Outlook Once Cancer Has Spread To The Bones
The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.
The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.
Rapidly treating bone metastasis can lead to a
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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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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Drugs To Treat Bone Metastases
The drugs used most often for treating bone problems in people with bone metastases are the bisphosphonate drugs pamidronate and zoledronic acid and the drug denosumab . These drugs are given intravenously or subcutaneously . Most patients are treated once a month at first, but may be able to be treated less often later on if they are doing well. Treatment with one of these drugs can help prevent further bone damage and events related to weakened bones such as fractures, hypercalcemia, and spinal cord compression.
These treatments can have a rare but serious side effect called osteonecrosis of the jaw . Patients complain of pain and doctors find that part of the jawbone has died. This can lead to an open sore that doesnt heal or tooth loss in that area. The jawbone can also become infected. Having jaw surgery or having a tooth removed can trigger this problem. It is best to avoid these procedures while you are taking one of these medicines. One way to avoid these dental procedures is to maintain good oral hygiene by flossing, brushing, making sure that dentures fit properly, and having regular dental checkups. Any tooth or gum infections should be treated right away. If ONJ does occur, the doctor will stop the bone medicine.
How Are Bone Metastases Treated
Although it is not possible to cure bone metastases, they are not usually life-threatening. Many women enjoy active lives for many years after bone metastases are diagnosed.
Treatments for bone metastases aim to improve your quality of life by reducing symptoms, such as pain or bone fractures. Treatment will depend on:
- which bones are affected
- whether your bones have been weakened and are in danger of breaking
- characteristics of your original breast cancer, such as type of tumour and the type of receptor the tumour had or HER2 receptor)
- other treatments you have had for primary or secondary breast cancer
- systemic cancer treatments which work on the whole body.
Treatments are often very effective in stopping the growth or decreasing the size of cancerous deposits in the bones. Current treatments are not usually able to completely remove all cancer cells from the bones.
There are three types of treatment for bone metastases:
- treatments to control pain
- local treatments for the bones which are directed at a single bone or area
- systemic cancer treatments (such as
- hormone-blocking therapy, HER2-blocking drugs and chemotherapy) which work on the whole body.
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Will I Need More Than One Treatment For Metastatic Breast Cancer
Medications are important for metastatic breast cancer to help control its spread. Resistance to therapies may develop, which can lead your care team to recommend a change in treatment.
When you start a treatment regimen, you and your care team will see how:
- The cancer responds to the therapy.
- The side effects impact you.
If the treatment isnt working or the side effects are unbearable, your care team can discuss switching the treatment method. They may recommend a different drug, dosage or schedule.
There are many treatments available. If one therapy isnt working for you for whatever reason, there is usually another one you can try.
Treatment Options For Metastatic Breast Cancer
Treatment for metastatic breast cancer often is based on systemic therapies, which use drugs rather than surgery or radiation. Metastases treatments are designed to shrink tumors and slow their growth, help ease symptoms and improve quality of life. Treatment may change, such as when one therapy stops working, or the side effects become too uncomfortable. Rather than having only one treatment, most patients undergo several treatments combined to help fight the cancer.
The four broad categories of drug-based treatments are:
Too Much Calcium In The Blood
Too much calcium in the blood can cause symptoms such as:
- Passing large amounts of urine
Hypercalcaemia is a medical emergency and can be serious if not diagnosed quickly. Its important to know who to report these symptoms to if they occur, so check this with your treatment team.
To relieve symptoms you might be told to drink plenty of water. However, many people will need to be given fluids into a vein to help flush the calcium out of the body.
If youre not already having bone-strengthening drugs, your treatment team will prescribe these.
Eating foods that contain calcium or taking prescribed calcium supplements does not cause hypercalcaemia.
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.
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When Can Bone Metastases Occur
Bone metastases may be present when metastatic breast cancer is first diagnosed, or the cancer may spread to the bones later.
The bones are the first site of metastases for almost half of women diagnosed with metastatic breast cancer . For many of these women, the bones will be the only site of metastases .
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:
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Osteoclasts And The Vicious Cycle Model Of Bone Loss
The entry of breast cancer cells into the bone micro-environment synergistically increases the complexity of cell-cell interactions. A working model to describe the bone remodeling compartment in the presence of metastatic cancer cells has been referred to as the ‘vicious cycle of bone metastasis’ . There are many excellent reviews describing this paradigm from its inception in the 1990 s. The minimal essential components are osteoblasts, osteoclasts, tumor cells and the mineralized bone matrix. According to this paradigm, the tumor cells produce a variety of growth factors, most notably parathyroid hormone-related protein . The role of PTHrP in bone metabolism is not fully understood, but it is known to cause upregulation of RANKL and downregulation of OPG , thus enhancing osteoclast function leading to bone degradation. In the process, growth factors stored in the matrix, such as transforming growth factor -, vascular endothelial growth factor , insulin-like growth factors , bone morphogenic proteins and fibroblast-derived factors, as well as calcium, are released into the bone microenvironment. These factors can stimulate the tumor cells to proliferate and produce more growth factors and more PTHrP, further perpetuating the vicious cycle of bone metastasis.
About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
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Symptoms If Cancer Has Spread To The Lymph Nodes
Lymph nodes are part of a system of tubes and glands in the body that filters body fluids and fights infection.
The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. You might have any of the following symptoms if your cancer has spread to the lymph nodes:
- a lump or swelling under your armpit
- swelling in your arm or hand
- a lump or swelling in your breast bone or collar bone area
One of the first places breast cancer can spread to is the lymph nodes under the arm on the same side as the breast cancer. This is not a secondary cancer.
What Are The Symptoms Of Breast Cancer That Has Spread To The Bones
When it does occur, signs and symptoms of bone metastasis include:
- Weakness in the legs or arms.
- High levels of calcium in the blood , which can cause nausea, vomiting, constipation and confusion.
Furthermore, where is the first place breast cancer spreads?
Breast Cancer Spreadscancer spreadsbreastmetastaticplacesspreads
What are the signs that breast cancer has spread?
You may have any of the following symptoms if cancer has spread to your liver:
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Stage Iv Breast Cancers May Be Recurrences Following Initial Treatment
Up to 5% of initial breast cancer diagnoses are of the most advanced or metastatic stage. However, this number has significantly reduced with the implementation of widespread breast cancer screening programs.
Metastatic breast cancer can appear to be a rapid deterioration of a disease that has been present for some time undetected.
But metastatic breast cancer can also be the result of a recurrence of breast cancer after successful initial treatment. Sometimes the terms local and regional recurrence indicate a return of breast cancer to the original tumor site or elsewhere in the breast or contralateral breast.
If the cancer returns in other areas of the body it is a distant metastasis or distant recurrence.
For more detail on Stage IV survival rates, recurrence rates and treatment please see our new post HERE.
How Is Metastatic Breast Cancer Treated
The main treatment for metastatic breast cancer is systemic therapy. These therapies treat the entire body. Systemic treatments may include a combination of:
Your care team will plan your treatment based on:
- Body parts cancer has reached.
- Past breast cancer treatments.
- Tumor biology, or how the cancer cells look and behave.
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Where Can Breast Cancer Spread
The most common places for breast cancer to spread to are the lymph nodes, bone, liver, lungs and brain. The symptoms you may experience will depend on where in the body the cancer has spread to. You might not have all of the symptoms mentioned here.
Remember other conditions can cause these symptoms. They dont necessarily mean that you have cancer that has spread. But if you have symptoms that you are worried about, discuss them with your GP, cancer specialist, or breast care nurse so that you can be checked.
Physiological States That Exacerbate Osteolysis
While not directly responsible for osteolysis in metastatic breast cancer disease, there are physiological parameters that can amplify the degree of bone loss. Clinical studies of newly diagnosed breast cancer patients have revealed that high bone turnover correlates with a higher risk of skeletal complications . For post-menopausal women, high bone turnover may be caused by estrogen deficiency. Estrogen profoundly affects bone remodeling by suppressing production of RANKL while increasing production of OPG. Estrogen also increases osteoblast pro-collagen synthesis and decreases osteoblast apoptosis . In addition, production of inflammatory cytokines is suppressed by estrogen . Estrogen has also been shown to promote osteoclast apoptosis and inhibit activation of mature osteoclasts. Unfortunately, some of the therapies used for breast cancer patients may exacerbate the problem. For example, the use of aromatase inhibitors increases the risk for osteoporosis. Chemotherapy may bring about ovarian failure and premature menopause .
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Getting Back On Track: How Bone Metastases Are Treated
Oncologists have a range of tools that can help alleviate the pain and discomfort of bone metastases as well as treat the cancer itself, including:
Other ways to effectively manage pain and discomfort from bone metastases include using hot and cold compresses practicing relaxation methods like meditation, physical therapy, or yoga and doing other gentle forms of exercise. Ask your health care team about programs that can help keep you safely active. Strong muscles protect bones, stresses Huston, and being active makes you feel better both physically and psychologically.
Where Does Breast Cancer Metastasize To
Sometimes, breast cancer spreads to other parts of the body. This does not always happen, but when it does, it is known as metastatic breast cancer.
Metastatic breast cancer is treated differently than localized breast cancer. As a result, oncologists typically check for evidence of metastasis during the diagnostic/staging process. Additionally, breast cancer can spread after a patient has been diagnosed. To watch for potential signs of metastasis, patients are typically scheduled for frequent imaging scans during and after treatment.
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High Blood Calcium Levels
When cancer spreads to the bones, too much calcium from the bones can be released into the bloodstream. This is called hypercalcemia.
High blood calcium levels can cause problems such as
- Feeling thirsty all the time and drinking lots of liquids
- Muscle weakness
- Kidney failure.
Treatment includes giving large amounts of intravenous fluids to protect the affected kidneys and medicines such as bisphosphonate drugs to bring blood calcium levels down quickly. Once the calcium level is back to normal, treating the cancer can help keep the calcium level from getting too high again.
Can Breast Cancer Cause Pain In Shoulder And Arm
After having treatment for breast cancer, you might experience pain in your arms and shoulders, mostly on the same side of your body as the treatment. Its also common to have stiffness, swelling, and a reduced range of motion in your arms and shoulders. Sometimes, it can take months for these complications to appear.