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.
How Common Is It
About 155,000 women in the United States live with metastatic breast cancer. Men can have metastatic breast cancer too, but it’s rare.
Only 6% to 10% of women with breast cancer are diagnosed at stage IV. About 20% to 30% of women are diagnosed with an early-stage breast cancer, and then the cancer spreads.
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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How Do Breast Cancer Cells Spread Around The Body
Breast cancer cells travel through the body like any other cancer cells. Firstly, cancer cells can invade neighbouring healthy tissue. Following this, the cancer cells then invade local lymph nodes or blood vessels.
When breast cancer spreads to the axillary lymph nodes this is still a relatively early stage of metastasis, and potentially curable.
The cancer cells will typically travel through the lymphatic system or blood vessels to other distant parts of the body.
Personal Genetic Testing For Inherited Gene Mutations
The National Comprehensive Cancer Network recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 inherited gene mutations . If you have a mutation in one of these genes, a PARP inhibitor may be included in your treatment plan.
Learn more about genetic testing.
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Support For Living With Secondary Breast Cancer
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.
Image credit: graphic adapted from: Sersa et al.Electrochemotherapy in treatment of tumours. European Journal of Surgical Oncology. 2008. 34: 232240. Adapted by permission under the Creative Commons Attribution-ShareAlike 3.0 license:creativecommons.org/licenses/by-sa/3.0.
Symptoms And Diagnosis Of Bone Metastasis
A sudden, noticeable new pain is the most common symptom of breast cancer that has spread to the bone. The pain may come and go at first but can become constant over time. It can be hard to tell the difference between bone metastasis pain and arthritis pain or exercise strain. If the pain feels just as bad or even worse when you rest or lie down, it can be a sign of a problem. Its a good idea to see your doctor right away if it is bone metastasis, prompt treatment can prevent a fracture down the road.
Complications of bone metastasis are called skeletal-related events and can include the following:
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sudden severe pain and the inability to move, which can be a sign of fracture
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pain in the back or neck, numbness or weakness in an area of the body, or difficulty passing urine or having bowel movements all possible signs of spine compression, which can happen when a fractured vertebra presses on the spinal cord nerves that control various bodily functions
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fatigue, weakness, nausea, loss of appetite, or dehydration, which can indicate very high levels of calcium in the blood due to bone breakdown
To diagnose bone metastasis, your doctor usually orders one or more of the following imaging tests:
Your doctor also may order a blood test to check for high levels of calcium or alkaline phosphatase , another substance that can be elevated because of bone metastasis.
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I Have To Prioritize And Try Not To Sweat The Small Stuff
For Sendelbach, each week begins with a list of her priorities. Obviously, getting to my doctors appointments is very important, she says. But if the clothes arent folded, is that a dire situation? Absolutely not!
Sendelbach has learned to make compromises: If her husband and son have to pick up their clean clothes from the couch, she can live with that.
I have learned, she says, to look at every situation and ask if this is going to truly make a difference in my day or my familys day for better or worse. If the answer is no, then that task might be left undone.
It wasnt always this way for Sendelbach, though. When she was first diagnosed with cancer, her son was just a year old and she had been married for only two and a half years. You know how it is when you first have a baby if everything isnt perfect, then the world is falling apart! she laughs. Now, to us we ate, were all still alive, the house is acceptable if were good, its all okay.
Treatment Of Stage Iv Breast Cancer
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of the body. When breast cancer spreads, it most commonly goes to the bones, liver, and lungs. It may also spread to the brain or other organs.
For women with stage IV breast cancer, systemic drug 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 some women live longer. These cancers are considered incurable.
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Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
Bone Weakening And Fracture
Secondary breast cancer in the bone may mean the affected bones are weakened, which can increase the risk of a fracture.
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. You may have radiotherapy after the surgery.
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How Does Breast Cancer Spread
Breast cancer can invade and grow into the tissue surrounding the breast or it can travel to other parts of the body and form a new tumor there. Nearly all types of cancer have the ability to spread , but whether or not it will spread is often linked to what type of breast cancer you have.
Breast cancer can spread in three ways:
Every cancer is different, but the type of breast cancer you have typically plays a role in how aggressive or slow moving it is and where its most likely to spread, says Dr. Roesch.
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 or painful wound in the breast
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent or treat bone fractures
- When a cancer is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms anywhere in the body
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 the goalwhether it is to try to cure the cancer or to prevent or treat symptoms.
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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.
I May Not Feel Like A Fighter Theres No Final Victory
The language used to describe cancer and its treatment is often the language of war: fighting cancer, battling cancer, being a warrior. But those words may not resonate with women who have metastatic breast cancer.
Sendelbach recalls using fighting words when she was first diagnosed with stage 1 breast cancer. I was 30 years old, and I was in fight mode, she says. I was like, Hell yeah, I can kick cancers ass and so on. When she was diagnosed with stage 4, though, she realized there would be no end in sight, no final victory for her.
Theres not a finish line, she says, so to be in fight mode doesnt really work. There has to be an end in sight to stay in that place.
For her, metastatic breast cancer is something she deals with day to day. She describes her journey as a marathon, not a sprint. If you have to stop sometimes to walk and take water breaks, she says, you should. If you try to run as fast as you can all the time, its inevitable that youre going to fail.
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De Novo Metastatic Breast Cancer And Recurrent Breast Cancer
It is important to understand the two types of Stage IV Breast Cancer and the differences between them:-
Are New Treatments For Metastatic Cancer Being Developed
Yes. Researchers are now studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells. One new area of research includes ways to boost the strength of the immune response against tumors.
Regulatory T-cells and RANKL proteins may play a role in breast cancer metastasisRecent breast cancer research suggests that the bodys regulatory T cells, which are an integral part of the immune response system, may play a key role in metastasis.
It is speculated that the T cells produce a protein which seems to accelerate the spread of breast cancer cells to other areas of the body. The inflammatory protein RANKL seems to influence the T-cells ability to spread cancer cells to distant areas of the body.
It is believed that by interfering with RANKLs ability to interact with the T-cells, the early metastasis of breast cancer cells can be significantly inhibited
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Metabolic Reprogramming And Organ
Primary breast tumor cells exhibit metabolic heterogeneity and participate in different metabolic reprogramming according to metastatic sites . Liver-metastatic breast cancer cells display a distinct metabolic reprogramming characterized by accumulation of glucose-derived lactate and reduction in the TCA cycle and OXPHOS . In brain metastatic breast cancer, the significant metabolic changes are mainly the enhanced glycolysis, mitochondrial respiration and the PPP. Intriguingly, breast cancer cells metastasized to the brain are less sensitive to glucose deficiency , which may attribute to upregulation of glutamine and branched chain amino acid oxidation .
Figure 2 Metabolic reprogramming in the metastatic cascade. Metabolic reprogramming occurs at several steps of metastasis. The intravasation of cells from the primary tumor is promoted by extracellular acidification. CTCs survive in oxidative stress by producing NADPH and GSH. Cancer cells show different metabolic characteristics based on the sites which they metastasize. Last, anabolic metabolism is reactivated during macro-metastatic tumor proliferation.
Clinical Trials Are A Promising Treatment Option
For people with advanced stages of cancer, clinical trials can be considered the gold standard of treatment. I recommend clinical trials highly, says Rosen. You get access to medication and treatment that you normally wouldnt have.
A clinical trial could even have positive results on your cancer. We are living in an exciting time for cancer treatment, says Kimmick. There are myriad new drugs coming out that will improve the lives of all women with breast cancer, both metastatic and early stage.
However, its important to be realistic about the potential outcome of your trial. Rosen was recently enrolled in a clinical trial in which the medication proved toxic for her. But she has no regrets about participating. It feels like Im helping researchers who are working on cures for cancer, she says. When I had a bad reaction to the drug, they were able to put my side effects in their study. I feel like I did help, and that makes me happy.
People interested in joining a clinical trial for treatment should talk to their doctor about options that might be good for them.
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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.
Treatment Of Breast Cancer Patients With Metastatic Disease
Although advances in the treatment for metastatic breast cancer have significantly improved the survival of patients , metastatic breast cancer is still considered an incurable disease . In general, the treatment for breast cancer metastasis can be divided into standard chemotherapy and targeted therapy.
Cytotoxic drugs used in standard chemotherapy for metastatic breast cancer include anthracyclines, taxanes and 5-fluorouracil as first, second and third lines of therapy, respectively . However, anthracycline use has been associated with cardiac dysfunction . Newer cytotoxic chemotherapeutic agents that have been developed are epothilones and ixabepilone . Both these agents exhibited increased efficacy in patients with metastatic breast cancer who had prior treatment with anthracyclines and taxanes .
Trastuzumab is a monoclonal antibody that selectively binds to the extracellular domain of human epidermal growth factor receptor 2 and blocks the proliferation of tumors that overexpress HER-2 . This antibody is regularly used with combination chemotherapy for both adjuvant treatment of breast cancer and metastatic breast cancer . The addition of trastuzumab to chemotherapy in the treatment of metastatic breast cancer was reported to improve overall survival rate, response rate and time-to-progression . The newer generation of HER-2-targeting antibodies, such as trastuzumab-MCC-DM1 and pertuzumab, have shown promising results in the treatment of metastatic breast cancer .
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