What Happens When Cancer Spreads To The Brain
If you or a loved one have been diagnosed with cancer, youve probably heard the term metastasis. This refers to when cancer develops in one part of the body and then spreads to another part of the body . This generally happens when cancer cells detach from the main tumor , travel through the bloodstream or lymphatic system and then settle in another part of the body and begin growing there, as well . The metastatic tumors are usually composed of the same type of cancer cells as the primary tumor, although they might develop new mutations.
When cancer spreads from a different part of the body to the brain, the metastatic tumors are referred to as brain metastases. The brain is a relatively common location for metastasis to occur. In fact, one in four cancer patients experience brain metastasis. And, brain metastases are the most common type of brain tumor diagnosed among adults. Although any type of cancer can spread to the brain, brain metastases most often originate from cancer in the lungs, breasts, kidneys or colon.
What You Need To Know
- Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
- The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney;and thyroid gland.
- Metastatic brain tumors are five times more common than primary brain tumors .
- Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.
Breast Cancer Cell Growth
Cancer begins when a normal breast cell undergoes a number of mutations in genes that control the growth of the cell. These mutations may occur over a long period of time, even decades, before a cancer cell forms.
A cancer cell must divide on average 30 times before it forms a mass that can be felt in the breast. Since tumor cells multiply and divide exponentiallyone cell becomes two, two cells become four, and so ona tumor will increase more rapidly in size the larger it is.
That said, not all cells are dividing at one time, and growth can be different at different stages in the formation of a tumor. Compared with many types of cancer, breast cancer has a “low growth fraction,” meaning that the proportion of cancer cells that are in an active cell cycle is low.
Some tumors, such as some leukemias and lymphomas, have much higher growth fractions .
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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.
One New Therapy Recently Approved Others On The Horizon
byJeff Minerd, Contributing Writer, MedPage Today December 16, 2020
Brain metastases are one of the most common and difficult-to-treat occurrences in metastatic breast cancer. They are found in 10% to 30% of patients. In patients with HER2-positive breast cancer, the rate of brain metastases is even higher — up to 50%.
Initial treatments for brain metastases include locally directed therapy with surgical resection, stereotactic radiosurgery, and/or whole-brain radiation therapy. Unfortunately, the rate of intracranial progression with these therapies is high. Even more problematic, most systemic therapies have limited efficacy due to their inability to pass through the blood-brain barrier.
“As patients live longer, they remain at risk for additional episodes of CNS progression and/or new CNS metastases,” Nancy Lin, MD, of the Dana-Farber Cancer Institute in Boston, told MedPage Today. “While radiation therapy can be effective, we don’t have as robust data on many systemic therapy options and very much need to develop new and better systemic options for treatment of brain metastases.”
One new therapy became available in April 2020. The FDA approved tucatinib , in combination with trastuzumab and capecitabine, for adult patients with advanced unresectable or metastatic HER2-positive breast cancer, including patients with brain metastases, who have received one or more prior anti-HER2-based regimens in the metastatic setting.
Drugs Being Investigated
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Dilemmas Of Stage Iv Breast Cancer
Indeed, there are many serious and personal questions involving stage IV breast cancer.; So, overall survival is less likely, and gains from intensive breast cancer treatment are unfortunately rather modest.; A serious consideration is, therefore,;quality of life during the course of treatment.
These decisions tend to be a dynamic process, based on individual cases, between patients and physicians.; Respect needs to be given to the expectations for treatment, the status of the disease and the patient wishes.
H&o How Common Are Brain Metastases
CA; Lung cancer, melanoma, and breast cancer are the 3 types of cancers that are most likely to metastasize to the brain. Other solid-tumor cancers and some hematologic malignancies also can metastasize to the brain, but this occurs much less frequently. Brain metastases are common enough in advanced lung cancer that we order magnetic resonance imaging of the brain at initial presentation, whereas we proceed with intracranial imaging in advanced breast cancer only if patients have symptoms that are suggestive of brain metastases.
Across all subtypes, approximately 10% to 15% of women with metastatic breast cancer develop brain metastases. This rate is as high as 30% for women with advanced human epidermal growth factor receptor 2 -positive disease, and as high as 50% for women with metastatic triple-negative breast cancer.
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How Does Spreading Happen
There are several ways cancer can spread in the body.
- Direct invasion happens when the tumor has spread to a nearby organ in the body. The cancer cells take root and begin to grow in this new area.
- Lymphangitic spread occurs when cancer travels through the lymphatic system. Breast cancer often involves the nearby lymph nodes, so the cancer can enter the lymph circulatory system and take hold in different parts of the body.
- Hematogenous spread moves in much the same way as lymphangitic spread but through the blood vessels. The cancer cells travel through the body and take root in remote areas and organs.
When cancer starts in the breast tissue, it may often spread to the lymph nodes before affecting other parts of the body. Breast cancer most commonly spreads to the:
The type of test you end up having will depend on your medical history and symptoms. For example, if you or your doctor suspects the cancer may have spread to your abdomen, you may have an ultrasound.
CT and MRI scans can help your doctor visualize various parts of the body all at once. A PET scan can be helpful if your doctor thinks the cancer may have spread but isnt sure where.
All of these tests are relatively noninvasive, and they shouldnt require a hospital stay. You may be given special instructions before your test.
If you have a CT scan, for instance, you may need to drink an oral contrast agent to help outline different features inside your body.
Cancer In The Tissue Around The Brain And Spinal Cord
Sometimes breast cancer spreads to tissues and fluid that surround the brain and spinal cord. This is known as leptomeningeal metastases.
Symptoms are similar to those of secondary breast cancer in the brain, but may be less obvious and more difficult to diagnose.;
Its usually diagnosed using an MRI scan, but you may also have a lumbar puncture to take a sample of fluid to be looked at under a microscope.;
Treatment can include steroids, radiotherapy and chemotherapy. Chemotherapy or targeted therapy drugs may be given directly into the fluid surrounding the brain and spinal cord to treat the cancer.;
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What Are The Complications Of Breast Cancer Recurrence
Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.
If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.
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H&o Is There Anything Else You Would Like To Say About How Quality Of Life Is Affected By Treatment For Brain Metastases
CA; We have to strike a careful balance when we decide how much therapy to administer to patients with brain metastases. Approximately a decade ago, a study attempted to tease out which was more responsible for decline in quality of life in patients with cancer: therapies or disease.Although treatments have side effects, they often do not compromise quality of life as much as the symptoms from progressive disease. The ultimate goal is to shield our patients from the side effects of brain metastases.
Why It Spreads And Recurs
You may be wondering why breast cancer cells travel at all. Or, why normal cells don’t spread around our bodies. Cancer cells differ from normal cells in many ways. One of these is that normal cells have what is known as “adhesion molecules.” These adhesion molecules act like glue and keep cells where they belong in a particular part of the body.
Normal cells also have “boundaries” or ways in which cells communicate with each other. This is like one country saying to another “you don’t belong here.” Cancer cells, in contrast, don’t respect these cellular communications, essentially ignoring the “fences” between different tissues.
Yet another confusing topic when talking about breast cancer spread is why it can happen years or even decades later. We know that, especially with estrogen receptor-positive breast cancers, cancer can seemingly disappear only to recur many years after the original tumor. Nobody is certain exactly how this happens, but there are theories about recurrence that suggest that some breast cancer cells are hardier than others and that these cancer “stem cells” are able to lie dormant even through treatment.
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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.
Level Of Care After Wbrt
Fifty-seven patients were never discharged from hospital following WBRT . The median survival in this group was 1.1;month . Among the patients that were hospitalized before WBRT, 45 did not come home again, whereas this was true for 12 patients among those who were at home before WBRT . Among patients with WHO 01 before WBRT, 124 came home again, whereas if WHO was 2, 46 patients came home, and if the WHO was 34, 14 came home . In the first logistic regression model adjusting only for age and calendar period, poor performance status was most strongly associated with not coming home . Other associated factors included triple-negative tumor status, short duration between primary breast cancer diagnosis and WBRT, few palliative chemotherapy lines, inpatient care before WBRT as well as high age at diagnosis . With additional adjustment for performance status, hospital or palliative inpatient care the week before WBRT remained significantly associated with not coming home after WBRT. Also, living with a partner and children at home emerged as a protective factor for not coming home .
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The Bloodtumor Barrier In Bm
Similar to the BBB, the presence of the BTB also limits the access of potentially effective drugs to BM. The excessive production of proangiogenic factors in metastatic tumors, such as BM from breast cancer or other cancers, stimulates abnormal angiogenesis, resulting in a vasculature characterized by the presence of fenestrated vessels that increase paracellular permeability, referred to as the BTB .49 In contrast to the normal BBB, the BTB is leaky and tends to allow the extravasation of lager molecules.50 However, BTB permeability exhibits clear heterogeneity, both within lesions and among the BMs of different breast cancer subtypes. High expression of the pericyte protein desmin was shown to be correlated with the increased permeability of the BTB, indicative of the involvement of vascular remodeling.51
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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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.
Brain Metastases And Wbrt
At the time of WBRT, about half of the patients had massive metastatic spread to the brain, whereas 33 patients had 13 metastases, 26 had 46 metastases, 11 had 79 metastases, and 53 had leptomeningeal metastases. Most of the patients were treated with 4;Gy;×;5 and 27 with 3;Gy;×;10 and all patients had concomitant steroids. The patients that received 3;Gy;×;10 were mostly treated during the early study period . Prior to WBRT, 17 of the patients had received stereotactic radiotherapy for their brain metastases, 7 had surgery, and 8 had both. Thirteen patients started but could not complete the WBRT. When treatment with WBRT was decided, 129 patients had WHO performance status score 01, whereas 71 were symptomatic with WHO score 2 and 41 with WHO score 34. In all, 96 patients were in hospital, whereas 146 were at home. .
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
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
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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