The Wide Window Of Relapse In Breast Cancer
In contrast with other solid tumours in which metastatic recurrence can occur within a few weeks or a few years following diagnosis, breast cancer is characterised by a wide window of relapse, spanning months to decades after surgery. The basis of this peculiar pattern of recurrence is still elusive, but is likely to be linked to the aforementioned molecular differences underlying each subgroup, with basal-like and HER2-enriched patients experiencing early relapses , as opposed to patients with luminal cancers characterised by a more favourable prognosis.,, Nonetheless, patients with luminal B tumours tend to have shorter survival times than luminal A patients. In addition to the contribution of the molecular subtype of the primary tumour, the risk and timing of recurrence is also influenced by other tumour-related factors that constitute the pillars of the TNM classification system: tumour size and spread , regional lymph node involvement and the presence of distant metastasis . Based on the premise that the chance of survival is intimately linked to the anatomic extent of the disease, the TNM staging system stratifies cancer patients at diagnosis into four stageswith patients with Stage I disease having a much better prognosis as opposed to patients with Stage IV diseasethus representing the gold standard tool for prognostication.
How Fast Breast Cancer Grows
People may wonder about growth or doubling time when considering how long to wait to begin treatment. This growth is also very important to understand if you have a lump and have been advised to simply observe it over time.
Unless your healthcare provider is extremely confident that a lump is benign, it should be evaluated right away rather than waiting.
In general, the growth of breast cancer can be quite variable, but several studies provide at least an estimate of what may be happening.
What Is Inflammatory Breast Cancer
Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called inflammatory because the breast often looks swollen and red, or inflamed.
Inflammatory breast cancer is rare, accounting for 1 to 5 percent of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.
Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.
Additional features of inflammatory breast cancer include the following:
- Compared with other types of breast cancer, inflammatory breast cancer tends to be diagnosed at younger ages.
- Inflammatory breast cancer is more common and diagnosed at younger ages in African American women than in white women.
- Inflammatory breast tumors are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.
- Inflammatory breast cancer is more common in obese women than in women of normal weight.
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Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
How Do Breasts Start To Develop
When breasts start to develop, a small bump called a breast bud grows under the nipple and areola .
The breasts get bigger and rounder as the fatty tissue and milk-producing glands inside the breasts continue to grow. The areola also gets bigger and darker and the nipples may stick out.
Youll probably notice that you and your friends grow in different ways. One girls breasts may start to develop first, but her friend may get her period earlier. Bodies dont develop in any set order and everyones different.
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Advanced Or Metastatic Breast Cancer: Stage Iv
Stage IV breast cancers indicate the presence of distant metastasis to other parts of the body, such as the liver or bones.
About 5% of women, in 2017 have a stage IV breast cancer at the time of initial diagnosis.
The long term survival rate for stage IV breast cancer tends to be low, but is improving all the time. In 2012 the National Cancer Institute statistics show the 5-year survival rate for Stage IV breast cancer to be around 22%.
However, a more recent study shows that 37% of women survive for 3 years after a Stage IV breast cancer diagnosis.
Also, it is important to remember that each case is individual and there is no telling exact survival rates for any of the stages of breast cancer.
Survival For Inflammatory Breast Cancer
Many factors can influence life expectancy for women with inflammatory breast cancer. These include:
- the exact position of the cancer
- how big the cancer is and whether it has spread only to the lymph nodes or to other organs
- how abnormal the cancer cells look under the microscope
- your age
- whether the cancer cells have receptors for hormone therapies
- how well the cancer responds to treatment
Inflammatory breast cancer can develop quickly and may spread to other parts of the body. So, in general, the outlook with this type is not as good as for women diagnosed with other types of breast cancer. But doctors think that the outlook is improving as breast cancer treatment improves.
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Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
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 Type Of Breast Cancer Is Most Likely To Metastasize
Metastatic breast cancer is breast cancer that has spread to other parts of the body. Cancer cells start in the breast and then multiply, invading the rest of the healthy breast tissue and eventually spreading to lymph nodes under the arms or in other organs.
While all types of breast cancer have the potential to metastasize, human epidermal growth factor receptor 2 -positive and triple-negative cancers are more aggressive and more likely to metastasize faster than the other types.
What Age Do Breasts Fully Develop
Breasts usually start to develop around the age of 9 to 11, but its normal for them to start earlier or later.
If a girls breasts start to develop at a younger age, this doesnt mean shell have bigger breasts than someone who starts to develop later. The rate at which breasts grow is different for everyone.
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Take Advantage Of Patient Navigators
Though intuition would tell us that people who are insured would experience shorter delays before surgery, that doesn’t appear to be true. A large 2019 study in PLoS One looked at over 1.3 million people to see how time to initial treatment affected survival. In this study, they found that with early stage breast cancer, waiting more than 35 days between diagnosis and surgery reduced survival rates. Surprisingly, uninsured people had faster times to initiation of treatment.
While the reasons weren’t certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Difficulty navigating the maze of large treatment centers may also be at play, and the authors made mention of recent clinical trials showing patient navigation could have a beneficial effect on assuring timely cancer care.
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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Summary Of Surgery Timing
Though we don’t have a solid answer on how soon surgery should be done after a diagnosis of breast cancer , it would seem earlier surgery is ideal .
Delaying for a lengthy period of time can be dangerous, with studies finding that those who delay over six months are twice as likely to die from the disease. This is important to keep in mind for those who have breast lumps they are “observing” without a clear diagnosis. Any breast lump needs to be explained.
Breast Cancer Staging And Lymph Nodes
After an initial cancer diagnosis, youll need to know if it has spread beyond the primary tumor. If you have enlarged lymph nodes, your doctor may be able to perform a needle biopsy. Otherwise, the lymph nodes can be checked when you have breast surgery.
Your doctor will assign a clinical stage based on:
- a physical exam
- imaging tests
- a biopsy of the tumor
After surgery, youll have more detailed information from the breast tissue and lymph nodes. This information helps provide the pathological stage.
Lymph node involvement is a key factor in staging breast cancer. In the TNM staging system:
- T is for tumor size
- N represents lymph node involvement
- M is for metastasis
Heres a closer look at what to know about cancer cells and lymph node involvement.
Other things that can influence breast cancer staging include:
- Tumor grade. This has to do with how abnormal the cancer cells appear under a microscope. The higher the grade, the more aggressive the cancer.
- Biomarker tests. The cancer cells will be checked for certain receptors, such as estrogen, progesterone, and HER2 . All of these can help fuel the growth of cancer cells in the breast.
All these factors are combined to determine the stage.
Breast cancer staging
Breast cancer has four stages. When lymph nodes are involved, its at least stage 2. Metastatic breast cancer is stage 4.
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Swollen Lymph Nodes: What Do They Mean
Swollen lymph nodes, or swollen glands, are a symptom of many illnessesfrom the common cold to some forms of cancerand a sign that something is wrong in the body. The swelling or enlargement, called lymphadenopathy, occurs in the lymph nodes when theyre filtering cells affected by a condition, such as an infection, injury or cancer. The most common reason lymph nodes swell is because of an infection, particularly viral infections such as a cold. Its much rarer for swollen lymph nodes to be a symptom of a more serious condition such as cancer.
The lymph nodes are likely to swell in one specific region depending on the illness. This will usually occur in the neck, armpits or groin. Less common is when lymph nodes swell in several regions at the same time. That condition may be brought on by infections such as strep throat or mononucleosis, a reaction to certain medicines, an immune system disorder such as rheumatoid arthritis, and forms of cancer such as lymphoma and leukemia.
When lymph node swelling persists and is accompanied by other symptoms, such as fever or night sweats, or when theres no obvious infection, it may be time to seek medical advice or evaluation from a doctor.
Reasons To Wait A Short While
While information suggests having surgery within a few weeks and chemotherapy within a month is ideal, there are some very good reasons why you may wish to wait a few days or a few weeks to begin treatment.
Most surgeons and oncologists will reassure you that you have some time, though there are always exceptions to that general rule . Advantages of taking some time include:
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Stages Of Breast Cancer And What They Mean
Breast cancer stages are usually expressed on a scale of 0 to 4.
Stage 0 is considered non-invasive breast cancer, with no evidence that the cancer has spread beyond the part of the breast where it began to grow, including to nearby lymph nodes.
Stages 1 to 3 generally describe breast cancer that may have spread to other parts of the breast and nearby lymph nodes, with stages increasing with the size of tumors and extent of spread.
Cancer that remains localized to the breasts is the most treatable.
Breast cancer tumors can grow directly from breast tissue to other nearby locations, such as the chest wall or the skin of the breast. This is considered stage 3 breast cancer.
Stage 4 is metastatic breast cancer , meaning that cancer that originated in the breast has now spread to other parts of the body.
In stage 4 breast cancer, cancer cells can spread beyond the breasts by invading lymph nodes near the breast and traveling to other parts of the body via the lymphatic system.
Cancer cells also can move through the bloodstream to inhabit other organs and regions of the body.
The most common destinations for MBC or advanced breast cancer cells are the brain, bones, lungs, and liver.
The outcome for Stage 4 breast cancer that has metastasized, or spread to distant organs of the body, is considerably lower than for earlier stages, with a 28 percent 5-year survival rate.
Signs And Symptoms Of Phyllodes Tumors
The most common symptom of a phyllodes tumor is a breast lump that you or your doctor can feel while examining the breasts. Phyllodes tumors tend to grow quickly, within a period of weeks or months, to a size of 2-3 cm or sometimes larger. This rapid growth does not automatically mean the phyllodes tumor is malignant benign tumors can grow quickly, too. The lump is usually not painful. If left unchecked, the lump can create a visible bulge as it pushes against the skin. In more advanced cases whether benign, borderline, or malignant a phyllodes tumor can cause an ulcer or open wound to form on the breast skin.
Is Tumour Dormancy The Sole Explanation For Recurrence
In pondering the mechanisms of metastatic relapse among breast cancer patients, one obvious question is whether early recurrence is simply the consequence of direct metastatic outgrowth, whereas late relapses reflect a period of tumour dormancy. To address this query, it is imperative to consider how long it takes for a single cancer cell to grow into a clinically detectable metastasis. Pioneering measurements of breast tumour volume doubling time carried out by radiographic analysis on more than 800 women concluded that it takes ~12 years on average for a single cell with a 10-µm diameter to reach a clinically detectable mass of 1cm,, and that metastases can have a TVDT up to twofold higher than their matched primary tumours. However, these initial analyses focused on a small number of samples, without taking into account the vast heterogeneity among breast tumours or the effect that adjuvant therapies might have on their growth rate, as the subjects in this study were untreated.
Fig. 3: The puzzling timing of metastatic relapse in breast cancer patients.
Women Whove Had Interval Cancer May Need Careful Screening Going Forward
In the meantime, women who experience the shock of having an interval cancer may need to review screening options after treatment, McCarthy says.
Once youre diagnosed with breast cancer, your oncologist and care team will work on your treatment plan based on the profile of your cancer, she says. But further down the line, it might be a discussion about whether mammography is sufficient or whether ultrasound or MRI may be used in screening as well.
Breast cancer screening is highly successful, overall, at preventing cancer deaths. But guidelines for who to screen and when may need to evolve. Women who have had a negative mammogram but who have concerns about their breasts should seek evaluation and not wait for the next routine mammography, she says.
For women experiencing interval cancer, it can be particularly frustrating because they are doing things right and seeking preventative care, and in their cases, it didnt help them, McCarthy says. We did such a good job at rightfully pointing out the benefits of mammography, but we forget that no screening test is perfect and there will always be false positives and false negatives.
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