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Metastatic Breast Cancer In Liver

Who Gets Liver Metastasis

What is Metastatic Liver Cancer?

After the bones and lungs, the liver is the third most common place for breast cancer to spread. About half of people diagnosed with metastatic breast cancer develop liver metastasis. Women with metastatic breast cancer to the liver usually have metastasis in other parts of the body as well, but not always. Breast cancer that spreads to the liver can include cancers with different cell characteristics, including hormone receptor-positive, HER2 -positive, or triple-negative breast cancers. Its possible for people of any background or age to develop liver metastasis.

Liver Metastasis: The 3rd Most Common Site

The liver is the third most common site for metastases. The symptoms of liver metastases, which are often quite subtle, dont begin to occur until after the cancer has taken up a lot of room in the liver, and that can take some time to happen.

The symptoms are commonweight loss, loss of appetite, nausea, gastrointestinal symptoms, and pain or discomfort under your right rib cage. You may have some pain in the right upper quadrant of your liver, which occurs when the livers covering tissue is stretched out.

A diagnosis of liver metastasis is often suspected from blood tests and confirmed by CT, MRI, PET scanning or, on occasion, ultrasound. The major treatment for extensive liver disease is chemotherapy, especially if your liver function blood tests are elevated. Hormone therapy can work well on hormone-sensitive and slower-growing liver metastases, and the decision to use it usually depends on the extent of damage present in the liver.

Source: DrSusanLoveResearch.org retrieved September 2016

Breast Cancer Metastasis To The Liver

Breast Cancer Metastasis to the Liver- A Comprehensive Overview of the Progression and TreatmentAbout 50% of people with metastatic breast cancer have liver metastases, and 5% to 12% develop liver metastases as the primary site of breast cancer recurrence. The exact rate is difficult to determine because metastasis often goes undetected and the majority of patients with metastatic breast cancer present with liver metastases after diagnosis of the primary breast cancer.

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Diagnosing Metastatic Breast Cancer

To diagnose metastatic breast cancer, your doctor may recommend one or more tests:

Blood Tests

  • A complete blood count to assess your bone marrow function
  • Tests for minerals and enzymes that can provide evidence of spreading cancer or other health conditions
  • Tests for proteins that signal the presence of cancer

Imaging Tests

Can Breast Cancer Recur At The Same Site

Breast Cancer Liver Metastases: US

Yes, it can recur locally or regionally. Symptoms of a local recurrence are a new lump, a firm area, pulling or swelling at the site, redness, change in the shape of the nipple, and thickening near the scar. Symptoms of regional recurrence, which includes the underarm lymph nodes and upper chest area on the same side as the initial cancer, are a lump, swelling, or numbness of the arm, pain, and problems swallowing. These symptoms warrant prompt reporting to your physician.

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Breast Cancer Metastasis To Liver Survival Rate

The survival rate for breast cancer spread to the liver depends on several factors, including the type and stage of the breast cancer, the size and number of liver tumors, and the patient’s overall health. In general, the survival rate for breast cancer metastasis to the liver is lower than the survival rate for breast cancer that has not spread to other organs.

According to the American Cancer Society, the five-year survival rate for breast cancer that has not spread to other parts of the body is about 98%. The five-year survival rate for breast cancer that has spread to other parts of the body is about 27%.

It is important to note that survival rates can vary widely depending on the specific circumstances of each individual. Some people with breast cancer metastasis to liver life expectancy may live longer than others.

Mechanisms Of Breast Cancer Metastasis

No one really knows what factors will make a certain patient more or less susceptible to breast cancer metastasis.

There is growing awareness that part of that susceptibility is due to host factors. The host factors are the characteristics of the non-malignant cells and the general biological environment surrounding the malignant breast tumor.

Sometimes the host factors are referred to as the pre-metastatic niche and it is thought that bone-marrow-derived progenitor cells may directly influence the dissemination of malignant cells to distant areas.

Non-neoplastichost cells within the tumor may also play a key role in the regulation of breast cancer metastasis.

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What Can I Expect While Living With Metastatic Breast Cancer

Your care team will monitor you every few months to check if the cancer is responding to treatment, and also to see if you are having any side effects. The process of restaging the cancer includes:

  • History/physical exam.
  • Imaging tests, including CTs and bone scan or PET scan.

Before your scans or tests, its normal to feel anxiety. It may help to bring a friend or family member to the appointment with you.

Palliative And Supportive Care

The Toxicity of T-DM1 in Breast Cancer Patients with Liver Metastases

Palliative and supportive care focuses on symptom control and support. Its an extremely important part of the care and treatment for many people living with secondary breast cancer and can significantly improve quality of life for them and their families.

People often associate palliative care with end-of-life treatment. However, many people value having it at any stage of their illness, alongside their medical treatment, to help prevent and relieve symptoms such as pain or fatigue. It can also help with the emotional, social and spiritual effects of secondary breast cancer.

The palliative and support care teams are based in hospitals, hospices and the community. You can be referred by your treatment team, GP or breast care nurse depending on your situation.

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How To Handle Emotions

Coping with the many symptoms that can occur with stage 4 breast cancer can be frustrating and discouraging, and people sometimes wonder if they will have to feel poorly the rest of their lives. Anxiety and depression are also severe for some people with advanced disease.

Fortunately, palliative care team consults are now offered at many cancer centers. While hospice is a form of palliative care, palliative care can be helpful even with early, curable tumors. Working with a palliative care team to address physical and emotional issues frees you up to work with your oncologist on issues that treat your cancer specifically.

While the research is also young, it appears that those people who receive palliative care consults not only have a better quality of life with advanced cancer, but they may actually live longer, too.

How Do Breast Cancers Spread

Cancer cells break away from the primary tumor, entering the bloodstream or the lymphatic system. As large vessels narrow, cancer cells stop traveling and lodge themselves in a new area. Then they begin dividing and moving into surrounding tissue. The cancer cells take over the new area, crowding out healthy cells and forming a new tumor. Cancer cells are insidious because the new tumor can set up its own network of blood vessels to obtain nutrients for growth and further spread.

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Prognostic Model And Validation

In the multivariate Cox regression model, molecular subtypes , MFI, sites of extrahepatic metastasis , and liver function tests were associated with OS . Specifically, the death risk of HR negative and HER2 negative patients increased compared to HR or HER2 positive counterparts. The length of MFI also had a significant impact on the survival of BCLM patients, and therefore, the survival of patients with a long MFI was shortened in comparison with patients with de novo MBC, and patients with a short MFI had more than twice the risk of death relative to them. In addition, presence of extrahepatic metastasis and abnormal liver function were all correlated with an unfavorable prognostic impact on OS. This prognostic model had the area under the curve of time-dependent ROC at 1 year OS with 0.78 in the training set and 0.80 in the validation set, indicating this model had a good discrimination . The bootstrapping method was used to confirm the stability of our prognostic model in the training set, and the final results were rather robust . Calibration curves of the prognostic model for 1 year and 3 year OS in the training set as well as 1 year OS in the validation set showed its good concordance .

Table 2. Multivariate Cox regression model .

Figure 1. Time-dependent ROC curves of the prognostic model in the training set and the validation set . Overall survival from metastasis of the three prognostic groups in the training and validation set .

Exercise And Secondary Breast Cancer In The Liver

Complete pathologic response of HER2

Some people with secondary breast cancer in the liver have no symptoms while others have a combination of pain, sickness, loss of appetite, hiccups, tiredness and fatigue. While physical activity may help reduce some symptoms its important to listen to your body and not push yourself too hard. Gentle, regular activity, such as walking, is often most effective.

If youre currently having treatment you may need to exercise at a slightly lower level. Stop straight away if it hurts or feels like youre working too hard.

When choosing your exercise, try to focus on aerobic activities such as walking, swimming or cycling. Activities such as dancing and gardening can also be beneficial. You could also include some light toning or conditioning exercises such as stretching or low-impact yoga. The most important thing is to choose something you can safely enjoy.

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How Is Metastatic Breast Cancer Diagnosed

If you have symptoms of metastatic breast cancer, your provider may recommend tests including:

  • Blood tests, including complete blood count and comprehensive metabolic panel.
  • Imaging studies, including MRI, CT, bone scan and PET.
  • Bronchoscopy, which uses a scope to look inside your lungs this can be done if there is a concerning spot in the lungs.
  • Biopsy to remove tissue from a suspicious area and analyze it.
  • A tap to remove fluid from an area with symptoms. For example, pleural tap removes fluid from the lung area. Spinal tap removes fluid from the spinal cord area.

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.

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Intrahepatic Chemotherapy And Chemoembolisation

Intrahepatic chemotherapy and chemoembolisation involve giving chemotherapy directly into the liver. This is done through a thin tube, called a catheter, into the main blood supply to the liver.

Giving chemotherapy directly into the liver means a higher concentration of the drug can be delivered to the area of cancer.

In chemoembolisation, the chemotherapy is delivered along with an oily liquid or foam which blocks the blood supply to the cancer. The cancer is deprived of oxygen and nutrients, and the chemotherapy stays in the area for longer. The liver continues to be supplied with blood in the normal way.

These treatments may not be routinely available on the NHS but may be offered as part of a clinical trial.

Prognostic Score For De Novo Metastatic Breast Cancer With Liver Metastasis And Its Predictive Value Of Locoregional Treatment Benefit

Ones For Wellness: Metastatic Breast Cancer
  • 1Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
  • 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
  • 3Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China

Background: There is a significant survival difference and lack of effective treatment among breast cancer patients with liver metastasis. This present study aimed to construct a novel prognostic score for predicting the prognosis and locoregional treatment benefit of de novo metastatic breast cancer with liver metastasis .

Methods: In total, 2,398 eligible patients between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results database. They were assigned to the training set including 1,662 patients and validation set comprising 736 patients depending on the time of diagnosis. The prognostic score was based on regression coefficients in the multivariate Cox regression analysis. And then, patients were stratified into low-, intermediate-, and high-risk groups by the prognostic score. The discrimination and calibration of prognostic score were evaluated using time-dependent receiver operating characteristic curves analysis and calibration curves, respectively. Subgroup analysis was performed to evaluate locoregional surgery and chemotherapy benefit in different risk groups.

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Breast Cancer Metastasis To Liver Prognosis

To diagnose metastatic breast cancer, your doctor may recommend one or more tests:

Blood Tests

  • A complete blood count to assess your bone marrow function
  • Tests for minerals and enzymes that can provide evidence of spreading cancer or other health conditions
  • Tests for proteins that signal the presence of cancer

Imaging Tests

Expert Review And References

  • Alexander HR Jr, Berlin J, Moeslein F. Metastatic cancer to the liver. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2011: 149:2177-2191.
  • BC Cancer Agency . Cancer Management Guidelines: Secondary Neoplasms of the Liver. BC Cancer Agency 2006: .

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What Are The Risk Factors

According to Research from 2015Trusted Source, the exact mechanics of how breast cancer spreads to the liver are still not known.

However, in one 2019 study, researchers found that a few distinguishing factors may place a person at higher risk of developing liver metastasis. These include:

  • number of lymph node metastases

Earlier or more frequent screening for liver metastasis may help improve outlook because a doctor may find the tumor sooner.

Symptoms Of Breast Cancer Metastasis To Liver

Breast Cancer Liver Metastases: US

Metastatic breast cancer may grow silently in the body while you are completely unaware. Early on in metastatic liver cancer there might not be any signs or symptoms to alert you. As the cancer grows, you may experience liver swelling. This may cause the following symptoms:

  • Bloating of your abdomen
  • Mass on upper right abdomen
  • Fever, chills, sweats
  • Confused thinking

Knowing the early symptoms can help you find and treat breast cancer that has metastasized to the liver early on and slow the progression of the disease.

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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.

Stage 4 Survival Rates

To get a perspective on the difference in survival rates during different stages of cancer, according to the American Cancer Society the rate of survival after diagnosis is:

  • For those at stage 2 there is an expected five-year survival rate of over 90%.
  • For those at stage 3 there is an expected five-year survival rate of 72%.
  • For stage 4 there is an expected five-year survival rate of 22%.

Because the earlier stages of breast cancer have much longer survival rates, early detection and treatment are important.

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Changes In Hormonal Receptor Status And Her

ER, PR, and HER-2 status is essential in determining the use and evaluating the effect of adjuvant hormone therapy, molecular targeted therapy, and even chemotherapy. Koo et al. conducted a study to assess the status of ER, PR, and HER-2 in primary and metastatic breast cancers and determined the relationship between ER, PR, and HER-2 and organ-specific metastases of breast cancer. The data showed that ER+ or PR+/HER-2- subtypes were predominant in the sites of liver metastases . Increased phosphorylation of HER-2 appears to be extremely important for the establishment of breast cancer liver metastases . Moreover, a high serum HER2 level or lack of ERs independently doubles the relative risk of progression and mortality .

Nevertheless, the ER, PR, and HER-2 status between primary breast cancers and liver metastatic foci can be changed after treatment, but are stable in most cases during the liver metastatic process . Botteri et al. conducted a retrospective study of patients with BCLM and found a positive relationship between liver biopsy findings and survival in patients with early metastases. Moreover, another study showed that biopsies of metastases are useful for the reassessment of the metastatic sites to define a more effective treatment strategy for patients with BCLM . Thus, the ER, PR, and HER-2 status needs to be reassessed by biopsy when liver metastases occur.

How Does Breast Cancer Spread To The Liver

Prognosis of Metastatic Liver Cancer

Breast cancer can spread to the liver through metastasis. Metastasis is the spread of cancer cells from the primary tumor to other body parts.

Cancer cells can spread through the bloodstream or the lymphatic system, a network of vessels that carries lymph throughout the body. Cancer cells can travel to other body parts and form new tumors when they enter the bloodstream or lymphatic system.

In the case of breast cancer, the cancer cells can spread to the liver and form a new tumor. This is more likely to occur if cancer has spread beyond the breast and lymph nodes, as the cancer cells are more likely to have entered the bloodstream or lymphatic system at this stage.

It is important to note that not all breast cancers will spread to the liver or other organs. Many breast cancers can be effectively treated with surgery, chemotherapy, radiation therapy, or a combination of these methods.

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