Where Does Breast Cancer Spread To
Breast cancer cells seem to prefer to settle into:-
- long bones in the arms and legs
- ribs
- skull
With an osteolytic metastasis, the cancer kind of eats away at the bone, creating holes.
With an osteoblastic bone metastasis, the bone mineral density actually increases, but this can cause the bones to fracture more easily. This requires a little more explanation. Breast cancer metastases tend to be lytic when they are untreated, and then they become densely sclerotic as they respond to treatment.
Even if no treatment is given yet, an osteoblastic metastasis from breast cancer generally indicates that the persons own body is trying to fight cancer with some success.
A CT scan may also be used to check for metastasis to the lungs or liver. A CT scan is essentially an X-ray linked to a computer. The breast cancer doctor injects a contrast dye agent into the bloodstream and this makes any cancer cells in the liver and chest easier to see.
What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasnt spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called locally advanced breast cancer. The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.
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The Breast Cancer Stages: From 0 To 4
The stage of your cancer will appear on your pathology report, a report that details the size, shape and look of the cancer cells under a microscope. . Most cancers, including invasive breast cancer, have four stages.
Stage 0 is abnormal cells that have not spread beyond the ducts or lobules of the breast, such as DCIS or LCIS, respectively.
Stage I cancer is invasive and spreading beyond where it started.
In Stage IA, the cancer is 2 cm or smaller and has not spread into the lymph nodes or outside of the breast.
In Stage IB, small clumps of cancer cells ranging from 0.2 to 2 mm exist in the lymph nodes. There may not be a tumor in the breast, but if there is, it measures no bigger than 2 cm.
Stage II cancer also has two subcategories. Stage IIA describes a cancer that has spread to 1 to 3 lymph nodes under your arms with or without a tumor up to 2 cm large in the breast, or the breast tumor measures 2 to 5 cm without cancer cells in the axillary lymph nodes.
Stage IIB refers to a tumor between 2 and 5 cm along with cancer in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone, or the tumor is larger than 5 cm when no cancer cells exist in the axillary lymph nodes.
In Stage IIIB, the tumor has reached the skin of your breast and/or your chest wall and up to 9 lymph nodes under your arms or near your breastbone.
Inflammatory breast cancer is automatically Stage IIIB or a later stage.
Stage IIIC involves three behaviors of the cancer:
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Grouping Breast Cancer Stages
There are five stages of breast cancer. These stages are determined based on the tumor size, lymph node involvement and whether the cancer has spread to another part of the body.
Stage 0
Non-invasive or in situ cancer . In Stage 0 there is no evidence of cancer cells breaking out of the part of the breast in which they started. Pagets disease is typically stage 0.
Stage I
Invasive breast cancer with small tumor size and limited nodal involvement.
Stage II
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What Does It Mean To Have Stage 1 Breast Cancer
In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.
Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.
Stages Of Breast Cancer: Stage Iiib
A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either
- axillary lymph node metastasis
- internal mammary node metastasis
presenting in such a way as to suggest that total surgical removal is not possible.
There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.
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Grade And Rate Of Growth
Predicting the cancer cells speed and way of growing is an important consideration in categorizing a patients breast cancer.
Rate of growth S-phase fraction and Ki67 tests will likely be performed to measure cell growth. These tests are not always accurate, so other factors will also be used to make decisions.
Patterns of cell growth How a cancer grows is measured on a scale of one to three, one for a cancer that grows slowly or predictably and three for a cancer that is more irregular in its growth pattern.
Necrosis/dead cells The presence of dead cells is one sign that the tumor has aggressive growth.
Lymphatic invasion If the tumor cells have gotten into the fluid channels of the breast, they are categorized this way. These cancers have an increased risk of spreading beyond the breast to lymph nodes and/or to other organs within the body.
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What Is The Most Aggressive Type Of Breast Cancer
Any breast cancer that is metastatic, or stage IV, is aggressive because it has already spread beyond the breast. Some other breast cancer types are considered more aggressive than others, including inflammatory breast cancer and triple-negative breast cancer. These may be more likely to spread, less responsive to treatment, or at higher risk of returning after treatment.
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What Do Cancer Stages And Grades Mean
The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells.
If youre diagnosed with cancer, you may have more tests to help determine how far it has progressed. Staging and grading the cancer will allow the doctors to determine its size, whether it has spread and the best treatment options.
Breast Cancer Stage: What Do They Mean
Stages are numbers used to describe how far a cancer has advanced and where it has spread in the body. Cancer that has not spread beyond your breast is considered local.
Regional cancer has spread into the breast skin, chest structures, and lymph nodes. When cancer spreads to other parts of the body, it is considered distant since it exists far away from just the breasts.
Your prognosis, or your long-term outcome, relies heavily on what stage your cancer is. Cancer stages are often further broken down into subcategories to provide more specific information.
Staging previously relied only on whether it is invasive or noninvasive, the tumors size, which lymph nodes contained cancer, and where and how far the cancer had spread.
Breast cancer stages now also take into account the tumors grade and the cancers estrogen receptor, progesterone receptor, and HER2 status.
Estrogen receptor, progesterone receptor, and HER2 status all have to do with the specific hormones and/or proteins involved in your cancer. The tumor grade describes what the cancer cells look like.
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Expert Review And References
- American Cancer Society. Breast Cancer. 2015: .
- de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. Journal of the National Cancer Institute. Oxford University Press 2010.
- Lonning PE. Breast cancer prognostication and prediction: are we making progress?. Annals of Oncology. Oxford: Oxford University Press 2007.
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
- Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing 2008: pp. 473-514.
Stage 2 Breast Cancer
Stage 2 breast cancer is divided into two groups:
- Stage 2A
- Stage 2B
Stage 2A can mean:
No cancer is seen in the breast but cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is 2cm or smaller and cancer is found in one to three lymph nodes under the arm or near the breastbone.
The cancer in the breast is larger than 2cm but smaller than 5cm and no cancer is found in the lymph nodes under the arm.
Stage 2B can mean:
The cancer in the breast is larger than 2cm but smaller than 5cm. Cancer is found in one to three lymph nodes under the arm or near the breastbone
The cancer in the breast is larger than 5cm and no cancer is found in the lymph nodes under the arm.
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Side Effects And Complications
All treatments have some side effects that range from mild to severe. Most clear up when treatment ends, but there can be some lasting complications.
Its important to tell your oncologist about all symptoms, even if they seem minor. Your healthcare team will work with you to ease side effects and deal with complications.
Risk Factors For Breast Cancer
There are several risk factors that increase your chances of getting breast cancer. However, having any of these doesnt mean you will definitely develop the disease.
Some risk factors cant be avoided, such as family history. You can change other risk factors, such as quitting smoking, if you smoke. Risk factors for breast cancer include:
- Age. Your risk for developing breast cancer increases as you age. Most invasive breast cancers are found in women over age 55 years.
- Drinking alcohol. Alcohol use disorder raises your risk.
- Having dense breast tissue. Dense breast tissue makes mammograms hard to read. It also increases your risk for breast cancer.
- Gender. White women are
While there are risk factors you cant control, following a healthy lifestyle, getting regular screenings, and taking any preventive measures your doctor recommends can help reduce your risk for developing breast cancer.
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Prognosis For Breast Cancer
The prognosis is the likely outcome of a disease.
If the test results show breast cancer, you may wish to speak with your treatment team about the prognosis.
The doctors will look at the type and stage of the cancer as well as your age and general health to give a prognosis, but no doctor can predict the exact outcome for you.
Tumor Grades: How The Cells Look
The tumor grade, sometimes called the cell grade, is a scale of G1 to G3 that identifies how abnormal the cancer cells look under a microscope.
Cells in grade 1 tumors look almost normal and grow and spread slowly. Grade 3 cells are the most abnormal and grow the fastest. Grade 2 cells fall between grades 1 and 3.
Part of a womans prognosis, or long-term outcome, depends on the cancers stage and the tumors grade. Other factors that affect prognosis include the type of breast cancer a woman has, the hormones or proteins involved, and how quickly tumor cells are dividing and the tumor is growing.
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Tnm System For Breast Cancer
Doctors also group cancers by the letters T, N, or M. Each of those letters tells you something about your cancer.
âTâ stands for tumor, or the lump of cancer found in the breast itself. The higher the number assigned after it, the bigger or wider the mass.
âNâ stands for nodes, as in lymph nodes. These small filters are found throughout the body, and they’re especially dense in and around the breast. They’re meant to catch cancer cells before they travel to other parts of the body. Here, too, a number tells you whether the cancer has spread to lymph nodes near the breast and, if so, how many.
âMâ stands for metastasis. The cancer has spread beyond the breast and lymph nodes.
Breast Cancer Staging Process
Breast cancer staging is determined by how large tumors are, how far theyve spread, and other characteristics like the genetics of the tumor. Your cancer stage can be determined before surgery or after surgery .
Cancers clinical stage is determined through a physical exam, biopsy , and imaging tests. These imaging tests may include X-rays, computed tomography , positron-emission tomography , magnetic resonance imaging , or ultrasound.
After surgery, your breast cancer stage will either be confirmed or updated as a pathologic stage, using the features found and any additional information about how far cancer has spread gathered during surgery.
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Questions To Ask The Health Care Team
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What tests will I need to have to determine my cancers stage?
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What is the stage of the cancer that I have? What does this mean?
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How did you determine the cancers stage?
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What is the cancers grade?
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Does the tumor have any genetic mutations?
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Are biomarkers used in determining the stage of my cancer or in defining my treatment? If so, what are those biomarkers, what are the results, and what does that mean?
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What does the stage, grade, and biomarker testing mean for my treatment plan or my prognosis?
Breast Cancer Stage Groups
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present. To plan the best treatment and understand your prognosis, it is important to know the breast cancer stage.
There are 3 types of breast cancer stage groups:
- Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests , and biopsies. The Clinical Prognostic Stage is described by the TNM system, tumor grade, and biomarker status . In clinical staging, mammography or ultrasound is used to check the lymph nodes for signs of cancer.
- Pathological Prognostic Stage is then used for patients who have surgery as their first treatment. The Pathological Prognostic Stage is based on all clinical information, biomarker status, and laboratory test results from breast tissue and lymph nodes removed during surgery.
- Anatomic Stage is based on the size and the spread of cancer as described by the TNM system. The Anatomic Stage is used in parts of the world where biomarker testing is not available. It is not used in the United States.
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What Is Stage 3 Breast Cancer
Also known as locally advanced breast cancer, the tumor in this stage of breast cancer is more than 2 inches in diameter across and the cancer is extensive in the underarm lymph nodes or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is a more advanced form of invasive breast cancer. At this stage, the cancer cells have usually not spread to more distant sites in the body, but they are present in several axillary lymph nodes. The tumor may also be quite large at this stage, possibly extending to the chest wall or the skin of the breast.
Stage 3 breast cancer is divided into three categories:
Stage 3A: One of the following is true:
- No tumor is found in the breast, but cancer is present in axillary lymph nodes that are attached to either other or other structures, or cancer may be found in the lymph nodes near the breast bone, or
- The tumor is 2 cm or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or other structures, or cancer may have spread to lymph nodes near the breastbone, or
- The tumor is 2 cm to 4 cm in size. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breast bone, or
- The tumor is larger than 5 cm. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
Stage 3C: