schoger, a writer and cancer advocate who lives near Houston. âSo many people interpret survivorship as going across the board. That everybody survives cancer now. But everybody does not survive cancer.â
An estimated 155,000-plus women in the U.S. currently live with âmets,â 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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What Treatments Are Available For Brain Metastases
The treatment array includes radiation, surgery, and chemotherapy. The size and number of metastases will determine treatment. Chemotherapy is challenging because of the blood brain barrier, which protects the brain by blocking entry of bacteria and toxins, but it also prevents entry of most chemotherapies. Clinical researchers are testing promising new drugs and studying ways to penetrate the blood brain barrier.
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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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
A Disease No One Gets
Sadly, people donât âgetâ mets. In fact, a recent survey sponsored by Pfizer Oncology shows just how misunderstood it is. Sixty percent of the 2,000 people surveyed knew little to nothing about MBC while 72 percent believed advanced breast cancer was curable as long as it was diagnosed early. Even more disheartening, a full 50 percent thought breast cancer progressed because patients either didnât take the right treatment or the right preventive measures.
âTheyâve built an industry built on four words â early detection equals cure â and that doesnât even begin to define breast cancer,â said Schoger, who helped foundBreast Cancer Social Media, a virtual community for breast cancer patients, caregivers, surgeons, oncologists and others. âWomen are blamed for the fate of bad biology.â
The MBC Alliance, a consortium of 29 cancer organizations including the biggest names in breast cancer , addressed this lack of understanding and support as well as what many patient advocates term the underfunding of MBC research in a recently published landmark report.
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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.
Support For Living With Secondary Breast Cancer In The Liver
Everyones experience of being diagnosed with secondary breast cancer is different, and people cope in their own way.
For many people, uncertainty can be the hardest part of living with secondary breast cancer.
You may find it helpful to talk to someone else whos had a diagnosis of secondary breast cancer.
- Chat to other people living with secondary breast cancer on our online Forum.
- Meet other women with a secondary diagnosis and get information and support at a Living with Secondary Breast Cancer meet-up.
- Live Chat is a weekly private chat room where you can talk about whatevers on your mind.
You can also call Breast Cancer Nows Helpline free on 0808 800 6000.
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What Can I Expect While Living With Metastatic Breast Cancer
Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:
- History/physical exam.
- Blood tests.
- Imaging tests, including CTs and bone scan or PET scan.
Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.
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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Can Breast Cancer Recur At The Same Site
Yes, it can recur locally or regionally. Symptoms of a local recurrence are a new lump, a firm area, pulling or swelling at the site, redness, change in the shape of the nipple, and thickening near the scar. Symptoms of regional recurrence, which includes the underarm lymph nodes and upper chest area on the same side as the initial cancer, are a lump, swelling, or numbness of the arm, pain, and problems swallowing. These symptoms warrant prompt reporting to your physician.
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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A Prognostic Model For Breast Cancer With Liver Metastasis
- 1Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
- 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- 3Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
Background: Breast cancer with liver metastasis consists of a group of heterogeneous diseases, and survival time may be significantly different, ranging from a few months to several years. The present study aimed to develop and externally validate a prognostic model for breast cancer with liver metastasis .
Methods: In total, 1022 eligible patients from January 2007 to December 2018 were selected from Fudan University Shanghai Cancer Center and were temporally in the training and validation set. According to regression coefficients found in the multivariate Cox regression analysis, the final results were transformed into the prognostic scores. On the basis of these scores, patients were finally classified into three risk groups, including low-, intermediate-, and high-risk groups. Bootstrapping was used for internal validation. Then, time-dependent receiver operating characteristic curves and calibration plots were used to assess discrimination and calibration of this prognostic model in the validation set.
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.
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