How Does Breast Cancer Spread
Breast cancer spreads when abnormal cells invade surrounding healthy tissues. In most cases, breast cancer first spreads to other parts of an affected breast, then to nearby lymph nodes. If cancerous cells make their way into the lymphatic system, they can then reach distant parts of the body.
The most common locations for metastatic breast tumors include the:
Even if breast cancer spreads to a distant organ, it is still classified as breast cancer. For instance, breast cancer that spreads to the lungs is considered to be metastatic breast cancer not lung cancer.
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Integrative Therapies For Metastatic Breast Cancer
You may find it beneficial to add integrative therapies to your treatment plan. There are many evidence-informed integrative modalities to boost the mind and body. Practices like gentle yoga, meditation, massage and music therapy may feel enjoyable and reduce stress and anxiety levels.
To help our patients maintain quality of life after a metastatic breast cancer diagnosis, our team of breast cancer experts may offer supportive care services to help manage side effects of the disease and its treatments. These may include:
Testing For Proteins And Genes
The breast cancer cells will be tested for certain proteins called estrogen and progesterone receptors. If the cancer has these proteins, it’s called a hormone receptor positive breast cancer. The cells are also tested to see if the cancer makes too much of the HER2 protein. If it does, it’s called a HER2-positive cancer. These cancers are sometimes easier to treat. If the cancer doesn’t test positive for any of these proteins, it’s called a triple-negative breast cancer.
The cells might also be tested for certain genes, which can help decide if chemo might be helpful and how likely it is that the cancer will come back. Ask your doctor to explain the tests they plan to do, and what the results might mean.
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Can Metastatic Breast Cancer Be Cured
There is no cure for metastatic breast cancer. Once the cancer cells have spread to another distant area of the body, its impossible to get rid of them all. However, the right treatment plan can help extend your life and improve its quality.
Metastatic breast cancer treatment aims to shrink tumors, slow their growth and improve your symptoms.
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Plans Have To Be Flexible
My energy is unpredictable, says Sendelbach. I literally never know how Im going to feel from one day to the next. Its so hard to make plans because if I say yes to something thats two weeks away, the day of, I could wake up and feel absolutely horrible.
When someone with metastatic breast cancer declines an invitation or cancels at the last minute, its most likely not because they dont want to be there. Says Sendelbach, We physically cant do it.
Silberman agrees. Ive been going through for a long time, she says, and Ive had friends drop away. Because of MBC and my treatments, its hard for me to be reliable.
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What Is Metastatic Breast Cancer
Metastatic breast cancer is the most advanced stage of breast cancer. Breast cancer develops when abnormal cells in the breast start to divide uncontrollably. A tumor is a mass or collection of these abnormal cells.
Metastasis refers to cancer cells that have spread to a new area of the body. In metastatic breast cancer, cells may spread to the:
Healthcare providers name cancer based on its primary origin. That means breast cancer that spreads to other body parts is still considered breast cancer. The cancer cells are still breast cancer cells. Your care team will use breast cancer therapies, even if the cancer cells are in other areas.
What Is The Lymph System
The lymph system is a part of your bodys immune system. It includes a network of lymph vessels and lymph nodes. Lymph vessels are a lot like the veins that collect and carry blood through the body. But instead of carrying blood, these vessels carry the clear watery fluid called lymph. Lymph fluid also contains white blood cells, which help fight infections.
Lymph fluid would build up and cause swelling if it were not drained in some way. Lymph vessels draw up the lymph fluid from around the cells to send it towards the chest. There, lymph fluid collects into a large vessel that drains into a blood vessel near the heart.
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Who Is At Risk Of Breast Cancer Recurrence
Everyone who has received a breast cancer diagnosis is at risk of recurrence, however the risk differs markedly depending on a number of factors listed below. Some breast cancers, when diagnosed very early when small and without lymph node involvement, have an excellent prognosis and are very unlikely to recur. On the contrary, larger cancers, with lymph node involvement or with a more invasive behaviour, are unfortunately at a higher risk of recurrence.
Living With Secondary Breast Cancer
You will see your cancer doctor or specialist nurse regularly during and after treatment. This means that any symptoms or problems can be managed early on. You may have regular scans to check how the cancer has responded to treatment.
You may need treatment at different times or have ongoing treatment with hormone therapy. There may be long periods when the cancer is controlled and you are getting on with day-to-day life.
We have more about well-being and coping in our information about living with secondary breast cancer.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation. Macmillan is also here to support you. If you would like to talk, you can:
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When Can Metastatic Breast Cancer Occur
Most often, metastatic breast cancer arises months or years after a person has completed treatment for early or locally advanced breast cancer. This is sometimes called a distant recurrence.
Some people have metastatic breast cancer when they are first diagnosed . This is called de novo metastatic breast cancer.
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:
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Breast Cancer Is A Heterogeneous Disease
Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.
What Is Stage Ii Breast Cancer
Stage II describes cancer that is in a limited region of the breast but has grown larger. It reflects how many lymph nodes may contain cancer cells. This stage is divided into two subcategories.
Stage IIA is based on one of the following:
- Either there is no tumor in the breast or there is a breast tumor up to 20 millimeters , plus cancer has spread to the lymph nodes under the arm.
- A tumor of 20 to 50 millimeters is present in the breast, but cancer has not spread to the lymph nodes.
Stage IIB is based on one of these criteria:
- A tumor of 20 to 50 millimeters is present in the breast, along with cancer that has spread to between one and three nearby lymph nodes.
- A tumor in the breast is larger than 50 millimeters, but cancer has not spread to any lymph nodes.
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How Long Does It Take For Breast Cancer To Metastasize
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Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.
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Surgery For Breast Cancer
Most women with breast cancer have some type of surgery. Common types of breast surgery are lumpectomy, mastectomy, and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.
Choosing between lumpectomy and mastectomy
Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that youll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.
When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to get it all out. Some women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.
If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. Its not done to treat the cancer. Its done to build a breast shape that looks a lot like your natural breast.
If youre going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.
Side effects of surgery
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.
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Metastasis Is A Highly Inefficient Yet Lethal Process
In the next few sections, we introduce the concept of tumour dormancy and discuss its ties with DTC dissemination in order to highlight how its reversible nature might alter the equilibrium between unsuccessful and successful metastases, thus possibly dictating the timing of metastatic relapse, or whether relapse occurs at all. We then focus on two key determinants of relapse in HR+ breast cancer: the extrinsic effect of targeted therapy, and the consequences of intrinsic HR function modulation.
Stage Iii Breast Cancer Locally Advanced
A stage 3 breast cancer is sometimes referred to as a locally advanced breast cancer.
Stage III breast cancers are actually a heterogeneous group of cancers but account for about 7% of all initial breast cancer diagnosis.
Basically, a stage III breast cancer is one in which there is:-
- a primary tumor of greater than 5cm in diameter with no apparent metastasis
- OR the tumor is between 2cm and 5cm in diameter with evidence of rather significant metastasis.
Another way of looking at it is that stage III breast cancers either have a large but operable breast tumor . Or sometimes Stage III breast cancers present with a medium-size breast tumor which is more difficult to fully treat and cure with surgery alone.
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Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think Ill live?
- Do you know if my cancer has any of these proteins: estrogen receptor, progesterone receptor, or the HER2 protein?
- What does it mean if my cancer has any of these proteins?
- What will happen next?
There are many ways to treat breast cancer.
Surgery and radiation are used to treat cancer in a specific part of the body . They do not affect the rest of the body.
Chemotherapy, hormone treatment, targeted therapy, and immunotherapy drugs go through the whole body. They can reach cancer cells almost anywhere in the body.
Doctors often use more than one treatment for breast cancer. The treatment plan thats best for you will depend on:
- The cancer’s stage and grade
- If the cancer has specific proteins, like the HER2 protein or hormone receptors
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Survival Happens Every Day
These rough estimates for how long breast cancer takes to treat can be helpful to plan your life around treatment. More importantly, they provide a light at the end of the tunnel for you to focus on. However, for your daily sanity, it may be better to break down your treatment into smaller parts. Take it from one day to the next. Remember, every day you make it, youre already winning. These factors all affect how long breast cancer takes to treat.
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About Those Lymph Nodes
A surgeon will usually take a lymph node biopsy to determine if the breast cancer has spread to the axillary lymph nodes. This is not always necessary, however. A lymph node biopsy is not usually necessary for DCIS. However, for invasive breast cancer, yes, they do need to check the lymph nodes.
Sometimes, doctors will perform a sentinel node biopsy, rather than a full lymph node excisional biopsy if the concerns about cancer spread are minimal. Cancer cells tend to appear first in the sentinel node before spreading to the other nodes, or other areas of the body.
How Fast Does Breast Cancer Spread
From Additional comments from Suzanne Partridge, MD, Medical Oncologist and Hematologist with OHC. Original article by Jamie Eske, Medical News Today
People who have recently been diagnosed with breast cancer may wonder how fast it could grow or spread. Its hard to predict because cancer occurs due to mutations in human cells, and mutations do not follow normal, predictable patterns of cell division. It also depends on the type, grade, and stage of breast cancer, and whether or not its invasive or noninvasive. The best resource for determining how quickly your breast cancer may spread or grow are your OHC doctors.
At OHC, we understand how a cancer diagnosis can affect your home, work and personal life, as well as that of your family. Our team of medical and radiation oncologist, researchers, advanced practice providers, and genetic counselors work with you to develop a treatment plan that includes therapy options to stop the growth and spread of breast cancer. Here are factors taken into consideration when determining if or when your cancer may grow or spread.
Grade Doctors grade breast cancer based on how much the cancer cells look like normal breast cells. A higher grade means that its is more likely to grow faster and to spread to other areas of the breast or body. Grade 1 is a slower-growing cancer and grade 3 is a faster-growing cancer.
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