How Does My Doctor Know If My Breast Cancer Has Spread
Dr. Anthony Elias answers: ‘How Does My Doc Know if the Cancer Has Spread?’
How Does My Doc Know if the Cancer Has Spread?
— Question: How does the doctor know if my breast cancer has spread or metastasized?
Answer: Breast cancer, like most other cancers can spread to many parts of the body.
A tumor that has actually spread and set up shop in a different part of the body is called a metastasis. And usually we talk to the patient and listen to whether you have any symptoms, any special symptoms that relate to something going wrong elsewhere in the body — for example, pain, or lump or bump or headaches that are unusual.
It’s very important to tell the doctor if you have any unusual symptoms, things that have come up that you’re not used to. We’re all entitled to our usual aches and pains, but if there’s something that’s persistent or nagging or interfering with you life that’s something you need to let the doctor know.
We then use various scans to document that there are tumor cells elsewhere. For example, things like chest x-rays, bone scans, CAT scans and other specialized scans. Sometimes blood tests help us with this as well.
It’s also important to know that even when the tumor hasn’t obviously spread, that we give things like chemotherapy or hormone therapy to try to reduce the risk of relapse because we know that some of the time there can be microscopic tumor cells that we can’t see.
What Are The Chances Of Breast Cancer Returning
Each persons risk of breast cancer recurrence is different and depends on many factors, such as the size, type, grade and features of the cancer and whether the lymph nodes were affected.
Your treatment team can tell you more about your individual risk of recurrence if you want to know this.
The risk of breast cancer recurring is higher in the first few years and reduces as time goes on.
However, recurrence can happen even many years after treatment, which is why its important to be breast and body aware, and report any changes to your treatment team or GP.
In the UK, the number of people surviving breast cancer has risen greatly over the past decade and most people diagnosed with primary breast cancer will not have a recurrence.
Imaging Tests To Look For Breast Cancer Spread
If you have been diagnosed with breast cancer, you might need more imaging tests. Your doctor will talk with you about which of these tests you may need.
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons including:
- To look at suspicious areas that might be cancer
- To learn how far cancer might have spread
- To help determine if treatment is working
- To look for possible signs of cancer coming back after treatment
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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:
- X-ray
- PET scan
- Bone scan
Biopsy. Your doctor removes a small amount of tissue from your body and looks at it under a microscope to see if there are any cancer cells in it.
Diagnosing Metastatic Breast Cancer
Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. Your care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:
Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.
Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.
Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.
Breast biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. Your original breast cancer diagnosis was likely confirmed with a biopsy.
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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:
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
- the skin
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What Is Metastatic Breast Cancer
Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.
Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.
- Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
- The more distant locations include the bones, lungs, skin, liver and brain, although its possible for other parts of the body to be affected.
Its important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.
Its also important to prepare yourself with information about the disease, its symptoms and how its detected and treated.
There Are Treatment Options For Metastatic Breast Cancer The Options Depend Upon The Type Of Breast Cancer And The Womans Age But In General They May Include:
- Hormone therapy
- Targeted therapy/drugs
- Immunotherapy
Radiation therapy and/or surgery may also be used to remove or shrink tumors that are blocking blood vessels, pressing on the spinal cord, are small enough to make removal practical or to provide relief of pain or other symptoms.
Metastatic breast cancer treatment focuses on the whole body. When one treatment stops working, another one is used. This allows for long-term cancer control for many patients
For more specific and in-depth information about metastatic breast cancer, please open/download/print National Comprehensive Cancer Network Guidelines for Patients: Breast Cancer Metastatic. As a member of the NCCN, Rogel Cancer Center physicians helped create these guidelines and routinely follow them.
If you have questions or want to learn how to make an appointment, please contact our Cancer AnswerLine at .
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Symptoms Of Breast Cancer
Breast cancer can have several symptoms, but the first noticeable symptom is usually a lump or area of thickened breast tissue.
Most breast lumps are not cancerous, but it’s always best to have them checked by a doctor.
You should also see a GP if you notice any of these symptoms:
- a change in the size or shape of one or both breasts
- discharge from either of your nipples, which may be streaked with blood
- a lump or swelling in either of your armpits
- dimpling on the skin of your breasts
- a rash on or around your nipple
- a change in the appearance of your nipple, such as becoming sunken into your breast
Breast pain is not usually a symptom of breast cancer.
Find out more about the symptoms of breast cancer.
Metastatic Breast Cancer Symptoms And Diagnosis
The most common breast cancer metastasis sites are the bones, the lungs, the brain, and the liver. The symptoms of metastatic breast cancer can be very different depending on the location of the cancer:
- constant back, bone, or joint pain
- difficulty with urinating this can be a sign that the nerves in your back are being pinched by a cancer
- numbness or weakness anywhere in your body
- a constant dry cough
- abdominal bloating, pain, or tenderness
- constant nausea, vomiting, or weight loss
- jaundice
- severe headaches
- vision problems
- seizures
- confusion
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The Role Of Caregivers
Caregivers also play a vital role in helping a person with cancer be as comfortable as possible. To help, a caregiver can:
According to the American Society for Clinical Oncology, in 2018, doctors will diagnose invasive breast cancer in an estimated 268,670 people in the United States.
The ACS state that the 5-year relative survival rate for people with metastatic breast cancer is around 22 percent. This means that people with metastatic breast cancer are 22 percent as likely as people without the condition to live at least 5 years following diagnosis.
However, many factors can affect how long a person with metastatic breast cancer lives for, including:
- the type of breast cancer
- the stage of breast cancer
- where the cancer has spread to
- how well the cancer responds to treatment
- any other health issues that the person has
Everyoneâs outlook is different. It is also important to note that survivals rates are just estimates, and that doctors base these figures on data from at least 5 years ago. Continuing advancements in cancer treatments means that survival rates are improving.
How Breast Cancer Spreads
Breast cancer can spread to other regions of the body in a few primary ways:
When breast cancer spreads to another organ it is still breast cancer. For example, if breast cancer were to spread to the lungs it would not be called lung cancer. Instead, we’d refer to it as breast cancer spread to the lungs or breast cancer with lung metastases. If you were to look at the cancer cells in the lungs under the microscope they would be cancerous breast cells, not cancerous lung cells.
Cancers that have spread to other tissues may be different than the original tumor, and this is another area of confusion. Cancers aren’t just a clone of abnormal cells that propagate mindlessly. Rather, they are continually changing and developing new mutations. For this reason, a tumor that was estrogen receptor positive when found in the breast may now be estrogen receptor negative. HER2 status may change as well. This also explains why metastatic tumors are sometimes more aggressive than the original tumor.
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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.
Can You Tell When Exactly My Breast Cancer Started
Often times, one of the most frequently asked questions I get when someone is diagnosed with breast cancer is when did it begin? says Roesch. And the general rule is that we really cant tell for sure when the cancer popped up. We can look at the subtype of breast cancer to perhaps get a better understanding if it was weeks vs. months for example, but theres no way to tell for sure.
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Living With Breast Cancer
Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.
How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.
Forms of support may include:
- family and friends, who can be a powerful support system
- communicating with other people in the same situation
- finding out as much as possible about your condition
- not trying to do too much or overexerting yourself
- making time for yourself
Find out more about living with breast cancer.
How Fast Does Metastatic Breast Cancer Spread
Like all cells, breast cancer cells grow by cellular division. But because cancer cells are mutated, their growth rate can be difficult to predict.
According to the Robert W. Franz Cancer Research Center at Providence Portland Medical Center, breast cancer cells need to divide at least 30 times before they are detectable by physical exam.
Each division takes about 1 to 2 months, so a detectable tumor has likely been growing in the body for 2 to 5 years.
Generally speaking, the more cells divide, the bigger the tumor grows. The larger the tumor, the greater the odds that it may invade nearby tissues, the lymphatic system, or the circulatory system, and spread to other organs.
Breast cancer grading and staging can provide some clues to how aggressive your cancer is.
Grade 3 breast cancer is likely to spread faster than grade 1 or 2, for example.
that can affect how quickly your breast cancer may spread include:
- the
are the two primary metrics used to assess breast cancer.
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How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:
- the size of the cancer tumor and whether or not it has grown into nearby tissue
- whether cancer is in the lymph nodes
- whether the cancer has spread to other parts of the body beyond the breast
Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.
Jump to a specific breast cancer stage to learn more: