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 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. You can be referred by your treatment team, GP or breast care nurse depending on your situation.
Metastatic Lung Cancer Treatment
Depending on where a secondary tumor develops, oncologists may suggest different types of treatment. Surgery may not be recommended if the cancer has spread extensively throughout the body, although it can sometimes be an option for local lung cancer metastases. Distant metastases are more likely to be treated with radiation therapy or chemotherapy. Clinical trials may also be an option.
At Moffitt Cancer Center, we have extensive experience in treating metastatic lung cancer. We offer our patients a wide range of treatment options, with recommendations tailored to each patients unique needs. When treating metastatic lung cancer, our oncologists take into consideration the size and location of the secondary tumor, as well as the cellular makeup of the primary tumor, to determine the best approach to treatment.
Medically Reviewed by Dr. Bob Creelan.
For more information about metastatic lung cancer treatment at Moffitt, call or submit a new patient registration form online to request an appointment. Youre welcome to obtain a physicians referral, or you can contact us directly without one if its easier for you.
How Breast Cancer Spreads
Breast cancer can spread through the lymphatic system, the bloodstream, or by local invasionfor instance, when cancer cells actually invade nearby tissues, such as the chest wall or ribs.
When breast cancers spread and enter the lymphatic system, they usually first arrive at nearby lymph nodes and may still be early-stage.
Metastatic breast cancer is the same thing as stage 4 breast cancer and is considered the most advanced stage. It refers to breast cancers that have spread beyond the breast and nearby lymph nodes to other regions of the body, which are called distant metastases.
While treatment options for metastatic breast cancer are similar no matter where cancer has spread, some treatments are used for specific sites of metastasis as well .
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What Is Metastatic Breast Cancer
The spread of breast cancer to other parts of the body is called metastasis. Its not uncommon. About 20 to 30 percent of all breast cancers will become metastatic.
Metastatic breast cancer is also known as stage 4 breast cancer. This means that cancer cells have spread in the body beyond the original site of diagnosis.
Cancer can spread through the lymphatic system or through the blood. This allows the cancer to travel to other organs. The most common organs that breast cancer cells travel to are the:
Breast cancer, like all cancers, is categorized by stages. The location, size, and type of tumor determine the cancers stage.
Stage 4 is the most serious and the most complicated to treat because the cancer has spread beyond its original location.
Stage 1 breast cancer is highly treatable because cancer cells are still isolated in the breast. Stages 2 and 3 are progressively more serious.
The pancreas is located near the stomach. It has two main jobs.
First, it releases fluid into the small intestine to help with digestion.
Second, the pancreas is responsible for the production of important hormones. This includes insulin, which helps manage blood sugar levels in the body.
If cancer develops in the pancreas, it may be a while before you notice any symptoms. Often the first symptom is jaundice, a yellowing of the skin. Liver problems can also lead to jaundice.
Other symptoms of cancer in the pancreas include:
Poor Appetite And Weight Loss
Sometimes people with secondary breast cancer cant eat as much as usual. This means they have difficulty maintaining their weight as well as providing the body with energy. Low energy levels can affect mobility and might make it harder to manage any symptoms such as breathlessness.
Poor appetite can be due to the effects of the cancer, treatment or anxiety. A small number of people may have difficulty swallowing.
You might find it easier to eat little and often instead of having set meals. If you still feel you arent eating enough, are losing weight or have no interest in food, talk to your doctor or specialist nurse about dietary supplements or ask to speak to a dietitian for specialist advice.
In some circumstances you may be prescribed medication to help stimulate your appetite.
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What Is Secondary Breast Cancer In The Lung
Secondary breast cancer in the lung happens when breast cancer cells spread to the lung. It can also be known as lung metastases or secondaries in the lung.
Secondary breast cancer in the lung is not the same as cancer that started in the lung.
Usually secondary breast cancer occurs months or years after primary breast cancer. But sometimes its found at the same time as the primary breast cancer, or before the primary breast cancer has been diagnosed. In this situation, the breast cancer has already spread to the other parts of the body such as the lung. This is referred to as de novo metastatic breast cancer, meaning the breast cancer is metastatic from the start.
Where Does Breast Cancer Usually Spread
Breast cancer can spread, or metastasize, to bones, the brain, the liver, and the lungs. Metastasis to each vital organ has a unique set of symptoms. Breast cancer that has spread to bones can cause pain and fractures. Spread to the brain, it can cause headache, dizziness, and seizures. Spread to the lungs, it can cause shortness of breath. Spread to the liver, it can cause jaundice or yellowing of the skin and swelling of the abdomen.
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Lung Metastasis: Symptoms Can Be Subtle
Many people who have metastatic breast cancer develop lung metastases. Usually the symptoms are shortness of breath and/or a chronic cough. The symptoms can be fairly subtle, and they typically come on slowly, since the cancer has to use up a lot of your lungs before it compromises your breathing.
There are a couple of different places the cancer can appear in your lung. One is in nodulesusually severalthat show up on a chest X ray. If it shows up in only one nodule, your doctor may want to do a needle biopsy or a full biopsy to find out if its lung cancer or a breast cancer that has spread.
Another form of metastasis in the lung is called lymphangitic spread. In this situation, the cancer spreads along the lymphatics and instead of forming nodules it occurs in a fine pattern throughout the lung. This isnt all cancer. Some of the changes in the lung are due to a lack of lymphatic drainage and fibrosis in the lymph channels. This type of metastasis is subtler and harder to detect on a chest X ray, but it, too, will ultimately cause shortness of breath, since it takes up room and scars the lungs, making them less able to expand and contract and bring oxygen into your bloodstream.
Source: DrSusanLoveResearch.org retrieved September 2016
Distant Metastasis And Screening Intensity
Distant metastasis was defined as any recurrences at any sites outside the breast and regional lymph nodes. The metastatic sites included the bones, lungs, pleura, liver, brain, and distant lymph nodes they were classified into bone, visceral , and mixed metastases for comparison. When metastases were observed in multiple organs within 2 months of treatment, they were defined as multiple site metastases. The clinical diagnosis of distant metastasis was made after histologic confirmation of metastasis or imaging findings compatible with metastasis when biopsy was not feasible. We also reviewed the presence of symptoms associated with metastases using each patients medical records. Ambiguous cases such as the perception of symptoms after knowing the presence of metastasis or symptoms not associated with the site of metastases were considered asymptomatic.
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From Cured To Stage 4
Others, like Teri Pollastro, a 54-year-old stage 4 patient from Seattle, respond surprisingly well.
Diagnosed with early stage ductal carcinoma in situ in 1999, Pollastro underwent a mastectomy but did not receive chemotherapy, radiation or tamoxifen, since her cancer was ER negative.
âThey used the C-word with me, they told me I was cured,â she said. âEvery time I went back to my oncologist, he would roll his eyes at me when I had questions.â
In 2003, Pollastro switched to Seattle Cancer Care Alliance where she saw Dr. Julie Gralow, a breast cancer oncologist and clinical researcher at Fred Hutchinson Cancer Research Center. Gralow discovered Pollastroâs cancer had metastasized to her liver.
âMy husband and I were in shock,â said Pollastro of her mets diagnosis. âYou donât go from being cured to stage 4.â
Pollastro went on Herceptin, a type of immunotherapy for women with HER2-positive metastatic breast cancer, and did six months of chemotherapy.
âI felt better right away with the treatment,â she said. âBut the problem is, it stopped . Thatâs what you can expect with mets. And thereâs always some residual cancer. And that starts percolating.â
And along with mets, she also had to deal with many misconceptions regarding her disease.
The Mercer Island, Washington, mother of two, who often counsels newly diagnosed patients, sometimes even found it difficult to relate to early stage breast cancer survivors.
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.
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What Happens When Breast Cancer Spreads To Bone
Breast cancer that spreads to bones can destroy normal bone. Symptoms are pain, compromised mobility, fractures, spinal cord compression, and hypercalcemia, or too much calcium in blood. Hypercalcemia can be life threatening and may cause the following symptoms: headache and fatigue excessive thirst and urination nausea, vomiting, and constipation abnormal heart rhythm muscle cramping and weakness pain and fractures and memory loss, depression, and irritability.
What Happens When Breast Cancer Spreads To The Lungs
When breast cancer spreads to the lung, it is usually as nodules or what is called lymphangitic metastasis, which are harder to detect. Both can cause shortness of breath. When tumors are on the outside of the lung, the pleural sac can fill with fluid, which is called a pleural effusion. To relieve shortness of breath from a pleural effusion, physicians perform thoracentesis, using local anesthesia before introducing a needle to withdraw fluid.
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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.
Lung Cancer With Skin And Breast Metastasis: A Case Report And Literature Review
Bikash Bhattarai et al.
1Department of Medicine, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY 11213, USA
Lung cancer is one of the most common cancers in America. Frequent sites of metastasis include the Hilar lymph nodes, adrenal glands, liver, brain, and bone. The following case report is of a primary lung cancer with metastases to the breast and skin. Case. A 48-year-old African American male with a past medical history of poorly differentiated left breast cancer status after modified radical mastectomy , chronic obstructive pulmonary disease, and smoking presents to the ER with progressive shortness of breath on exertion, upper back pain, and weight loss for 2 months in duration. On physical examination he is found to have a MRM scar on his left breast and a left periumbilical cutaneous mass. Chest X-ray and chest CT reveal a right upper lobe mass and biopsies from the breast, lung, and the periumbilical mass indicate a poorly differentiated carcinoma of unclear etiology all tumor markers are negative. The patient is male and a chronic smoker therefore the diagnosis is made as lung carcinoma with metastases to the breast and skin. . A high index of suspicion for cutaneous metastases should be cast when investigating cutaneous pathologies in patients at risk for primary lung malignancy.
2. Case History
Conflict of Interests
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Sgk1 Mediated Breast Cancer Metastasis
Based on the above findings, we first determined SGK1 expression in cells with Dex treatment. Both mRNA and protein levels of SGK1 were upregulated in mouse and human breast cancer cell lines treated with Dex . Moreover, SGK1 expression in 4T1 orthotopic tumor tissue was also augmented after Dex treatment . To clarify whether SGK1 was regulated by PI3K, which was indicated by sequence analysis, we inhibited PI3K with wortmanin , and found that wortmanin suppressed the increased expression of SGK1 caused by Dex treatment , suggesting that Dex upregulated the expression of SGK1 via PI3K signaling.
Fig. 4: SGK1 mediates Dex-induced breast cancer metastasis.
Taken together, these data demonstrated that SGK1 was required for Dex-induced metastasis.
How Breast Cancer Spreads To The Lungs
Breast cancer starts in the breast. As the abnormal cells divide and multiply, they form a tumor. As the tumor grows, cancer cells can break away from the primary tumor and travel to distant organs or invade nearby tissue.
Cancer cells can enter the bloodstream or migrate to nearby lymph nodes under the arm or near the collarbone. Once in the blood or lymph systems, cancer cells can travel through your body and land in distant organs or tissue.
Once cancer cells reach the lungs, they can start to form one or more new tumors. Its possible for breast cancer to spread to multiple locations at the same time.
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Requirements For Eligible Patients
Patients were selected from a database. All patients had accepted complete treatment and follow-up in our hospital so that detailed information was available. Eligibility requirements included the following.
Data were collected between January 2003 and December 2007 from patient files with IDC in the Department of Medical Records, Shandong Provincial Hospital, China. A total of 432 patients files with IDC were screened and 354 patients were excluded because they did not meet the above requirements. A total of 78 patients who meet the above requirements were considered eligible and analyzed in the present study. All patients were Chinese women. Informed consent was obtained from each patient before primary treatment. The study was approved by the institutional review board as it has no conflicts with the Helsinki Declaration.
Treating Metastatic Breast Cancer
When treating metastatic breast cancer, the goal is to help minimize or eliminate symptoms and lengthen your life without sacrificing your quality of life.
Breast cancer treatment depends on many factors, such as the type of breast cancer, previous treatments, and your overall health. Another important factor is where the cancer has spread and whether the cancer has spread to multiple locations.
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Chemotherapy Allows Breast Cancer Cells To Get Into Lungs Finds Study
A new study has added to the evidence that chemotherapy enhances cancer’s spread beyond the primary tumour, showing how one chemo drug allows breast cancer cells to squeeze through and attach to blood vessel linings in the lungs.
The findings of the study were published in the ‘International Journal of Molecular Sciences’.
The research in mice leaves no doubt that the chemo drug caused changes to non-cancer cells that enable this process. Scientists pre-treated healthy mice with the chemotherapy agent and gave them intravenous injections of breast cancer cells four days later.
Within three hours of injection, the cancer cells were penetrating weakened junctions between blood vessel cells in the lungs and binding to those vessels’ underlining structure — avoiding being washed away by blood flow.
“This is the key step giving cancer cells a foot in the door at a secondary site,” said Tsonwin Hai, professor of biological chemistry and pharmacology at The Ohio State University and senior author of the study.
“The whole point of our pre-treatment model is to ask the question: Does chemotherapy affect normal cells in such a way that they will turn around and help cancer cells? The answer is yes. It’s a cautionary note for the use of chemotherapy,” Hai added.
In control mice that did not receive chemotherapy, the cancer cells’ adhesion to blood vessel walls was comparatively minimal, Hai said.
Angiogenesis Hypoxia And Stroma
Angiogenesis in preneoplastic lesions, a atypical adenomatous hyperplasia has no new vessels but instead relies on the normal vascular architecture of preexisting alveolar septa in the vascular variant of squamous cell dysplasia, b the preneoplastic cells induce angiogenesis using vascular growth factors produced by the dysplastic cells
Desmoplastic stroma reaction is almost absent in this well-differentiated lepidic predominant adenocarcinoma whereas prominent in this squamous cell carcinoma
The role of hypoxia in tumor cell migration and metastasis
Experimental adenocarcinoma in a mouse. Carcinoma is induced by mutant KRAS. At a certain size of the in situ adenocarcinoma, central hypoxic necrosis develops , which is the prerequisite for invasion
Desmoplastic stroma supports invasion and guides the carcinoma cells in this squamous cell carcinoma , whereas scar tissue inhibits invasion as in this adenocarcinoma example . The only way for the carcinoma cells is invasion into lymphatics, which happened in the center
Epithelial to mesenchymal transition is common in pleomorphic carcinomas of the lung this can also be demonstrated by cytokeratin immunohistochemistry, showing epithelial tumor cells positively stained on the left side, whereas tumor cells at the right side have lost cytokeratin and acquired vimentin
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