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Metastatic Breast Cancer To Bone

How Often Do You Need Testing

Bone Only Metastatic Breast Cancer, What Is The Best Approach?

How often you get which tests depends on your diagnosis and your doctors preferences. But its common for doctors to recommend imaging tests in patients with metastatic breast cancer every 2-6 months to assess for bone metastases. If they recommend blood tests, a common schedule for tumor marker tests is every 1-3 months. Blood chemistry tests are commonly done every 1-3 months.

Your doctor may also recommend additional tests if you experience bone-related symptoms or side effects. You can always ask your doctor about why different tests are recommended at certain times.

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 and its treatment options. The booklet is available as a PDF, so it is easy to print.

Surgery Of The Bone/radiotherapy

If a fracture of the bone has occurred or is likely to occur, then an orthopedic assessment is necessary to determine if a surgical intervention is needed before RT or RT alone is adequate. In emergent cases where a spinal compression has occurred, surgical decompression is the optimal treatment of choice. If surgery is not feasible, then an emergent RT is also an option .

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Advanced Cancer That Progresses During Treatment

Treatment for advanced breast cancer can often shrink the cancer or slow its growth , but after a time, it tends to stop working. Further treatment options at this point depend on several factors, including previous treatments, where the cancer is located, a woman’s menopause status, general health, desire to continue getting treatment, and whether the hormone receptor status and HER2 status have changed on the cancer cells.

Symptoms Of Metastasis May Vary Depending On Where The Cancer Has Spread To

Patient with breast cancer and bone metastasis. A. CT scans at baseline ...

Here are some symptoms that vary by locations commonly associated with breast cancer metastasis.

Metastasis in the bone may cause:

  • Severe, progressive pain
  • Bones that are more easily fractured or broken

Metastasis to the brain may cause:

  • Persistent, progressively worsening headache or pressure to the head
  • Vision disturbances
  • Behavioral changes or personality changes

Metastasis to the liver may cause:

  • Abnormally high enzymes in the liver
  • Abdominal pain, appetite loss, nausea, and vomiting

Metastasis to the lungs may cause:

  • Chronic cough or inability to get a full breath
  • Abnormal chest X-ray
  • Other nonspecific systemic symptoms of metastatic breast cancer can include fatigue, weight loss, and poor appetite, but its important to remember these can also be caused by medication or depression.

If you notice these symptoms, be sure you talk with your physician. They could be important for getting the treatment you need.

Materials on this page courtesy of National Cancer Institute

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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

Bone Metastases And Bone Problems

People with bone metastases are at risk of serious bone complications such as bone fractures , spinal cord compression and bone pain.

Bone complications are a concern for people with bone metastases as they can cause pain and may lead to loss of mobility, impacting quality of life. Bone complications can also decrease survival . With the use of bone-strengthening drugs, bone complications are not common .

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Symptoms Of Metastatic Breast Cancer

The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.

  • If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
  • If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
  • Breast cancer that has spread to your lungs or liver usually causes no symptoms.

The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.

These treatments may include:

  • hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
  • chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
  • immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
  • a combination of these therapies

In some cases, surgery or radiation therapy may be used to treat stage 4 breast cancer.

The following are the common treatment options for different types of stage 4 breast cancer.

Breast Cancer Metastasis To Bone Life Expectancy

Metastatic Bone Cancer: Bone Pain When Breast & Prostate Cancer Spreads

Metastatic breast cancer in the bones prognosis typically isn’t as favorable as early-stage breast cancers. The five-year relative survival rate for people with metastatic breast cancer is about 29%.

That means people with metastatic breast cancer are about 29% as likely to be alive five years after diagnosis as people who don’t have that cancer.

However, some evidence shows that metastatic breast cancer in the bones seems to have one of the best survival rates compared to other types of metastatic breast cancer.

A 2019 study published in the journal BMC Cancer looked at five years of data to track the survival rates of stage four breast cancer patients and calculated specific rates based on the site of metastasis.

The researchers found that patients with bone metastasis had the best overall survival rate, with 50.5% surviving for over three years.

For comparison, people with brain metastases had a three-year OS rate of 19.9%. People with liver and lung metastasis had a three-year OS rate of 38.2% and 37.5%, respectively.

Other research published in BMJ Open estimated that the one-year survival rate of metastatic breast cancer in the bones is 51%. And the five-year survival rate is 13%. But those numbers are estimates, not foregone conclusions.

A lot of factors can impact a person’s prognosis, said Dr. Lin, including:

  • The type of cancer they have
  • Where cancerous cells spread
  • Any other pre-existing conditions or health problems

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Demographic And Clinicopathological Features

This retrospective cohort study consists of 554,585 breast cancer patients with recorded bone metastasis event and intact ER/PR information, among which 19,439 patients were confirmed with developing bone metastasis and 10,447 patients with bone-only metastasis and valid survival time . In order to investigate the differences in the incidence of bone metastasis across the four HR status breast cancers, the numbers and percentage of bone metastatic events were outlined . Bone metastasis is most likely to develop in ER-positive/PR-negative breast cancers than in other subgroups, while the incidence of bone metastasis is similar between ER-positive/PR-positive and ER-negative/PR-negative breast cancers. Thereafter, to exclude the potential influence of other concurrent metastases, including brain, liver, or lung metastasis, we outlined the demographic and clinicopathological features of the 10,447 breast cancer patients with sole bone metastasis, which was included into the subsequent survival analysis . Among the cohort, 71.9% , 16.3% , 0.7% , and 11.1% of the bone metastatic breast cancer patients had ER-positive/PR-positive, ER-positive/PR-negative, ER-negative/PR-positive, and ER-negative/PR-negative primary tumors, respectively.

Figure 1 Flowchart of the cohort selection.

Table 1 Bone metastasis incidence in breast cancer patients stratified by hormone receptor status.

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.

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Targeting Agents For Bc Bone Metastasis

In targeted DDSs, the targeting agents play vital roles. The drug can be accurately delivered to the metastatic tumour sites with targeting agents, increasing the treatment efficacy and decreasing side effects generated by some cytotoxic compounds. Various bone targeting agents include tetracycline, bisphosphonate, -carboxylated glutamic acids and some amino acids , and glutamic acid ), and aptamers are investigated in different cancers . However, the most commonly used bone targeting agents for DDSs have involved Arginine-Glycine-Aspartic acid peptide , and two drugs from bisphosphonates family, alendronate and zoledronic acid . These agents have been found to have high potential to be employed in the development of bone targeted pharmaceuticals.

Overall illustration of targeting agents utilised in the development of DDSs aiming at treating BC bone metastasis.

How Is Metastatic Breast Cancer Diagnosed

Bone metastasis

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.

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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.

Positron Emission Tomography Scan

This is another nuclear scanning technique sometimes used to detect metastases by creating a 3-dimensional picture of your body, with the use of radio waves that show up after an injection. PET scans are not routinely used to look for bone metastases. If your doctor recommends that you have a PET scan you should speak to your doctor about possible costs as it is not usually covered by Medicare.

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What Bones Do Breast Cancer Affect

Although metastatic breast cancer can potentially occur in any bone in the body, it most often affects the ribs, spine, pelvis and long bones in the arms and legs. Breast cancer that has spread to the bones may cause: Sudden bone pain, such as hip or back pain, which may feel similar to the discomfort associated with arthritis or exercise strain

Advances In Treatment Of Metastatic Breast Cancer With Bone Metastasis

Dr. Julie Gralow on Treating Breast Cancer Bone Metastases

Ziping Wu, Jinsong Lu

Department of Breast Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University , China

Contributions: Conception and design: All authors Administrative support: None Provision of study materials or patients: All authors Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Abstract: Bone is the most commonly seen metastatic site in all the metastatic breast cancer . Treatment includes systemic treatment according to different molecular subtypes and specified treatment of the bone. Bisphosphonate and denosumab are the only two drugs approved to use in bone metastatic site. The optimal dosing schedule and duration of the drugs are still under research. New drugs and therapies including curcuminoids, sunitinib and nano particles are potentially available in the near future.

Keywords: Metastatic breast cancer bone metastasis bisphosphonate denosumab

Submitted Jun 01, 2018. Accepted for publication Jun 07, 2018.

doi: 10.21037/cco.2018.06.05

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What Are Bone Metastases

Bone metastases are areas of cancer that develop when breast cancer cells travel to the bones. The tumors that develop, sometimes called lesions, can:

  • Make the bones weaker and less dense. These types of tumors are called osteolytic, or simply lytic. Lytic lesions are caused by cancer cells causing old bone to break down without new bone being made, leaving weak spots or holes.
  • Make the bones more dense, but not necessarily stronger. These types of tumors are called osteoblastic, or simply blastic. Blastic lesions are caused by new bone being made without old bone breaking down. This makes the bone harder, but this harder bone can still break more easily than normal bone.

Its common for people to have lytic and blastic lesions at the same time. Doctors use imaging tests, such as x-rays, to figure out the types of bone lesions a person might have. For lytic lesions, treatment may include bone-strengthening medicines called bisphosphonates. Blastic lesions can be treated with radioactive material injected into a vein, called radiopharmaceuticals. Radiopharmaceuticals can travel to bone metastases and destroy cancer cells.

Metastatic Disease About The Knee: Evaluation And Surgical Treatment

According to the latest cancer statistics, at least 1,368,030 new cancer cases are diagnosed annually in the United States. 12 Those cancers with a propensity for bone metastases rank among the most commonly diagnosed types of new cancers. Both breast and prostate cancer rank first in numbers of new cases for women and men, respectively.

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Diagnosing Metastatic Breast Cancer

Getting a clear picture of where breast cancer has spread is essential for creating a personalized treatment plan. The patient’s care team will likely use a combination of the following tests and tools to diagnose both localized and advanced breast cancer:

Ultrasound exam: With this imaging technique, sound waves create a picture of internal areas of the body.

Magnetic resonance imaging : This procedure produces detailed images using magnetic fields and radio waves.

Blood chemistry studies: A blood sample is taken to measure the amounts of certain substances that are released by your organs and tissues. A higher or lower amount of a particular substance may be a sign of disease.

Breast biopsy: A biopsy is the removal of cells or tissues so a pathologist may view them through a microscope. An original breast cancer diagnosis is typically confirmed with a biopsy.

How Is Metastatic Breast Cancer Treated

Bone metastasis

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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Symptoms When Breast Cancer Has Spread To The Bones

The main symptoms of breast cancer that has spread to bone are:

  • Pain particularly in the back, arms or legs, often described as gnawing which occurs when resting or sleeping, and may get worse when lying down especially at night

Find out more about the symptoms of secondary breast cancer.

Other possible effects include:

How Is Metastatic Breast Cancer In Bones Diagnosed

Your doctor will likely start with a discussion of your symptoms and a physical examination.

Diagnostic testing may include blood tests to find out if your blood has too much calcium or alkaline phosphatase , either of which can be elevated because of bone metastasis. But this can also be due to other conditions. Blood tests alone cant confirm metastatic breast cancer in bones or pinpoint the location.

Sometimes, an X-ray can reveal bone metastasis. But other times, your doctor may order one or more of the following imaging tests to look for signs that cancer has reached bone:

Breast cancer isnt a single disease, but a group of diseases. So, treatment is personalized to reflect your:

  • specific type of breast cancer
  • extent of metastasis
  • age and overall health

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Most Common Places It Spreads

It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.

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