Exploring Mechanisms Of Metastasis
In humans, breast cancer can recur in patients more than a decade after the disease has been treated. In most of these cases, the cancer has metastasized to bone.
Our study addresses a difficult clinical problemthe disease can recur in patients who thought they had been cured of breast cancer years earlier, explained Dorothy A. Sipkins, M.D., Ph.D., of the Duke Cancer Institute, who led the research.
Past work had suggested that these late recurrences may be caused by the emergence of breast cancer cells that had previously spread to the boneknown as micrometastasesbut had remained dormant. But the mechanisms involved in the spread of breast cancer to bone are poorly understood.
E-selectin is an adhesion proteina protein that helps cells bind to other cells and to their surroundingsthat is present on the surfaces of cells lining blood vessels. Because the protein has been associated with the homing of hematopoietic stem cells into the bone marrow at certain regions, or niches, where it is highly expressed, the researchers investigated whether breast cancer cells could co-opt E-selectin to also mediate their movement into the bone.
E-selectin is a sticky protein expressed by certain blood vessels that serves as a portal into the bone marrow, explained Cynthia Dunbar, M.D., of the Hematology Branch at the National Heart, Lung, and Blood Institute, who was not involved in the research. The bone marrow seems to provide a protective home for breast cancer cells.
Can You Live 20 Years With Metastatic Breast Cancer
What is the prognosis? While there is no cure for metastatic breast cancer, there are treatments that slow the cancer, extending the patients life while also improving the quality of life, Henry says. Many patients now live 10 years or more after a metastatic diagnosis.
Symptoms Of Breast Cancer In The Bones
Although metastatic breast cancer can potentially occur in any bone in the body, it most often affects the ribs, spine, pelvis and long bones in the arms and legs. Breast cancer that has spread to the bones may cause:
- Sudden bone pain, such as hip or back pain, which may feel similar to the discomfort associated with arthritis or exercise strain but is persistent or progressively worse even with rest or conservative measures
- An increased risk of bone fractures that result from minimal trauma, such as a minor fall
- An elevated level of calcium in the blood, which can lead to fatigue, nausea, dehydration and loss of appetite
- Numbness or muscle weakness in an arm or leg
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Symptoms Of Secondary Breast Cancer
Secondary breast cancer means that a cancer that began in the breast has spread to another part of the body. Secondary cancer can also be called advanced or metastatic cancer.
It might not mean that you have secondary breast cancer if you have the symptoms described below. They can be caused by other conditions.
Metastatic Breast Cancer Treatment Options
Breast cancer that spreads into the bones is considered stage 4, which is the most advanced stage of the disease. Unfortunately, cancer at this stage typically isnt curable. However, we can treat the symptoms and manage the sites to which it has spread. Patients whose cancer has spread to the bones can continue to live for a long time with a high quality of life with new advanced treatments.
Fighting metastatic breast cancer usually involves a two-pronged approach. The first consideration is local control, which involves treating the cancer site in which the patient is experiencing symptoms. If a patient comes to see me about a lesion on their hip, and I recommend treatment just for that location, thats local control. Bone typically responds well to local control for cancer because it is one of the few tissues of the body that regenerates to a degree when part of it is surgically removed.
Surgery to remove the cancer and radiation therapy to kill cancerous cells are examples of local control methods I use to treat patients bone metastases. Some patients need to have their existing bone strengthened with a metal pin or nail. Others need to have an area of bone resected, or removed, and replaced with a prosthesis.
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Bone Weakening And Fracture
Secondary breast cancer in the bone may mean that the affected bones are weakened, which can increase the risk of fracture. This is called a pathological fracture, which means the break in the bone is due to disease and not caused by an accident.
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.
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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How Fast Can Breast Cancer Spread
Metastasis occurs when breast cancer cells begin to grow in another body part.
It is hard to say exactly how quickly breast cancer can grow, including the timeframe, as the disease affects each person differently.
Cancer occurs due to mutations in human cells. Mutations do not follow normal, predictable patterns of cell division, so it is difficult to predict the progression.
Tumors appear when damaged cells replicate over and over to form a clump of abnormal cells. Breast cancer cells can break off and move through the lymph or blood vessels to other areas of the body.
If breast cancer cells begin to grow in another body part, this is called metastasis. Breast cancer is most likely to metastasize to the lymph nodes, lungs, and bones.
Regardless of the location of the new tumor, doctors still consider it to be breast cancer.
Breast cancer growth and its chances of spreading depend on the following:
What Is A Primary Tumor
The primary tumor refers to the original breast tumor. So, any metastases are either secondary tumors, or simply metastatic breast cancer.
Note, when breast cancer spreads to the bones, it is not bone cancer, it is metastatic breast cancer in the bones.
Metastatic describes a breast cancer that has already spread to distant areas and organs of the body. Metastatic cancer is the most advanced stage of breast cancer. Furthermore, the most common sites for breast cancer to metastasize to are the:-
Once breast cancer is at this most advanced metastatic stage, the odds of completely curing the breast cancer are quite low. .
The treatment of metastatic breast cancer, after a reasonable effort, will often focus on the quality of life and relieving symptoms rather than a cure.
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The Stages Of Breast Cancer
NOTE: Although a lot of this information is still valid, The American Joint Committee on Cancer has recently updated their classifications for staging breast tumors.
We will be updating all our articles on staging in the near future. In the meantime, please click HERE for a brief summary of the major changes in January 2018.
If a breast biopsy confirms that breast cancer is indeed the diagnosis, the staging process begins.
The stages of breast cancer are really the extent of breast cancer. So, in order to choose and begin the best treatment, it is necessary to stage breast cancer. The staging process shows the progression of breast cancer.
Breast cancer progresses in relatively predictable and consistent ways, so it is possible to categorize breast cancer in terms of stages.
There are basically five stages of breast cancer, with some subcategories .
Tests To Diagnose Metastatic Breast Cancer
If you have any of the symptoms of metastatic breast cancer, your doctor may recommend one or more of the following tests:
- blood tests
- whole-body bone scan, with or without X-rays of specific bones
- MRI of the spine or brain
- CT scan of the chest, abdomen, pelvis, and/or brain
- PET scan
- X-ray or ultrasound of the abdomen or chest
- bronchoscopy if you have a constant cough or trouble breathing
- biopsy of any suspicious area
- a “tap,” removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall and a spinal tap removes fluid from around the spinal cord
You can read the following pages for information on symptoms of breast cancer metastasis and diagnosis:
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Bone Metastases And Bone Problems
People with bone metastases are at risk of serious bone complications such as bone fractures , spinal cord compression and bone pain.
Bone complications are a concern for people with bone metastases as they can cause pain and may lead to loss of mobility, impacting quality of life. Bone complications can also decrease survival . With the use of bone-strengthening drugs, bone complications are not common .
Progression While Being Treated With Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or an aromatase inhibitor , along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while on an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy is usually the next step.
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When Breast Cancer Spreads To The Bones
Advances in breast cancer treatment mean you’re now more likely than ever to live a long life after a breast cancer diagnosis. However, it’s important to be aware that the cancer could spread.
Cells can break off from your original tumors and travel through your blood and lymphatic circulations into other parts of your body. When you have breast cancer, it often first spreads to your bones. This is called bone metastasis, and may cause severe pain and a decrease in your quality of life.
Once infiltrated by cancer, your bones can quickly lose calcium and cause hypercalcemia, a condition in which calcium is released into the blood. If not treated, may lead to coma and kidney damage. The loss of bone calcium is particularly serious for older women, who have naturally weaker bones.
Bone metastasis is serious, but treatment can help stop further damage to your bones and improve your symptoms. Medications, other cancer therapies such as radiation, and taking steps to prevent falls may ease your pain and protect your skeleton.
Metastatic Breast Cancer In Bones
Like any cancer, breast cancer can spread to other parts of the body. Breast cancer that has invaded bone can have a significant effect on quality of life, but there are treatments to help manage symptoms and slow disease progression.
Read on to learn more about metastatic breast cancer in bones, including symptoms and what you can expect of treatment.
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Which Bones Does Breast Cancer Spread To First
For more than half of women who develop stage IV breast cancer, the bones are the first site of metastasis. Although breast cancer can spread to any bone, the most common sites are the ribs, spine, pelvis, and long bones in the arms and legs.
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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Tests Detect Tumors In Your Bones
Your doctor may check you for bone metastasis if you have these signs, or if you have certain risk factors, including larger tumors or later-stage cancer. Tools he or she may use to make the diagnosis include:
- Imaging tests, including X-rays, bone scans, , and computed tomography scans
- Blood tests to check for high calcium levels or other chemicals that indicate your cancer has spread
- Urine tests, which can find substances that are released when bone is damaged
- Biopsies, when your doctor takes a sample of your tissue and looks at it under a microscope
When your doctor tells you the stage of your breast cancer, he or she will use three letters: T , N , and M. The “M” category describes whether your cancer has spread to distant parts of your body. If you have bone metastasis, your cancer is in stage M1.
How We Can Manage Breast Cancer That Spreads To The Bones
Has my cancer spread? After a woman has had the time she needs to process a cancer diagnosis, this tends to be one of her first questions.
The process of a cancer spreading is called metastasis. When breast cancer spreads, the bones are one of the most common places it goes. One study noted that 70 percent of breast cancer patients had a cancer that spread to at least one bone. As an orthopedic surgical oncologist, I care for women whose cancer has spread to the bones and who need surgery to reduce pain and improve their quality of life. My colleagues and I work closely with our breast oncology team to provide advanced therapies and to advocate for women who are being treated for breast cancer or who have been treated for it in the past. Unfortunately, breast cancer can come back years after beating the disease, and its vital that women recognize the subtle signs that a cancer has spread to the bones.
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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:
Local Or Regional Treatments For Stage Iv Breast Cancer
Although systemic drugs are the main treatment for stage IV breast cancer, local and regional treatments such as surgery, radiation therapy, or regional chemotherapy are sometimes used as well. These can help treat breast cancer in a specific part of the body, but they are very unlikely to get rid of all of the cancer. These treatments are more likely to be used to help prevent or treat symptoms or complications from the cancer.
Radiation therapy and/or surgery may also be used in certain situations, such as:
- When the breast tumor is causing an open wound in the breast
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent bone fractures
- When an area of cancer spread is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms
In some cases, regional chemo may be useful as well.
If your doctor recommends such local or regional treatments, it is important that you understand their goalwhether it is to try to cure the cancer or to prevent or treat symptoms.
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